This document reports on a rare case of a 55-year-old man who presented with both a retrosternal goiter and a thymic carcinoid tumor. Retrosternal goiter occurs when more than 50% of the thyroid gland extends below the thoracic inlet, while thymic carcinoid tumor is a very rare tumor that originates from argentaffin cells in the thymus gland. During surgery to remove the large right-sided thyroid lobe that extended into the mediastinum, a solitary thymic carcinoid tumor was also found and removed. Histopathological examination confirmed a colloid goiter and the rare thymic carcinoid tumor. The patient had an early good outcome after the one-stage surgery
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Skull Metastasis from Papillary Thyroid Carcinoma: Case Report and Literature...semualkaira
Although papillary thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull
is exceptional. Here, we report a case of papillary thyroid carcinoma revealed by frontal skull metastasis.
Austin Journal of Pulmonary and Respiratory Medicine is a peer reviewed academic journal dedicated to publish clinical and experimental research in respiratory medicine including Thoracic Oncology, Thoracic Surgery, Epidemiology, Pathophysiology, Thoracic Imaging, Paediatric Pneumology, Intensive Care, Sleep Medicine, Bronchial Diseases, Lung Cell Biology.
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Austin Journal of Pulmonary and Respiratory Medicine is a peer reviewed academic journal dedicated to publish clinical and experimental research in respiratory medicine including Thoracic Oncology, Thoracic Surgery, Epidemiology, Pathophysiology, Thoracic Imaging, Paediatric Pneumonology, Intensive Care, Sleep Medicine, Bronchial Diseases, Lung Cell Biology.
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Although papillary thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull
is exceptional. Here, we report a case of papillary thyroid carcinoma revealed by frontal skull metastasis.
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Although papillary thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull
is exceptional. Here, we report a case of papillary thyroid carcinoma revealed by frontal skull metastasis.
Austin Journal of Pulmonary and Respiratory Medicine is a peer reviewed academic journal dedicated to publish clinical and experimental research in respiratory medicine including Thoracic Oncology, Thoracic Surgery, Epidemiology, Pathophysiology, Thoracic Imaging, Paediatric Pneumology, Intensive Care, Sleep Medicine, Bronchial Diseases, Lung Cell Biology.
The aim of the journal is to provide a forum for pulmonologists, general physicians, pharmacologists, internists, researchers, physicians and other health professionals to find most recent advances in the areas of Pulmonology and Respiratory Medicine.
This open access journal cover all the aspects of respiratory diseases including but not limited to Bronchial Diseases, Chronic Obstructive Pulmonary Disease, Respiratory tract infections, Upper respiratory tract infections, Lower respiratory tract infections, Lung Cancer, Pleural cavity diseases, Pulmonary vascular diseases, Pulmonary embolism, Pulmonary arterial hypertension, pneumothorax and more.
Austin Journal of Pulmonary and Respiratory Medicine is a peer reviewed academic journal dedicated to publish clinical and experimental research in respiratory medicine including Thoracic Oncology, Thoracic Surgery, Epidemiology, Pathophysiology, Thoracic Imaging, Paediatric Pneumonology, Intensive Care, Sleep Medicine, Bronchial Diseases, Lung Cell Biology.
CT angiography based Study of Variations in Coeliac Trunk and its surgical im...iosrjce
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A case of giant mediastinal liposarcoma of thymic origin a rare clinical entityDr.Debmalya Saha
Abstract
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few
cases reported till date. This case study presents a 45-year male with rare type
of thymoma. On the contrast-enhanced CT images, there was a large mass lesion
of predominantly fat attenuation in the pre-vascular compartment of the
mediastinum insinuating on both sides of the visceral compartment of the
mediastinum, and extending upto the bilateral cardio phrenic and anterior
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and AP window and a calcified right hilar lymph node, suggestive of
well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut
tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-
collagenous tissue with area of necrosis, focal myxoid changes in the
background with presence of cells which are spindle to oval in shape with
mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin.
The entire tumor was resected en masse after meticulous dissection
without the support of cardiopulmonary bypass (CPB) with an intact pericardium.
Final histopathology report of the surgical biopsy specimens is consistent
with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation.
Postoperative follow-up CECT of thorax revealed no evidence of
residual mass in the pre-vascular compartment. The patient is disease-free
and asymptomatic after 6-month and he is under routine follow-up under
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(PORT).
A Slide show on the Principles of Management of Cancer by Surgery, having practiced this branch for almost 25 years ,I decided to crystalize this knowledge.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Cystic hygroma or cystic lymphangioma is a congenital malformation of the lymphatic system that manifests itself as a soft, benign, and painless mass. It is widely accepted that they arise from the remnants of embryonic lymphatic tissue which retains the potential for proliferation. They grow in the fashion of sprouting and are capable of transgressing anatomical boundary. They can occur almost at any anatomical site.
CT angiography based Study of Variations in Coeliac Trunk and its surgical im...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Austin Surgical Oncology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Surgical Oncology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Surgical Oncology. Austin Surgical Oncology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of surgical oncology.
