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Aim: To study the spectrum of lesions in the mediastinum. Methodology: This is a prospective study of various types of lesions in the mediastinum. The specimens included CT guided biopsies, excision biopsies and tissue biopsies obtained from the departments of Cardiothoracic and Surgical Oncology at Andhra Medical College & General Hospital, Vishakapatnam from June 2022 to May 2024. Results: There were 50 cases of mediastinal lesions, both non neoplastic and neoplastic lesions during the study period of two years. Neoplastic lesions were the majority in number 35(70%) with benign being 15 (30%) and malignant are 20 (40%). Non-neoplastic lesions were 15 (30%) in number with the most common age group affected being 21-30 years and 41-50 years and the commonest lesion was chronic nonspecific lymphadenitis constituting to 6 cases (40%). Of the benign lesions, The common age group affected benign lesions was 41-70 years with female preponderance and majority being schwanomma. Among the malignant neoplasms, the common age group affected was 41-60 years and commonest lesion was metastatic deposit. As most non-neoplastic and neoplastic lesions of the mediastinal lesions have similar clinical manifestations and radiological appearances, only provisional diagnosis can be made in these cases. Many of these lesions are inaccessible to FNAC and in some FNAC is not recommended for fear of hemorrhage. Conclusion: The study concluded that correct and final diagnosis can be made only by histopathological examination. Therefore, histopathological diagnosis is mandatory for proper early treatment and to assess the prognosis of these patients. [ABSTRACT FROM AUTHOR]