Primary Mediastinal Goiter Resected via Cervical Approach

Abstract

Primary mediastinal goiter is a rare entity. In most cases their finding is incidental. Excision is mandatory because of the risk of compression of vital structures within the chest. We report the case of a primary posterior mediastinal goiter that was resected through a cervical approach. being discharged she received a thoracic surgery consultation for tumor resection. Two months after discharge she was hospitalized again for surgery. A cervical surgical approach with the intention to convert to thoracotomy was planned. Through a standard collar incision, digital exploration and tumor dissection was made that properly surround it in its entirety surface with no evidence of adherences to any intrathoracic structure. The goiter had its blood supply from a branch of esophageal arteries at its cranial edge, which was identified and ligated. The surgical specimen was then removed with a clamp getting scarce bleeding at the surgical bed. Hemostasis was verified leaving a closed drainage that was later withdrawn. The cervical thyroid gland was explored during surgery with no abnormalities found. There were no intraoperative or postoperative complications and the patient was discharged from the hospital three days after surgery. Macroscopically, a tumor of 10 × 5 × 2 cm, with a multi-nodular surface, covered by a thin, translucent full capsule, with reddish brown and yellowish areas was reported (Figure 3a). Its interior was multi- nodular, composed by light brown areas of granular consistency, hemorrhagic areas and yellowish colloid-appearance areas. Indurated consistency areas were not identified. Microscopically (Figure 3b), small follicles of thyroid tissue with no colloid plus dilated cysts with abundant colloid were identified. Foamy macrophages, some with hemosiderin in their cytoplasm were also reported. There were no findings suggestive of malignancy. Dysphagia and cough disappeared after surgery and the patient remained asymptomatic after 19 months of follow-up. Discussion PMG, also known as aberrant goiter or ectopic mediastinal goiter implies the presence of intra-thoracic thyroid tissue independent of the cervical thyroid gland; its vascular supply comes from intra- thoracic vessels and is considered a benign entity. It's localized primarily in the anterior mediastinum (85% of cases). The middle and posterior mediastinum are less frequent locations in 15% of cases (4). It is a rare condition. Due to thyroid gland migration during embryonic development (between the 3rd and the 8th weeks) the location of primary ectopic goiter may occur from the tongue