Severe Compressive Symptoms Research Articles

FRI504 Ectopic Hyperactive Mediastinal Thyroid Tissue: A Case Report

Abstract Disclosure: C. Dimech: None. G. Jaiswal: None. A. Bhargava: None. Ectopic thyroid tissue is usually located along the normal path of the caudal migration of thyroid tissue during embryonic life. Substernal goiters are thought to occur by either the enlargement of ectopic mediastinal thyroid tissue (primary mediastinal goiter) or abnormal extension of thyroid issue into the superior mediastinum (secondary mediastinal goiter). Typically these goiters remain asymptomatic, and rarely result in hyperthyroidism or local compression of the surrounding area. We report a case of an 89-year-old Caucasian female with history of a multinodular goiter status post right hemithyroidectomy, who initially presented for subclinical hyperthyroidism. Further evaluation revealed negative thyroid stimulating antibodies. A thyroid ultrasound demonstrated a surgically absent right lobe, with a small heterogenous left lobe. A nuclear medicine radioactive iodine uptake and scan showed hypermetabolic residual thyroid tissue with a large area of increased radiotracer uptake projecting over the right anterior chest, concerning for ectopic thyroid tissue. A subsequent chest CT without contrast revealed an approximately 5 centimeter partially calcified anterior mediastinal/retrosternal mass. Given the patient’s age and co-morbidities, a decision was made to treat the hyperthyroidism with methimazole and monitor the ectopic tissue for worsening symptoms of compression. In cases with severe compressive symptoms, or difficult to treat hyperthyroidism, a surgical option must be considered. Presentation: Friday, June 16, 2023

SAT570 Thyroid Lymphoma In A Patient With Hashimoto’s Thyroiditis

Abstract Disclosure: T. Aggarwal: None. S. Reyes: None. I.C. Glitza Oliva: None. E. Korytnaya: None. Background:Primary thyroid lymphoma (PTL) accounts for < 5% of thyroid malignancies. Patients with Hashimoto’s thyroiditis (HT) are at greater risk for developing PTL, with a relative risk of 67 compared to those without thyroiditis. The most common and more aggressive subtype of PTL is diffuse large B cell lymphoma (DLBCL) which is found in more than 50% of the cases, followed by MALT lymphoma and follicular lymphoma (FL), which represents only about 10% of cases. PTL can be classified as a nodular, diffuse, or mixed type based upon ultrasound (US) findings. Diffuse type PTL presents the biggest diagnostic challenge due to resemblance to thyroiditis on US imaging. Certain US features such as enhanced posterior echoes, markedly hypoechoic appearance of thyroid tissue and linear echogenic strands are suggestive of diffuse type PTL but can also be seen in HT. Positive predictive value for US was only 33.7% for diffuse type of PTL. Diagnosis of PTL is ultimately established by biopsy with immunophenotypic assessment. Management of PTL includes chemotherapy, radiation therapy or combined modality treatment. Given sensitivity of PTL to radiation and chemotherapy, surgery is rarely performed and is reserved only for alleviation of severe compressive symptoms in aggressive disease or protection of airway. Case Presentation: A 58-year-old female with 10-year history of HT, hypothyroidism and goiter underwent total thyroidectomy due to worsening compressive symptoms in her neck. She denied weight loss, fevers, or night sweats. Preoperative US showed enlarged heterogenous hypoechoic thyroid gland with echogenic strands and normal vascularity, consistent with the appearance in HT. Surgical pathology unexpectedly showed extensive follicular hyperplasia, focal grade 3b FL (80%), and large foci of DLBCL arising within FL (20%). Background changes of oncocyte metaplasia and lymphocytic infiltrates consistent with Hashimoto Thyroiditis were described. Both cytogenic FISH studies as well as immunohistochemistry failed to reveal MYC and BCL2 and/or BCL6 rearrangements. Positron emission tomography (PET) scan showed mild to moderately fluorodeoxyglucose- avid lymph nodes in the right superior mediastinal, right superior paratracheal and left neck region. The patient has completed 6 cycles of R-CHOP chemotherapy with complete response as evidenced by normal follow up PET imaging. Conclusion:PTL is a rare malignancy and less than 1% patients with Hashimoto’s thyroiditis develop thyroid lymphoma. Diffuse- type PTL should be included in the differential diagnosis while managing patients with HT who present with worsening compressive symptoms involving aerodigestive tract and rapid enlargement of goiter and have markedly hypoechoic thyroid gland with heterogenous internal echoes and posterior acoustic enhancement on US images. Presentation: Saturday, June 17, 2023

Dysphagia as a Rare Presentation of Cervical Cancer with Mediastinal Metastasis.

