The mediastinum is a hollow space within the thoracic cavity that may give rise to a wide spectrum of tumoral conditions from the benign to the intermediate to the highly malignant neoplasms. In addition, other inflammatory and infectious conditions may also arise in this space, which renders the practice of mediastinal pathology, almost a general surgical pathology practice. However, there are numerous mediastinal conditions that are important not only for diagnosis but also for treatment and clinical outcome. Due to the unusual location and because of the complexity of the tumors occurring in the mediastinum, there are only a few experts in this particular anatomic area. In fact, there are no more than 3-4 individuals worldwide with enough experience to properly diagnose, classify, and make treatment suggestions when these tumors arise in the mediastinum.