Thyroid cancer with a cystic mediastinal tumor invading the right main bronchus

Clinical outcomes of combined cervical and transthoracic surgical approaches in patients with advanced thyroid cancer

BACKGROUND

Advanced thyroid disease involving the mediastinum may be managed surgically with a combined transcervical and transthoracic approach. Contemporary analysis of this infrequently encountered cohort will aid the multidisciplinary team in personalizing treatment approaches.

METHODS

Retrospective review of patients undergoing combined transcervical and transthoracic surgery for thyroid cancer at a single high-volume institution from 1994 to 2015.

RESULTS

Thirty-eight patients with median age 59 years (range 28-76) underwent surgery without perioperative mortality. Most patients had primary disease. A majority had distant metastases outside the mediastinum but had locoregionally curable disease. Common complications were temporary (39%) and permanent (18%) hypoparathyroidism, and wound infection (13%). One-year overall survival was 84%; 1-year locoregional disease-free survival was 64%. Median time to locoregional recurrence was 36 months. Only esophageal invasion was associated with worse oncologic outcomes.

CONCLUSIONS

Combined transcervical and transthoracic surgery for advanced thyroid cancer can be performed without mortality and with acceptable morbidity.

Case report: Thyroid carcinoma invading trachea: Multidisciplinary resection and reconstruction assisted by extracorporeal membrane oxygenation

Background

When thyroid cancer invades the trachea, tumor resection and trachea reconstruction are required. Although the traditional way of anesthesia and tracheal intubation can maintain the necessary ventilation function during the operation, tracheal intubation affects the surgical field of vision and is not conducive to the protection of the recurrent laryngeal nerve beside the trachea during the operation.

Case presentation

Extracorporeal membrane oxygenation (ECMO) is used to replace traditional tracheal intubation in the process of resection and end-to-end anastomosis of tracheal tumors, and complete tracheal tumor resection and trachea reconstruction are achieved.

Conclusion

Using ECMO for thyroid carcinoma resection, invaded trachea resection, and trachea reconstruction is safe and effective, which reduces the obstruction of endotracheal intubation on the operative field, guarantees the rapid and efficient end-to-end anastomosis in the upper trachea, and clearly avoids laryngeal recurrent nerve injury in the process of anastomosis.

Incidental Mediastinal Thyroid Cancer

Cystic mediastinal masses are most commonly benign congenital lesions. Rarely, a cystic mediastinal mass will prove to be malignant. The patient, a 50-year-old woman who initially presented with uveitis, was incidentally found to have a right paratracheal opacity on chest X-ray (CXR). Chest computed tomography (CT) demonstrated a 5cm right paratracheal hypodense cystic mass. The patient underwent a right robotic-assisted thoracoscopic resection of the mediastinal mass. Final pathology revealed a 4.5cm mass consistent with metastatic papillary thyroid carcinoma (similar histology in 2 excised lymph nodes). The patient subsequently had a total thyroidectomy with central and right neck dissections.

An unusual presentation of thyroid cancer

Well-differentiated thyroid cancers can present with nodal metastasis that have undergone cystic degeneration. Rarely, mediastinal nodes may undergo cystic changes and pose a diagnostic dilemma, especially if the primary lesion is occult. We describe the case of a patient who presented with a large mediastinal cystic lesion which turned out to be metastasis from thyroid cancer.

Thymic basaloid carcinoma with aggressive invasion of the lung and pericardium: report of a case

We report a case of basaloid carcinoma of the thymus, invading the lung and pericardium. The patient was a 72-year-old man who suffered thoracic trauma in a fall and was taken to his family physician. Computed tomography revealed a huge mediastinal tumor with cystic components, pressing into the lung. He was referred to our hospital, where magnetic resonance imaging showed suspicious invasion of the pericardium and mediastinum. We made an assumed diagnosis of a mediastinal malignancy and performed mediastinal tumor resection. The tumor was adherent to the lung, pericardium, and left innominate vein. The final pathological diagnosis was a basaloid carcinoma of the thymus. Basaloid carcinoma is often a component of a multiloculated thymic cyst (MTC) and should be considered when MTC is identified within an anterior mediastinal tumor.