An accessory mediastinal thyroid: A case report

Abstract

Key Clinical Message Various differential diagnoses and etiologies exist for mediastinal masses. One of the most uncommon is the ectopic mediastinal goiter. It is crucial for a clinician, especially cardiothoracic surgeons, to think about it when encountering such masses.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

“…The sample-focused analysis according to our methods identified another 37 EMT adults (22 females and 12 males; specific demographic data were not available for three cases; mean age was of 56.32 years, females subgroup: mean age of 56.04, range: 30-80 years; males subgroup: average age of 56.83, range: 31-74 years; across 35 articles featuring a single case study and two articles introducing each two subjects [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93]), whereas benign EMTs were associated with a normal thyroid panel in terms of function, negative autoimmunity, and lack of nodules/cancer/goiter in eutopic (cervical) gland before and after EMT removal or identification if the EMT was not resected (of note, we also, included the cases whereas no specific thyroid data were provided, thus, it was presumably normal) [13,29, (Table 3). Regardless of the pathological traits, awareness of EMTs is essential, while removal was decided in most of the cases (rather than conservative approach) depending on the location and EMT anatomical features; the risk of malignancy (the rate of conversion from benign to a malignant EMT is not clearly understood, especially in long standing goiter-like EMT); the ectopic tissue enlargement with compressive symptoms/signs such as respiratory obstruction or compression on mediastinal organs; the risk of hemorrhage [84]; the patient's co-morbidities and medical/surgical history as well as the general health status [7,13].…”

“…CT scan represented the most important and the mostly used imagery evaluation, and it was a mandatory step of approaching (suspected or confirmed) EMTs [7,11,13,29,35,37,42,48,55,[58][59][60][61][62][63]70,71,[73][74][75][76]79,80,82,89,92,93,95,96,100,102,103,105,106,[117][118][119][120][121][122]124,125,129]. The largest diameter varied from 1 to 15 cm; no correlation between the size and a malignancy trait in EMTs could be established.…”

“…The size groups (according to the largest diameter via our practical perspective) may be regarded as follows: <2 cm [22,59,81,89,118]; between ≥2 cm and <3 cm [11,35,55,83]; between >8 cm and <10 cm [13,73,102,117]; more than 12 cm [37,45,60,115]. The most common groups were as follows: between ≥3 cm and <5 cm [9,58,62,80,85,86,93,95,103,106,119]; between ≥5 cm and <6 cm [29,74,78,79,98,100,121,122]; between ≥6 cm and <8 cm [50,55,64,70,75,82,84,88,92,100,120,123,…”

“…), risk of expansion due to further enlargement (grow) and hemorrhage, respectively, risk of gaining toxic activity (hyper-function causing hyperthyroidism), and risk of malignant transformation (which is rather uncommon). The removal, depending on the location, size and surgeon's skills, is either performed transcervical or via sternotomy or through thoracotomy [74,174]). In contrast to the retrosternal goiter (that has no separation line from the orthotopic thyroid and shares the same vessels), an EMT has its own blood supply (intra-thoracic vessels) [42]).…”

“…Alternatively to FNA or EBUS-TBFNA, TTNB was used for histological rather than cytological analysis; for example, Sadidi et al [74] performed TTNB to access an EMT located at the upper-middle mediastinum in a 54-year-old female who was admitted for cough and dyspnea for 3 years. The pathological report upon biopsy showed an adenomatous goiter; the procedure was followed by EMT removal via thoracotomy with a good post-surgical outcome.…”