A rare clinical case of malignant ectopic retrosternal goiter of a large size in a patient with aberrant right subclavian artery
https://doi.org/10.21294/1814-4861-2024-23-2-119-125
- Р Р‡.МессенРТвЂВВВВВВВВжер
- РћРТвЂВВВВВВВВнокласснРСвЂВВВВВВВВРєРСвЂВВВВВВВВ
- LiveJournal
- Telegram
- ВКонтакте
- РЎРєРѕРїРСвЂВВВВВВВВровать ссылку
Full Text:
Abstract
Background. Ectopic goiter accounts for only 0.2 % to 1 % of all mediastinal goiters. The aberrant right subclavian artery (arteria lusoria) is an extremely rare anomaly of the major vessel, with a prevalence not exceeding 0.3 % in the general population. This paper presents the first case of malignant ectopic retrosternal goiter of a large size in combination with the aberrant right subclavian artery. Clinical case description. A 61-year-old male presented to the thoracic surgery department of P. Herzen Moscow oncology Research institute with a large posterior mediastinal mass measuring 108×106×79 mm and adjacent to the right lobe of the thyroid gland. The tumor displaced the trachea and esophagus. Open biopsy through a thoracotomy incision revealed thyroid gland cells without signs of atypia. A detailed examination revealed mediastinal vascular anomaly – retrotracheal position of the right subclavian artery. a complete longitudinal sternotomy, complemented by a right-sided thoracotomy at the 3rd intercostal space, served as the surgical approach. The operation lasted 320 minutes, with a blood loss of 3500 ml. The postoperative period was uneventful. The morphological examination of the surgical specimen revealed nodular hyperplasia of the ectopic thyroid tissue with the growth of well-differentiated follicular carcinoma without metastatic involvement of removed lymph nodes. Considering the identified follicular carcinoma, total thyroidectomy was performed. Conclusion. In surgical planning, it is crucial to assess the location of major mediastinal vessels and their relationship with the goiter. Therefore, all patients with mediastinal lesions should undergo preoperative contrast-enhanced ct. Retrosternal goiter predisposes to a higher rate of malignancy compared to cervical goiter. If the lower edge of the goiter is at the level of or below the aortic arch, cervical access should be supplemented with sternotomy. In cases of a massive thoracic component, additional thoracotomy is justified.
About the Authors
O. V. PikinRussian Federation
Oleg V. Pikin - MD, DSc, Head of the Thoracic Surgical Department, P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia ; Professor, Thoracic Surgery Department named after L.K. Bogusha, Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia.
3, 2nd Botkinsky Drive, Moscow, 125284; 2/1, Bld 1, Barrikadnaya St., Moscow, 123242
O. A. Alexandrov
Russian Federation
Oleg A. Alexandrov - MD, PhD, Head of the Thoracic Surgery and Oncology Department, National Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Health of Russia; Scientific Researcher, Thoracic Surgery Department, P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia.
3, 2nd Botkinsky Drive, Moscow, 125284; Bld 2, Dostoevsky St., Moscow, 127994
V. A. Glushko
Russian Federation
Vladimir A. Glushko - MD, DSc, Leading Researcher, Thoracic Surgery Department, P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia.
3, 2nd Botkinsky Drive, Moscow, 125284
A. V. Levshakova
Russian Federation
Antonina V. Levshakova - MD, DSc, Head of the Department of Computer and Magnetic Resonance Tomography, P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia.
3, 2nd Botkinsky Drive, Moscow, 125284
References
1. Huins C.T., Georgalas C., Mehrzad H., Tolley N.S. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008; 6(1): 71-6. https://doi.org/10.1016/j.ijsu.2007.02.003.
2. Foroulis C.N., Rammos K.S., Sileli M.N., Papakonstantinou C. Primary intrathoracic goiter: a rare and potentially serious entity. Thyroid. 2009; 19(3): 213-8. https://doi.org/10.1089/thy.2008.0222.
3. Natsis K.I., TsitouridisI. A., Didagelos M.V., Fillipidis A.A., VlasisK.G., Tsikaras P.D. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009; 31(5): 319-23. https://doi.org/10.1007/s00276-008-0442-2.
4. Can A.S., Nagalli S. Substernal Goiter. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
5. Patel K.N., Yip L., Lubitz C.C., Grubbs E.G., Miller B.S., Shen W., Angelos P., Chen H., Doherty G.M., Fahey T.J. 3rd, Kebebew E., Livolsi V.A., Perrier N.D., Sipos J.A., Sosa J.A., Steward D., Tufano R.P., McHenry C.R., Carty S.E. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020; 271(3). https://doi.org/10.1097/SLA.0000000000003580.
6. Campbell M.J., Candell L., Seib C.D., Gosnell J.E., Duh Q.Y., Clark O.H., Shen W.T. Unanticipated thyroid cancer in patients with substernal goiters: are we underestimating the risk? Ann Surg Oncol. 2015; 22(4): 1214-8. https://doi.org/10.1245/s10434-014-4143-2.
7. Mercante G., Gabrielli E., Pedroni C., Formisano D., Bertolini L., Nicoli F., Valcavi R., Barbieri V. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head Neck. 2011; 33(6): 792-9. https://doi.org/10.1002/hed.21539.
8. Pikin O.V., Kolbanov K.I., Ryabov A.B., Aleksandrov O.A., Glushko V.A., Vorob'eva Yu.E. Kombinirovannyi dostup v khirurgicheskom lechenii patsientov s opukholyami vnutrigrudnoi lokalizatsii. Onkologiya. Zhurnal im. P.A. Gertsena. 2022; 11(3): 13-7. https://doi.org/10.17116/onkolog20221103113.
9. Cawich S.O., Dwarika W., Mohammed F., Ramdass M.J., Ragoonanan V., Augustus M., Harnanan D., Naraynsingh V., Spence R. Lessons Learned after Iatrogenic Complete Transection of the Right Common Carotid Artery with Segmental Vessel Loss. Case Rep Vasc Med. 2021. https://doi.org/10.1155/2021/8812870.
10. Ognerubov N.A., Antipova T.S. Aberrantnaya pravaya podklyuchichnaya arteriya (arteria lusoria): opisanie sluchaya. Vestnik rossiiskikh universitetov. Matematika. 2017; 22(6): 1473-7.
11. Saeed G., Ganster G., Friedel N. Arteria lusoria aneurysm with truncus bicaroticus: surgical resection without restoring blood supply to the right arm. Tex Heart Inst J. 2010; 37(5): 602-7.
12. Saito T., Tamatsukuri Y., Hitosugi T., Miyakawa K., Shimizu T., Oi Y., Yoshimoto M., Yamamoto Y., Spanel-Browski K., Steinke H. Three cases of retroesophageal right subclavian artery. J Nippon Med Sch. 2005; 72(6): 375-82. https://doi.org/10.1272/jnms.72.375.
13. Bayford D. An account of a singular case of obstructed deglutition. Mem Med Soc Lond. 1794; 2: 271-82.
14. Work W.P. Unusual position of the right recurrent laryngeal nerve. Ann Otol Rhinol Laryngol. 1941; 50: 769-75.
Review
For citations:
Pikin O.V., Alexandrov O.A., Glushko V.A., Levshakova A.V. A rare clinical case of malignant ectopic retrosternal goiter of a large size in a patient with aberrant right subclavian artery. Siberian journal of oncology. 2024;23(2):119-125. (In Russ.) https://doi.org/10.21294/1814-4861-2024-23-2-119-125
ISSN 2312-3168 (Online)