Dysphagia has a broad aetiology and so it is essential to identify the precise cause. Cervical cancer metastasis is distinctive in that it usually involves local lymph node invasion; however, approximately 1% of cases have mediastinal involvement, which can cause severe compressive symptoms in rare situations. To highlight an uncommon severe manifestation of cervical cancer relapse, we describe a case of dysphagia in a woman with a history of cervical cancer. After a thorough investigation that included endoscopy, endoscopy with ultrasound, an oesophagogram and fine needle aspiration, we eventually reached the diagnosis of mediastinal metastatic cervical cancer. Following interventions, the patient’s condition gradually improved, both clinically and radiographically.LEARNING POINTSMediastinal lymph node enlargement causing dysphagia can be a presenting sign of a metastatic lesion from treated cervical cancer.A PEG tube is helpful in relieving dysphagia caused by metastatic mediastinal lymph node enlargement and as bridge for nutrition during chemotherapy.The VEGF inhibitor bevacizumab can be used in advanced metastatic cervical cancer.Check-point inhibitors like pembrolizumab can be used in metastatic cervical cancer.

Multidisciplinary Management of Intrathoracic Goiter: A Case Report

Introduction: Intrathoracic goiters are associated with compression of nearby structures, triggering severe compressive symptoms. Total thyroidectomy is the gold standard to treat these cases. Case Presentation: A patient with a huge intrathoracic goiter suffering from compressive symptoms underwent a thorough clinical, functional and imaging assessment and underwent total thyroidectomy in an Endocrino-Metabolic surgical referral center; after the surgery she suffered from transient hypocalcaemia but was discharged without major complications and continued periodical endocrinological follow-up. Conclusion: Management of intra-thoracic goiter requires a multidisciplinary approach of a skilled team both pre, during and after surgery to maximize the safety and efficacy of the procedure and reduce or promptly manage surgical or medical complications.

Tratamiento quirúrgico del bocio intratorácico

The definition by Katlic gives the best description of intrathoracic goitre, a condition that includes a small sub-group (1-4%) of patients with multinodular goitre who generally have severe compression symptoms and require specialised care in reference centres. The pre-operative study must include thoracic imaging techniques to plan the most suitable action. Total thyroidectomy is recommended, and in more than 95% of cases the goitre can be removed using a cervical approach. A wide cervical approach and the identification of the recurrent nerve near the cricothyroid joint help to free the thyroid from all its cervical attachments before gently retracting it upwards from the thoracic component for its removal. Intrathoracic goitres that require a sternotomy for its removal are recurrent goitres, those that have advanced cancer, those that reach the carina, and left posterior goitres that extend to the right pleural cavity.

Alleviation of Severe Compressive Symptoms in A Patient with Advanced Lung Carcinoma Using Tracheal And Superior Vena Cava Stents

Lung cancer is now the leading cause of death from cancer worldwide. Although surgery remains the treatment of choice, the majority of patients will be unresectable at presentation with a poor survival outcome. In those patients who also have tracheobronchial involvement; the aim of intervention is to restore airway patency, thus improving quality of life in a minimally invasive way. Superior vena cava (SVC) infiltration by lung carcinoma is present in 3%-5% of patients with lung cancer. In patients with malignant SVC syndrome, the average life expectancy is 3 to 10 months. In these cases the disease progresses rapidly and obstruction develops before there is time for collaterals to develop. We present a case of a 75-year-old man who had alleviation of severe compressive symptoms secondary to advanced lung carcinoma using tracheal and SVC stents placed as a single procedure.