A Case of Ectopic Thyroid Presenting as a Superior Mediastinal Mass

Imai, Takayuki; Mori­shita, Yohei; Ito, Shigemi; Saijo, Satoshi; Asada, Yukinori

doi:10.7759/cureus.9541

Cited by 5 publications

(12 citation statements)

References 21 publications

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“…Mediastinal tumours are most commonly thymomas, neurogenic tumours or benign cysts, altogether accounting for 60% of cases [ 8 ].. Primary mediastinal seminomas are considered rare entities, being most common in men in the third to fourth decade of life. However, there have been cases arising in women [ 3 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

2021

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Background First described in 1955 Primary mediastinal seminomas are rare. Only 1–4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically present in men aged between 20 and 40 years. Very few cases are reported in the literature. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. We present a rare case of a 48 year old man with a primary mediastinal seminoma with florid follicular lymphoid hyperplasia; found following excision of a clinically presumed thymoma. Case presentation A 48 year old man was referred for excision of a thymic mass. The presumed diagnosis was a thymoma; following preoperative investigations. The mass was incidentally found on a radiological imaging. However, the patient did report mid-sternal discomfort on lying flat and breathlessness. The patient underwent a thymectomy via a partial median sternotomy with good recovery. Histological assessment was that the mass was in fact a primary mediastinal seminoma with florid follicular lymphoid hyperplasia. A primary testicular malignancy was excluded and the patient required no further oncological treatment. Conclusions Only 11 cases have previously been reported of primary mediastinal seminoma with florid follicular lymphoid hyperplasia. Although rare, a primary mediastinal seminoma should be considered as a differential diagnosis for presentations with a thymic mass. Tumour markers can be helpful, however are only positive in third of cases. Ultrasound imaging of the gonads is essential to exclude a primary gonadal lesion. Pure seminomas are radiotherapy and chemotherapy sensitive however the mainstay treatment of primary mediastinal seminomas remains surgical excision. Radiotherapy is reserved postoperatively for incomplete surgical margins.

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Section: Discussionmentioning

confidence: 99%

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

2021

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“…e evaluation of a mediastinal mass is challenging, and obtaining a prompt histological examination is crucial to ensure an early diagnosis and treatment. yroid carcinoma can rarely present as an intrathoracic mass, with few cases described in the literature [1][2][3]. In such situations, it is difficult to differentiate between metastatic occult thyroid carcinoma and malignant transformation of ectopic thyroid tissue [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…Mediastinal thyroid cancer is extremely rare, with few cases reported in the literature [1][2][3]. Surgical excision of the malignant lesion, whenever possible, is the treatment of choice [4].…”

Section: Introductionmentioning

confidence: 99%

Mediastinal Thyroid Carcinoma and Graves’ Disease: A Rare Presentation

Pinheiro

Damasio

Figueiredo

et al. 2021

Case Reports in Endocrinology

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Background. Mediastinal thyroid carcinoma is extremely rare, with few cases reported in the literature. Case Report. A 73-year-old man presented with weight loss for 6 months. Imaging by computed tomography (CT) documented a large mediastinal mass below the thyroid gland and pulmonary metastases. Neck ultrasound found two spongiform nodules in the right thyroid lobe, and fine-needle aspiration citology (FNAC) of these nodules revealed they are benign. Endobronchial ultrasound-guided needle biopsy of the mediastinal mass was compatible with papillary thyroid cancer. A few weeks later, the patient developed overt hyperthyroidism due to Graves’ disease, which was treated with antithyroid drugs. 99mPertechnetate scintigraphy showed increased diffuse uptake in the thyroid parenchyma but the absence of uptake in the paratracheal mass and in the lung nodules. The patient was not considered eligible for surgical intervention or therapy with tyrosine kinase inhibitor due to tracheal and mediastinal vessel invasion and was treated with palliative radiotherapy. Two months later, restaging PET-FDG showed an intense uptake in the right lobe of the thyroid gland, lymph nodes, lungs, bone, muscle, myocardial, kidney, and adrenal gland. Conclusion. In this case, thyroid carcinoma presented as a mediastinal mass with concurrent hyperthyroidism due to Graves’ disease. Although uncommon, the clinicians should be aware of these situations. Obtaining a prompt histological examination of an intrathoracic mass is crucial to ensure an early diagnosis and treatment.

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“…The sample-focused analysis according to our methods identified another 37 EMT adults (22 females and 12 males; specific demographic data were not available for three cases; mean age was of 56.32 years, females subgroup: mean age of 56.04, range: 30-80 years; males subgroup: average age of 56.83, range: 31-74 years; across 35 articles featuring a single case study and two articles introducing each two subjects [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93]), whereas benign EMTs were associated with a normal thyroid panel in terms of function, negative autoimmunity, and lack of nodules/cancer/goiter in eutopic (cervical) gland before and after EMT removal or identification if the EMT was not resected (of note, we also, included the cases whereas no specific thyroid data were provided, thus, it was presumably normal) [13,29, (Table 3). Regardless of the pathological traits, awareness of EMTs is essential, while removal was decided in most of the cases (rather than conservative approach) depending on the location and EMT anatomical features; the risk of malignancy (the rate of conversion from benign to a malignant EMT is not clearly understood, especially in long standing goiter-like EMT); the ectopic tissue enlargement with compressive symptoms/signs such as respiratory obstruction or compression on mediastinal organs; the risk of hemorrhage [84]; the patient's co-morbidities and medical/surgical history as well as the general health status [7,13].…”

Section: Exploring the Thyroid Panel In Patients Confirmed With Emtmentioning

confidence: 99%

“…The suspicion and consecutive confirmation of EMTs required the exploration of neck thyroid as a mandatory evaluation and, in cases with thyroid nodules in cervical gland, thyroid FNA was performed [11,22,58,59,69,80,87,98,117].…”

Section: Outcome After Identification Of Emtsmentioning

confidence: 99%

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

Carsote,

Ciobica,

Sima

et al. 2024

Cancers

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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.

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A Case of Ectopic Thyroid Presenting as a Superior Mediastinal Mass

Abstract: Imai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 5 publications

References 21 publications

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

Mediastinal Thyroid Carcinoma and Graves’ Disease: A Rare Presentation

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

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