CASE REPORTS   

Chirurgia 2015 October;28(5):201-4

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Adjacent occurrence of an aberrant intrathoracic goiter and a cervical adenomatous goiter: report of a case with a difficult preoperative diagnosis

Shimizu J. ¹, Moriya M. ¹, Kamesui T. ¹, Hayashi S. ¹, Shinagawa S. ², Kuriyama M. ²

¹ Department of Surgery, Hokuriku Central Hospital, Oyabe, Japan; ² Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan

A 79-year-old woman was referred to our hospital because of an abnormal shadow found on her chest radiograph during a routine checkup. Chest computed tomography (CT) showed a 4×3 cm mass at the lower pole of the right lobe of the thyroid (with calcification inside the mass and border irregularity). In addition, a lobulated tumor measuring ≥10 cm (with internal degeneration and multiple calcifications) was observed in the region from the left brachiocephalic vein to the anterior mediastinum. From the routine CT findings, it was difficult to determine whether the two tumors were onnected. Intrathoracic goiter was diagnosed, and the patient underwent surgery in Septermber 2013. The tumors were approached through a right cervical collar incision and a median sternotomy incision. The cervical adenomatous goiter was adjacent to the intrathoracic goiter. Although they were apparently connected to each other preoperatively, through exfoliation they were found to be two distinct tumors each covered with a thin capsule. The tumors were completely removed through resection of the intrathoracic goiter, followed by resection of the right lobe of the thyroid. Pathological diagnosis was an adjacent adenomatous hyperplasia arising from an ectopic thyroid and a normally placed thyroid. Intrathoracic goiter is defined as a tumor with ≥50% of the tissues presenting in the mediastinum. An intrathoracic adenoma with no connection to the thyroid is classified as an aberrant intrathoracic goiter, which accounts for <1% of all goiters. Concomitant occurrence of an aberrant intrathoracic goiter and a cervical adenomatous goiter is very rare. Although the accurate preoperative diagnosis was difficult, a frontal plane CT scan was useful for diagnosing these two tumors.