Abstract
BackgroundThe mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue. The differential diagnoses with other diseases such as lymphomas, thymic tumors and dermoid cysts is mandatory, in fact each one, needs different management and treatment.Case presentationHere, we discuss a rare case of mediastinal ectopic thyroid presenting with a paratracheal mass laying on the right bronchus without symptoms. A 63-year-old male presented with an abnormal well-defined mass along the right paratracheal side, detected by chest x-ray. The CT scan confirmed the presence of a 6 × 8 cm heterogeneously enhanced mass, located behind the superior vena cava and left brachiocephalic artery, reaching azygos vein and right bronchus, without a mass effect. Taking into account the clinical importance of a mediastinal mass, we removed it surgically, through a double surgical approach consisting in a classical transverse cervicotomy for the left thyroid lobe, followed then by a longitudinal sternal splitting to remove the mediastinal mass and complete the thyroidectomy.ConclusionsIn case of mediastinal masses, the surgical excision is recommended, presenting the double advantage to clarify the diagnosis and to treat the pathology. As demonstrated in this case, a mediastinal ectopic thyroid should be taken into account in the differential diagnosis, considering its clinical importance.
Highlights
The mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue
In case of mediastinal masses, the surgical excision is recommended, presenting the double advantage to clarify the diagnosis and to treat the pathology
As demonstrated in this case, a mediastinal ectopic thyroid should be taken into account in the differential diagnosis, considering its clinical importance
Summary
The ETT was correlated with Akt/mTOR pathway high expression; pathology of skull ectopic thyroid cancer orthotopic thyroid was related with MAPK/BRAF/ERK signaling pathway high expression; and the metastatic thyroid cancer was related with NFkB/MMP9 high expression. Other interesting working hypothesis takes into account the role played by genetic expression in the understanding of molecular mechanisms regulating the size, shape, and position of thyroid [6] In these cases, several mutations in genes playing a role during thyroid morphogenesis such as NKX2-1, PAX8, FOXE1, NKX2-5, TSHR, have been reported [7]. According to our experience, the surgical excision of mediastinal ectopic thyroid is recommended to obtain, at the same time, the definitive diagnosis and treatment. It represents the elective treatment in case of thyroid cancer or multinodular goiter, taking into account that both tend to increase their mass and compress the mediastinal structures around
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