Intrapericardial Ectopic Goiter: A Very Unusual Presentation.

Mediastinal ectopic goiter is a thyroid tumor that lies entirely below a plane extending from the superior surface of the first thoracic vertebra to the suprasternal notch, and commonly lies in the vicinity of the thymus. Intrapericardial ectopic goiter is extremely rare. We present an extremely rare case of a 63-year-old woman with an intrapericardial ectopic goiter and review the pertinent literature.

A case of cervico-mediastinal paraganglioma mimicking an ectopic goiter.

INTRODUCTION AND IMPORTANCE: Mediastinal paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal paraganglia, occasionally secreting catecholamines. Nonfunctional mediastinal paragangliomas present nonspecific clinical and radiological features and represent a diagnostic challenge. CASE PRESENTATION: A 53-year old woman presented with cough and dyspnea increasing over time. CT-scan and ultrasonography showed a large vascularized cervico-mediastinal mass, consistent with an intrathoracic ectopic goiter. Preoperative angiography showed a blood supply from neck vessels. The lesion was completely removed through a cervical approach. The diagnosis of paraganglioma was a histological surprise. The patient is alive without recurrence 30 months after surgery. CLINICAL DISCUSSION: When preoperatively diagnosed, the treatment of choice of a mediastinal paraganglioma is surgical excision. However, a preoperative diagnosis of mediastinal paraganglioma is difficult to obtain, especially in cases of nonfunctional lesions. Distinction between an intrathoracic goiter and a nonfunctional paraganglioma can be extremely difficult and, given the rarity of the latter, an ectopic goiter is suspected in first instance. CT-scan and ultrasonography are of little use in the differential diagnosis. However, scintigraphy with 123I-metaiodobenzylguanidine can be an useful diagnostic tool when a paraganglioma is suspected. In case of vascularized cervico-mediastinal mass, such as paragangliomas or intrathoracic goiter, preoperative angiography should be performed to study the blood supply and orient the surgical approach. CONCLUSION: Although uncommon, paragangliomas should be considered in the differential diagnosis of mediastinal masses, especially when an ectopic goiter is suspected.

Intrapericardial goiter.

Intrapericardial goiter cases are only a few in the literature. We present a 53-year-old woman who was operated for 8-cm anterior mediastinal mass located completely intrapericardial and histopathological examination revealed an ectopic goiter. It may be difficult to distinguish between mediastinal masses within or outside the pericardium. Thoracoscopy may be needed in such cases.

Surgical treatment of substernal goiter: An analysis of 44 cases.

OBJECTIVE: Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). METHODS: A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. RESULTS: The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. CONCLUSION: The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.

Primary mediastinal goiters.

BACKGROUND: Primary mediastinal goiters (PMG) are very uncommon; few cases were reported in the literature. PATIENT DESCRIPTION: We report here two cases of mediastinal goiters that met all criteria of PMG. Transternal approach was necessary for complete removal and pathological diagnoses confirmed their adenomatous goiter nature. The rarity of their occurrence, their clinical characteristics and surgical management were discussed. CONCLUSION: PMG is part of the differential diagnoses of mediastinal masses. Safe excision is ensured through transthoracic approach.

Bócio ectópico intratorácico primário no mediastino posterior: relato de caso e revisão de literatura / Primary ectopic intrathoracic goiter in posterior mediastinum: a case report and review of the literature

O bócio ectópico intratorácico primário é entidade muito rara que corresponde à presença de tecido tireoidiano aberrante hiperplasiado, localizado no interior do tórax, sem possuir nenhum contatoou relação com a tireóide cervical, que se encontra geralmente com aspecto normal. Apresentamos um caso de paciente do sexo feminino, 61 anos de idade, com os achados de radiografia etomografia computadorizada, associado a revisão de literatura, demonstrando os achados de imagem, diagnósticos diferenciais, possíveis fatores etiológicos e os tratamentos.

The ectopic primary intrathoracic goiter is an uncommon tumor that corresponds to a hyperplasia of an ectopic thyroid tissue, that develops in the thorax, distinct from the cervical thyroid gland,which usually exists on its normal aspect. We report the case of a 61-year-old female patient, with the aspects of the radiograph and computed tomography examinations, comparing them with the literature, demonstrating the image aspects, differential diagnosis,possible etiology factors and treatments of the disease.