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An otherwise healthy 28-year-old man comes to the physician because of a dry hacking cough for 3 months. A routine examination 6 months ago showed no abnormalities. His paternal grandfather had colon cancer. Examination today shows normal findings. An x-ray film of the chest shows a large anterior mediastinal mass. Which of the following is the most likely origin of this neoplasm?
A ) Colon
B ) Kidney
C ) Prostate
D ) Stomach
E ) Testicle
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testicular can metastasize to paraaortic lymph nodes which are posterior mediastinal.
anyone has idea about this Q?
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When I took the exam I didnt know what the answer is, but now I know its E. Here is an article to shed some light. Conclusion is in the last paragraph.
3. Mediastinal Masses C22 - C37
The mediastinum is divided anatomically into the following compartments (according to Felson): superior, anterior, middle, and posterior. In Radiology, we use a modified division based on radiographic landmarks. The anterior mediastinum is bounded anteriorly by the sternum. The posterior boundary is made up of a line from the intersection of the trachea with the sternum drawn inferiorly to intersect the diaphragm. The line follows the posterior border of the heart and IVC (inferior vena cava). This second line makes up the anterior boundary of the middle mediastinum. The middle and posterior mediastinum are divided by a line 1 cm posterior to the anterior border of the vertebral bodies. In all cases, the differential diagnosis is limited by the location of the mass. Some have altered the division so that the esophagus, and all tissue posterior to it, is included in the posterior mediastinum.
Anterior mediastinal masses
The anterior mediastinum can be further divided. Thoracic inlet lesions are those that extend above the clavicles. In the adult these are almost always caused by thyroid masses, usually goiters. Other less common causes include, lymphoma (especially when associated with palpable neck nodes) and cystic hygroma (lymphangioma). The latter usually manifests in childhood.
Cardiophrenic angle masses also have a limited differential diagnosis. The most common cause of a mass in this location is prominent pericardial fat. Comparison with prior films will document the stability of this lesion. The right cardiophrenic angle is the most common location of pericardial cysts. They may also occur on the left. Foramen of Morgagni hernia also occur in this location.
Anterior mediastinal masses limited to the retrosternal space also have a limited differential diagnosis. These include Lymphoma, Thymoma, Germ Cell tumors and vascular lesions such as ascending aortic aneurysm.
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Testicular ca can go to a lot of places. Happened to those younger than 35. Think of the 7 times world champ from Richardson TX, several in brain.
