Giant sternal metastasis secondary to follicular carcinoma of the thyroid gland: report of a case

Abstract

A 70-year-old woman was admitted to our department for investigation and treatment of a progressively enlarging multinodular goiter and a fast growing mass infiltrating the sternum. The patient was euthyroid, but computed tomography (CT) and ultrasonography showed a mass in the anterior mediastinum infiltrating the sternum, with a dominant nodule in the right lobe of the thyroid. Fine needle aspiration biopsy results from both the cervical and the mediastinal masses were suggestive of follicular thyroid carcinoma. The patient underwent total thyroidectomy, thymectomy, and total removal of the mass, along with parts of the sternum, sternocleidomastoid muscle, and attached ribs. The thoracic wall was reconstructed with gortex dual mesh covered by muscle flaps from both pectoralis major muscles. Pathological analysis of both masses confirmed the fine needle aspiration findings and the patient received three cycles of radioactive iodine treatment. She had an uneventful postoperative course, but died of a stroke 8 years later.

Cytodiagnosis of distant metastases from follicular thyroid carcinoma

“…Marginal vacuoles are variable sized and show slight eosinophilic discolouration at the periphery of the vacuoles. Similar cytological features have been observed by some other authors also …”

“…Tissue diagnosis, either by biopsy or fine needle aspiration, is necessary to confirm or refute the diagnosis of metastatic disease. Although distant metastases from follicular carcinoma have been reported in literature, only a few reports illustrating their cytomorphologic features are available …”

Metastasis of Thyroid Cancer to the Sternum after Total Thyroidectomy and Laryngectomy

“…Autoplastic reconstruction is indicated for smaller defects, while alloplastic materials are indicated for larger defects. Several studies have reported good results in response to reconstruction with skin flap, myocutaneous flaps, Marlex mesh, Gore-Tex dual mesh, methyl methacrylate sandwiched between Marlex mesh, steel mesh to titanium plate, and so on [1, 6, 7]. In the present case, reconstruction was performed with a polypropylene/ePTFE composite, which is originally used for the reconstruction of the abdominal wall [8].…”

Well-Differentiated Thyroid Carcinoma Presenting with Sternal Invasion: Complex Resection and Reconstruction in the COVID-19 Era

“…Bone and soft tissue reconstruction should be considered separately. Multiple methods of reconstruction of the sternum have been described including methyl methacrylate and synthetic mesh [8][9][10]. Our preference ordinarily would be to reconstruct the neo-manubrium with a vascularised bone flap (e.g., free fibula) to provide stability and vascularity.…”