1
|
Carsote M, Ciobica ML, Sima OC, Ciuche A, Popa-Velea O, Stanciu M, Popa FL, Nistor C. Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach. Cancers (Basel) 2024; 16:1868. [PMID: 38791947 PMCID: PMC11120123 DOI: 10.3390/cancers16101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.
Collapse
Affiliation(s)
- Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Oana-Claudia Sima
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| |
Collapse
|
2
|
Ozturk A, Cicek T, Aktas Z, Demirag F, Yilmaz A. Mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration: Report of three cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:299-301. [PMID: 28940588 DOI: 10.1002/jcu.22530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
An ectopic thyroid gland results from the abnormal migration of the thyroid in the course of its development. Primary ectopic mediastinal thyroid is very rare and occurs in less than 1% of all goiters that can be surgically excised. Ectopic thyroid tissue has a characteristic sonographic appearance as smooth-bordered, homogeneous, hypoechoic tissue with fine specular echoes. We report 3 cases of mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbrochial needle aspiration biopsy.
Collapse
Affiliation(s)
- Ayperi Ozturk
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Tugba Cicek
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Zafer Aktas
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Funda Demirag
- Department of Pathology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aydin Yilmaz
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
3
|
Walz PC, Iwenofu OH, Essig GF. Ectopic mediastinal goiter successfully managed via cervical approach: case report and review of the literature. Head Neck 2011; 35:E94-7. [PMID: 22084034 DOI: 10.1002/hed.21920] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Ectopic mediastinal goiter is a rare entity that presents diagnostic and treatment challenges to the clinician. METHODS A case of primary ectopic mediastinal goiter is presented and use of a cervical approach for excision is described herein. Additionally, precedent literature highlighting surgical treatment approaches is reviewed. RESULTS The distinction between primary and secondary ectopic mediastinal goiter is significant as this indicates the vascular supply to the ectopic mass. Previous authors suggested open thoracic procedures for all primary mediastinal goiters to safely divide intrathoracic vascular supply, but favorably positioned anterior mediastinal goiter may be safely removed via cervical approach. This is the second case of primary ectopic mediastinal goiter successfully resected via cervical approach. CONCLUSION Select cases of primary mediastinal goiter may be amenable to excision via cervical approach, avoiding potential complications of open thoracic procedures. Additionally, CT-guided biopsy is an effective tool in preoperative diagnosis of anterior mediastinal masses.
Collapse
Affiliation(s)
- Patrick C Walz
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University School of Medicine, Columbus, Ohio, USA.
| | | | | |
Collapse
|
4
|
Augustin F, Schmid T, Sieb M, Lucciarini P, Bodner J. Video-Assisted Thoracoscopic Surgery versus Robotic-Assisted Thoracoscopic Surgery Thymectomy. Ann Thorac Surg 2008; 85:S768-71. [DOI: 10.1016/j.athoracsur.2007.11.079] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 10/27/2007] [Accepted: 11/28/2007] [Indexed: 11/28/2022]
|