Mediastinal Aberrant Goiter

Mediastinal

Aberrant

Report JACK

SALOMON,

M.D.

AND

of Two

Cases

Moiutis

J.

Aviv,

Israel

Tel

T

O

BE

DISTINGUISHED

sternal

aberrant

goiter intrathoracic

usually

found in the

bridge

connection

tissue

is

Cited

by

thoracic as

of this cases added

goiter

the

cervical and

cervical was

Haller. excessively

able

to

only

last true

decade, aberrant

patients

800 patients in Beilinson there

tumor

such.

*From

The the

partment,

the

and

operated

of Hospital,

Aviv Medical School. **Head, Thoracic-Cardiovascular ment, Beilinson Hospital, Medical School.

1: upper right esophagus.

this

of

Surgery University

of

(Fig.

anteriorly

larged

and

The

systemic

May

DeTel-

was

spine, Its

removed

by

no

tumor

with

the

same

was

showing case

was detectable

a

mediastinal indicating

en-

palpated.

180/100

part

mm

posterolatthe

small

tissue

shadow displacement

posterior and

to fist

dissection tissue.

thyroid

same

not

well

in

pedicle

surrounding

revealed

the

esophagus in

sharp

su-

mediastinal

located

about and

by

a right

the

the

was

was

encapsulated

protruding

blunt

was

examination

413

size

There

radiogram of the

It

found.

in

left

was

through

a well between

thorax.

DepartTel-Aviv

1965,

for the routine chest a mediastinal

esophagus

was

16

cough

gland

pressure

of

of pre-

arch

the

border

blood

mediastinum, thoracic

aortic to

history

ages

complained

thyroid

lower

20,

previous

The

and

thoracotomy,

tumor

the

cervical its

to

prob-

at the

dyspnea and Prior to admission, 1) revealed

mediastinum.

The

a

she

above

right

lesion.

eral

of

Case 1 (left): Postero-anterior chest mediastinum. (Right): Esophagogram

with

located

Hg. On

upon

Surgery

pains

displaced

communica-

University

admission,

shadow perior

had biopsies

Upon

radiography

such

picture

Thoracic-Cardiovascular Beilinson

Rivest

and

REPORTS

breast

months.

cases

therapeutic

condition.

woman

negative

39.

two

and this

to

54-year-old

last four

and he Among

clinically purpose

1:

cordial

two cases of goiter. Both

were

CASE

and

goiter operduring the

were only intrathoracic

presented

mediastinal

with Hospital

these

diagnostic

related

A

as

14

present

the

of two

incidence rare.

collect

is to

F.C.C.P.**

CASE

intra-

reported

M.D.,

lems

thyroid.

The

LEVY,

discuss

gland, without

Laurence,’

goiter A.

tion

SUB-

called thyroid

from the entire literature to them three personal cases. than upon

FIGURE

the

and

seems

was

more ated

as

to

by

A

a condition goiter where

from

Clute

1749

1947

is

mediastinum

aberrant

early in

away

FROM

Goiter*

the

the right

and

was

(Fig.

2). this

connecting

The

histologic

with

occupying of the

charac-

the upper

SALOMON

414

AND

Diseases

LEVY

of

the Chest

S FIGURE 2: ing colloid

Case excretion.

teristics

follicular

left

of the

hospital

(Fig.

recovery

CASE

specimen

adenoma 12

days

(Fig. later

of the

excised

3, left). She

after

uneventful

goiter.

examination a

4).

In

the

from

was

face

examination

radiography

with

small

calcifications

was

mediastinum

and

anterior aortic

not

enlarged.

left

over

thyroid (Fig.

6)

The

On

was

the

aortic of

3, right).

the

with She

was arch.

8

x

through located

with

its

The

specimen

16, 1965

about

excised

in

10

cm

a

left

the

an-

posterior

sur-

histopathologic showed

features

of

was

discharged

typical

follicular

adenoma 13 days

3:Case 1 (left): Microspecimen (X80) of the aberrant goiter illustrating colloidal adenoma. lined with typical colloidal epithelium; their cavities are full with colloidal material. Case : Microspecimen practically identical to case 1 showing typical features of follicular adenoma.

2

The

The

rest

cervical of

thyroid

the physical

recovery

after

5,

was

arch.

uneventful

contain-

(Fig.

overriding

following

cyst

September of

lying

tissue

operation

a larger

mass

tumor

mediastinum,

(Fig.

chest

the

terior

center,

normal. soft

(Fig.

prior

routine

shadow in

suffering six months

the

circumscribed

diameter

woman began on exertion for On

5, left), a identified

aberrant

thoracotomy.

to admission.

FIGURE Follicles (right)

Gross

2:

A 49-year-old slight dyspnea

gland

1.

right).

