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Abstract Background: primary mediastinal lymphadenopathy is a rare condition that needs proper management to reach the diagnosis properly. We study the different pathologies obtained from mediastinoscopy. Objective: the aim of this study is to study different pathologies of primary mediastinal lymphadenopathy, the radiological characteristics of lymph nodes and the role of mediastinoscopy in the diagnosis. Patients and methods: this is a retrospective study that was conducted at the surgical oncology department of the National cancer institute, Cairo university. The study included patients with primary mediastinal lymphadenopathy presented to NCI through the period from January 2007 to December 2016. Results: Mediastinal lymphadenopathy almost affects both sexes equally, affecting all age groups, giving rise to different pathologies. Different benign pathologies are more than malignant ones, yet they are all serious cases and necessitating tissue diagnosis. Conclusion: mediastinal lymphadenopathy is a rather rare yet serious condition for which all patients should be properly investigated and the tissue diagnosis is mandatory |