• Most mediastinal epithelial neoplasms are metastases, usually from trachea, bronchi, lung, esophagus
• Usually rapidly fatal

• Primary lung tumors may present as huge mediastinal mass with occult bronchial primary

• CD5 (suggestive of thymic), PLAP (germ cell), PSA (prostate), S100 (melanoma, others), thyroglobulin (thyroid)

• Premelanosomes suggests melanoma

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