Four cases of thyroidectomy for suspected thyroid carcinoma after previous irradiation for Hodgkin's or non-Hodgkin's lymphoma are reviewed. The patients ranged in age from 18 to 33 years at the time of thyroid surgery with an average latency period of 12 years (range, 8-20 years) from radiation therapy to thyroidectomy. All patients had a clinically palpable thyroid nodule, and pathologically showed a pattern of multiple adenomatous nodules with cytologic atypia. The microscopic changes were sufficiently striking to cause the primary pathologist to request consultation to rule out thyroid carcinoma in each case. Fine-needle aspiration was performed in one case and suggested a thyroid neoplasm. The pathologic findings are reviewed and distinction of this lesion from thyroid carcinoma is discussed.
A 66-year-old man with a history of smoking was seen for increasing shortness of breath. A chest radiograph demonstrated a right lower lobe mass. Chest computed tomography confirmed the presence of a 2.7-cm lung lesion suggestive of neoplasm. Preoperative cardiac clearance included echocardiography. Transthoracic echocardiography demonstrated a 1-cm mass in the apex of the left ventricle. No other cardiac pathology was noted. Removal of the mass was accomplished through a left ventriculotomy with cardiopulmonary bypass by means of an Embol-X aortic cannula (Embol-X, Inc, Mountain View, Calif). The intraoperative finding was that of a friable tumor embedded within the apical endocardium and myocardium (Figure 1). Pathologic findings included a 1-cm friable tumor with histologic features consistent with papillary fibroelastoma. The heparin-coated mesh filter of the Embol-X cannula captured a 1-mm tumor fragment. The patient had an uneventful recovery and was discharged at 6 postoperative days.Papillary fibroelastomas account for 8% of all cardiac tumors, with 85% involving the cardiac valves. An apical left ventricular location is a rare finding. The main indication for removal is the risk of embolic complications, particularly stroke. [1][2][3] Removal is surgical.
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