Volume September,

52,

No. 3 L967

MEDIASTINAL

415

GOITER

ABERRANT

of

authors,

most

was

not

able

thoracic

extremely

to verify

goiter

goiter goiters

among

cervical

become sion

thyroid

feels

being

of

24,000

in

proper.

with

the

Means’

even

mass

resting

goiter

ultimately the

impres-

origin. Other are convinced

aberrant intrathoracic goiters no demonstrable connection gland

aberrant from

may

as to give

ectopic however,

vestigators,

intra-

than

that extensions

which

so separated

Lahey4

aberrant

more

operations. He are adenomatous

the

rare.’

a true

inthat

do exist with to the thyroid reported

a case

upon

the

right

diaphragm. Usually

the

in

FIGURE

radiogram.

4:

Case

1.

Normal

postoperative

chest

the vical

the

majority

connection

identified

thyroid -

sometimes

cular

to

of

astinum

goiters,

these clearly

although

it may

thin

a

pedicle.

On

5: Case 2 around the

fibrous the

other

and

the and

be band hand,

cereasily

reduced or

vascom-

aberrant or ectopic thythorax are, in the opinion

(left): aortic

size,

effects. of the

Displacement trachea or

cough, stridor As adenomatous and

Chest knob.

resulting edema, there ply

in

forms

difficulties

may cava

be

the

of the goiter

radiogram showing mediastinal shadow Case 2 (right): Normal postoperative

may

affected,

etc.

may

case

where

the

thyroid goiter

diagnosis be

upper

sub(sim-

into of

relatively

occupying the chest radiogram.

as

region, cyanosis,

In

of

cervical

well

such

in this

cervical the

in

Other

obstruction,

region) of

patients

continuation

with

protrusion

compression may result

or nerves pain,

lo-

mechanical

symptoms.’

venous

lesion

are to

in swallowing. tend to enlarge

the deny

hoarseness,

substernal

in

and/or esophagus

even

is a direct

sternal

result

gradually,

vena

goiters due

goiters

also

superior

a ci c

occasionally,

may

or

and

structures intrathoracic

between gland is

pletely separated, roids within the

FIGURE

and

adjust DISCUSSION

In

cation

slowly

r a thor

t

but

asymptomatic,

the these easy.

left

medi-

416

SALOMON

AND

Diseases of the Chest

LEVY

,_B

I.L FIGURE

6:

These

cases

Case

2. Cross

present

of all cervical authors

and

thoracic

or

when ‘

not

are anatomic

from may

the other

aortic

arch

10 per

cent

to different today

as

relationship

does

the cervical be difficult.

differential mediastinal

not

others,

One

may,

of course, aberiodine

studies

with

scintigram.

So

the

oniy

known

case

of

goiter

diagnosed

of

radioactive

prior

to

substance rate, being

surgery was

even

by reported

if such

of thyroid

means

by Dundas.’

a tumor origin,

At

is identified

its excision

tunl,.r

of

therefore,

to cause

toms

has

widely

been

#{231}y#{231}p mP.i rpng y treatment.

may

be

mediastinum.

remote

possibility

or exist,

sympindicating surgical such as

f r

hyperthyroidism does theoas they do in other forms of

adding for

compression observed,

ffi n c ssity complications

Finally,

another

reason

excision

to

these

of

the

ad-

“tumors.”

REFERENCES H. M. goiter.” J. D.:

1 CLuTE,

thoracic 2 Rivas, Ann.

AND

“Mediastinal

H. G.:

HOLLENBERO,

/. Sure.,

aberrant 1947. “Intrathoracic

15:283, 1946. 4 Luizy, F. 1-I.: “Intrathoracic Clin. N. Amer., 25:609, 1945. Sun.,

Mau’ s, J. H.: The thyroid J. B. Lippincott, Philadelphia, 6 CoLcocx, B. P.: “Intrathoracic 5

Clin.

N.

7 Dut. ots,

Scand,,

For reprints, Petah

pital,

K. S.: “Intra54: 151, 1941.

LAWRENCE,

Amer.

126:797,

Surg.,

I. Thor.

as

the

left

degeneration. Furthermore, of these tumors to expand

and,

3

any

the

10.1,,

because

cysts, diverof the

as

aberrant

order

visability

identify these mediastinal tumors rant goiters by the use of radioactive far,

excised

goiter,

must such

bronchial

in

the

hemorrhage retically

region, In these

diagnosis tumors

of

of malignant the tendency

intra-

However,

ganglioneuromas, esophagus, aneurysm

and

specimen

goiters.

lymphogranulomatas,

neurofibromatas, ticula of the

gross

‘hen those tumors are in the posterior mcdi-

but

or away diagnosis

the

1 to

known

substernally,

of

according

substernal

circumstances include all as:

about

goiters

such

astinum an exact

section

Amer.,

33:773,

P,: “Intrathoracic

Israel.

goiter,”

goiter,” and

1937.

1953, goiter,”

128:729, 1964. please write: Dr. Levy, Tiqva,

goiter,”

its

Surg.

diseases,

goiter,” Ada

Beilinson

Surg. Chir. Hos-