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CASE REPORT

ABASSIA CHEST DISEASES HOSPITAL. Ectopic mediastinal thyroid tissue A case report and review of The literature. CASE REPORT. Dr. Raed Mostafa Alareeni Egyptian fellowship of thoracic surgery. Dr. Adel Deab Hea d of thoracic surgery center. Dr. prof . Mahmoud El batawi

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CASE REPORT

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  1. ABASSIA CHEST DISEASES HOSPITAL Ectopic mediastinal thyroid tissue A case report and review of The literature CASE REPORT Dr. RaedMostafaAlareeni Egyptian fellowship of thoracic surgery Dr. Adel Deab Head of thoracic surgery center Dr. prof. Mahmoud El batawi Cardio – Thoracic surgery consultant March- 2014

  2. CASE PRESENTATION • A 59-year – old Femele presented to our department for management of a mediastinal mass. She had a history of cough, dyspnea, and dysphagia over the last six mounths. Physical examination was normal. She had undergone subtotal thyroidectomy 30 years earlier, and had not been placed on thyroid supplement ever since. Thyroid function tests done a week prior to admission were normal. Chest radiography revealed a mass in the superior mediastinum with trachea deviation (Figure 1) Figure1. Chest x-ray revealed a mass in the superior mediastinum with tracheal deviation. • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  3. Computerdtomographic scan of the chest showed a round mass 70 x 60 mm in size, at the patient side of the middle mediastinum (Figure 2) • Figure2. Computed tompgraphic scan of the chest showed a round mass, 70×60 mm in size, at the right side of the middle mediastinum • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  4. Abdomen, brain and bone scan was negative for metastasis disease subsequently, the patient was subjected to surgery. Atypical Rtpostero lateral thoracotomy was performed. Intra operativele findings revealed a firm and encapsulated mass with in the middle mediastinum next to superior vena cava and trachea extended to the Rt apex of lung and next to azygaus vein (Figure 3). Figure3. Intraoperative findings revealed a firm and enapsulated mass in the superior mediastinum next to the superior vena cava aand the trachea. • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  5. The mass derived its blood supply from RT snbclavianvseless. The mass was Completeleexciased. (Figure 4-5). Figure4: Macroscopic appearance of the reseetedspecimen. Figure5: Macroscopic appearance of the reseetedspecimen(after 10 days) • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  6. Histo-pathological examination of the mass using hematoxylineosin, revealed multinodular goiter with colloid cyst (Figure 6) the postoperative period was uneventful Figure 6: Histopathologiccxamination of the mass, using hematoxylin –eosin revealed multinodular with colloid cysts • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  7. DISCUSSION • Ectopic thyroid tissue has been found along the midline from the base of the tounge to the mediastinum. Ninety percent of the reported cases are found at the base of the tounge, while 10% lie in the anterior aspect of the neck superficial to the hyoid bone. Ectopic thyroid tissue is rarely faund in other locations(3-4). • Heterotopic thyroid tissue in the anterior mediastinum has probably originated embryological from rudiments of developinq thyroid dragged into the chest during the descent of the heart and great vesseles with the development of the embryonic neck and the unfolding of the embryo(5). • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  8. Ectopic intra thoracic thyroid can be distinguished from retrosternal goiter or secondary intra thoracic goiter from the fact that the former receives its basal supply from mediastinal vessels rather than neck and is not connected to the cervical thyroid except from a thin band of conective tissue. patient with intra-thoracic thyroid are usually asymptomatic with the tumor reported as an incidental finding on chest radiography. They are usnalyeuthyroid as in the present case. Some times they may present with respiratory symptoms similar to the those of this dysphagia, weight loss, chest pain superior vena cava syndrome. • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  9. Chest x-ray is usually diagnostic for a soft tissue mass. Other findings include tracheal displacement, tracheal compression or calcifications. • Chest computed tomography and magenetic resonance imaging provide important information abaut location of the ectoptic thyroid tissue and its relation with the great vessels and other mediastinal structures. Scintiqraghy, when intra thoracic thyroid is suspected, its useful and effective for differential diagnosis of other mediastinal tumors. • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  10. However, uptake of I131 is not always observed in ectopic thyroid tissue and scintigraphy is not always diagnostic(6). True malignant transformation in ectopic thyroid tissue is extremely rare(7). Nevertheless these masses should be resected surgically due to the risks of malignant transformation, progressive enlargement, hemorrhage within the mass causing respiratory failure, and compression of neighboring vital mediastinal organs(8). • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  11. With regards to the surgical approach, thoractomy provides both surgical convenience and allows a complete resection with easy access and better visuallitation(9). Axillarythoracotomy although muscle sparing is not indicated for surgical treatment of mediastinal masses, especially in cases with no definite preoperative diagnostic thoracoscopic excision has also been reported with excellent results(10). Operability must be determined early and in many cases is not able to be confirmed until after thoracotmy or sternotomy. • Surgery has a very low mortality rate (0-2%) and an acceptable morbidity(11). • Prognosis following a successful surgical excision is excellent. • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

  12. Thank you • Dr. RaedMostafaAlareeni • Egyptian fellowship of thoracic surgery • Email. Dr.raed.areny@gmail.com

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