Tumors of the Diaphragm

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Tumors of the Diaphragm
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• The diaphragm is commonly involved with malignant
  pleural disease or malignant peritoneal disease.
• Only rarely, however, is the diaphragm the source
  of either benign or malignant processes.

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HISTORIC BACKGROUND

• Grancher described a primary diaphragmatic tumor,
  a benign fibroma in 1868.
• Clark described a diaphragmatic lipoma in 1886.
• The last report found a total of only 71 case
  reports.

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PRESENTATION AND EVALUAION

• Tumors of the diaphragm are not associated with
  any characteristic symptom.
• 50 of patients were asymptomatic and were found
  incidentally.
• If any symptom is characteristic, it is that
  lower chest discomfort, heaviness and referred
  pain to the top of the shoulder.

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PRESENTATION AND EVALUAION

• Large masses which compress the lung may cause
  dyspnea, hemoptysis or cough.
• Large masses which compress the heart may cause
  lower leg edema, if venous return is compromised.
• Differentiated diagnosis includes hematoma,
  infections( TB), congenital abnormality, hiatal
  hernia or metastasis.

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PRESENTATION AND EVALUAION

• Lobulations, localized eventration, slip or
  hypertrophic crus may simulate tumors of the
  diaphragm.

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PRESENTATION AND EVALUAION

• Distinguishing the mass
• 1. The lung mass is suggested with the
• presence of irregular margins with the
• nearby lung, acute angle between the
• mass and the diaphragm, focal lung
• volume loss, vessels and bronchi
• appearing curve into the lesion.

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PRESENTATION AND EVALUAION

• 2. A pleural mass is suggested by the presence
• of obtuse angle between the mass and the
• diaphragm.
• 3. Herniated organs can be enhanced with the
• use of oral or IV contrasts.
• 4. Ultrasound or MRI can localized a liver
• mass.

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PRIMARY BENIGN NEOPLASTIC LESIONS

• Table 53-1

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PRIMARY BENIGN NEOPLASTIC LESIONS

• 1. Lipoma( most common benign tumor of the
  diaphragm )
• (1) It appears a sharp-bordered, smooth,
• possibly lobulated mass on the
• radiogram.
• (2) It often has dumbbell or
• hourglass shape.
• (3) It is predominantly from the left and
• posterolateral area of the diaphragm.

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PRIMARY BENIGN NEOPLASTIC LESIONS

• 2. The other 2 groups of predominating
• benign lesions are cystic formation and
• neurogenic tumors.
• 3. Half of neurogenic tumors of the diaphragm
• are associated with hypertrophic pulmonary
• osteoarthropathy or/and clubbing finger.
• 4. Treatment is surgical excision.

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PRIMARY MALIGNANT NEOPLASTIC LESIONS OF THE
DIAPHRAGM

• Most are mesenchyma origin.
• Leiomyosarcoma, malignant fibrous histiocytoma
  and fibrosarcoma were ever reported.
• Surgical resection with or without chemotherapy
  of radiotherapy was often performed.
• Primary closure of the diaphragm is usually not
  possible.

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PRIMARY MALIGNANT NEOPLASTIC LESIONS OF THE
DIAPHRAGM

• Mortality and morbidity after resection of the
  tumor is low.
• The prognosis appears grim.
• Long term survival is rare.