A rare clinical case of malignant ectopic retrosternal goiter of a large size in a patient with aberrant right subclavian artery

Q4 Medicine
O. V. Pikin, O. Alexandrov, V. Glushko, A. Levshakova
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引用次数: 0

Abstract

Background. Ectopic goiter accounts for only 0.2 % to 1 % of all mediastinal goiters. The aberrant right subclavian artery (arteria lusoria) is an extremely rare anomaly of the major vessel, with a prevalence not exceeding 0.3 % in the general population. This paper presents the first case of malignant ectopic retrosternal goiter of a large size in combination with the aberrant right subclavian artery. Clinical case description. A 61-year-old male presented to the thoracic surgery department of P. Herzen Moscow oncology Research institute with a large posterior mediastinal mass measuring 108×106×79 mm and adjacent to the right lobe of the thyroid gland. The tumor displaced the trachea and esophagus. Open biopsy through a thoracotomy incision revealed thyroid gland cells without signs of atypia. A detailed examination revealed mediastinal vascular anomaly – retrotracheal position of the right subclavian artery. a complete longitudinal sternotomy, complemented by a right-sided thoracotomy at the 3rd intercostal space, served as the surgical approach. The operation lasted 320 minutes, with a blood loss of 3500 ml. The postoperative period was uneventful. The morphological examination of the surgical specimen revealed nodular hyperplasia of the ectopic thyroid tissue with the growth of well-differentiated follicular carcinoma without metastatic involvement of removed lymph nodes. Considering the identified follicular carcinoma, total thyroidectomy was performed. Conclusion. In surgical planning, it is crucial to assess the location of major mediastinal vessels and their relationship with the goiter. Therefore, all patients with mediastinal lesions should undergo preoperative contrast-enhanced ct. Retrosternal goiter predisposes to a higher rate of malignancy compared to cervical goiter. If the lower edge of the goiter is at the level of or below the aortic arch, cervical access should be supplemented with sternotomy. In cases of a massive thoracic component, additional thoracotomy is justified.
右锁骨下动脉畸形患者胸骨后恶性大甲状腺肿的罕见临床病例
背景。异位甲状腺肿仅占所有纵隔甲状腺肿的 0.2 % 至 1 %。右锁骨下动脉(锁骨动脉)异常是一种极为罕见的大血管异常,在普通人群中的发病率不超过 0.3%。本文介绍了首例合并右锁骨下动脉畸形的恶性异位胸骨后巨大甲状腺肿。临床病例描述。一名 61 岁的男性因纵隔后部巨大肿块(108×106×79 毫米)就诊于 P. Herzen 莫斯科肿瘤研究所胸外科,肿块紧邻甲状腺右叶。肿瘤移位到气管和食管。通过开胸切口进行开放性活检,发现甲状腺细胞无不典型性。详细检查发现纵隔血管异常--右锁骨下动脉位于气管后位置。手术采用完全纵向胸骨切开术,辅以右侧第3肋间胸廓切开术。手术持续了 320 分钟,失血 3500 毫升。术后恢复顺利。手术标本的形态学检查显示,异位甲状腺组织呈结节状增生,并伴有分化良好的滤泡癌生长,切除的淋巴结未发生转移。考虑到已确定为滤泡癌,该患者接受了全甲状腺切除术。结论在制定手术计划时,评估纵隔主要血管的位置及其与甲状腺肿的关系至关重要。因此,所有纵隔病变患者都应进行术前造影剂增强 CT 检查。胸骨后甲状腺肿的恶变率高于颈部甲状腺肿。如果甲状腺肿的下缘位于主动脉弓水平或以下,则应辅之以胸骨切开术进入颈部。如果胸腔内有大量甲状腺肿物,则需要进行额外的开胸手术。
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来源期刊
Siberian journal of oncology
Siberian journal of oncology Medicine-Oncology
CiteScore
0.40
自引率
0.00%
发文量
117
审稿时长
8 weeks
期刊介绍: The main objectives of the journal are: -to promote the establishment of Russia’s leading worldwide positions in the field of experimental and clinical oncology- to create the international discussion platform intended to cover all aspects of basic and clinical cancer research, including carcinogenesis, molecular biology, epidemiology, cancer prevention, diagnosis and multimodality treatment (surgery, chemotherapy, radiation therapy, hormone therapy), anesthetic management, medical and social rehabilitation, palliative care as well as the improvement of life quality of cancer patients- to encourage promising young scientists to be actively involved in cancer research programs- to provide a platform for researches and doctors all over the world to promote, share, and discuss various new issues and developments in cancer related problems. (to create a communication platform for the expansion of cooperation between Russian and foreign professional associations).- to provide the information about the latest worldwide achievements in different fields of oncology The most important tasks of the journal are: -to encourage scientists to publish their research results- to offer a forum for active discussion on topics of major interest - to invite the most prominent Russian and foreign authors to share their latest research findings with cancer research community- to promote the exchange of research information, clinical experience, current trends and the recent developments in the field of oncology as well as to review interesting cases encountered by colleagues all over the world- to expand the editorial board and reviewers with the involvement of well-known Russian and foreign experts- to provide open access to full text articles- to include the journal into the international database- to increase the journal’s impact factor- to promote the journal to the International and Russian markets
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