Austin Surgical Oncology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
A case of giant mediastinal liposarcoma of thymic origin a rare clinical entityDr.Debmalya Saha
Abstract
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few
cases reported till date. This case study presents a 45-year male with rare type
of thymoma. On the contrast-enhanced CT images, there was a large mass lesion
of predominantly fat attenuation in the pre-vascular compartment of the
mediastinum insinuating on both sides of the visceral compartment of the
mediastinum, and extending upto the bilateral cardio phrenic and anterior
costophrenic angles, anterior to the right ventricle with loss of fat plane with
the pericardium, with few sub-centimetric lymph nodes in the right paratracheal
and AP window and a calcified right hilar lymph node, suggestive of
well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut
tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-
collagenous tissue with area of necrosis, focal myxoid changes in the
background with presence of cells which are spindle to oval in shape with
mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin.
The entire tumor was resected en masse after meticulous dissection
without the support of cardiopulmonary bypass (CPB) with an intact pericardium.
Final histopathology report of the surgical biopsy specimens is consistent
with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation.
Postoperative follow-up CECT of thorax revealed no evidence of
residual mass in the pre-vascular compartment. The patient is disease-free
and asymptomatic after 6-month and he is under routine follow-up under
Radiotherapy department since he received 30 Gy of postoperative radiotherapy
(PORT).
A Slide show on the Principles of Management of Cancer by Surgery, having practiced this branch for almost 25 years ,I decided to crystalize this knowledge.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Cardiac conduction defects can occur due to various causes.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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2. dyspnea on arm elevation. Chest radiograph showed left-sided tracheal deviation with a rounded left hilar mass (Fig. 1-A).
Electrocardiography, echocardiography, fiberoptic bronchoscopy and thyroid function tests were normal [T3 ¼ 1.6 nmol/L
(normal value: 0.9e2.8), T4 ¼ 90 nmol/L (normal value: 58e161) and TSH ¼ 1.2 mIU/L (normal value: 0.5e4.7)]. Chest CT scan
(Fig. 1-B) showed a large well-defined solid anterior mediastinal mass while neck CT scan (Fig. 1-C) revealed a large complex
thyroid mass with calcification displacing the trachea to the left side. Fine needle aspiration cytology (FNAC) revealed benign
follicular epithelial thyroid cells. The patient underwent one-session surgery. Endotracheal intubation wasn't difficult. Once
the sternum was divided; the mediastinal mass was found loosely adherent to the great vessels and easily resected (Fig. 2-A).
The incision was then extended into the neck. Thyroid enlargement was huge extending down into the mediastinum. Right
thyroid lobectomy was performed (Fig. 2-B). After securing hemostasis and placement of drains, the wound was closed.
Postoperatively, the trachea regained its central position (Fig. 2-C). Histopathological exam revealed a colloid goiter and TC
tumor (Fig. 3).
3. Discussion
In this report, a man of 55 with TC tumor and RSG is described. Preoperative work up failed to arrive at definite tissue
diagnoses. Although most RSGs can be removed via a cervical incision, median sternotomy was chosen due to co-existence of
the anterior mediastinal mass. Worthy to note, both thymus and thyroid glands normally contain argentaffin cells. They are
named C-cells in the thyroid gland and can give rise to thyroid medullary carcinoma (TMC). However, the chief locations of
argentaffin cells are the gastrointestinal and respiratory tracts. In this case, neither TMC nor gastro-intestinal or bronchial
Fig. 1. A: Preoperative CXR -B: Chest CT scan -C: Cervical CT scan.
A.Y. Taha et al. / Journal of the Egyptian Society of Cardio-Thoracic Surgery xxx (2017) 1e42
Please cite this article in press as: Taha AY, et al., Retrosternal goiter and thymic carcinoid: A rare co-existence, Journal of the
Egyptian Society of Cardio-Thoracic Surgery (2017), https://doi.org/10.1016/j.jescts.2017.11.004
3. carcinoid tumors were present; hence, the tumor was solitary and primary. Moreover, the tumor did not invade nearby
structures or metastasized distantly. The carcinoid syndrome that usually results from serotonin secretion was absent.
RSG is said to exist in up to one fifth of patients undergoing thyroidectomy, 90% of which are located in the anterior
mediastinum. Diagnosis of RSG is most frequently made in the 5th or 6th decades with symptoms related to tracheal or
esophageal compression by the slow-growing thyroid gland [2]. Similarly, this 55-year old patient had a long-standing goiter
associated with shortness of breath.
Primary TC tumor is very rare. Just 100 cases have been reported world-wide by 1994 [6]. From 1995 to 2010, Ahn S et al.
from South Korea, found only 18 cases; most of them were males (male/female ratio, 15/6) [7]. The patients may be
Fig. 2. A: Thymic Carcinoid -B: Right thyroid lobectomy -C: Post-operative Chest Film.
Fig. 3. Microscopic Appearance of TC Tumor; nests of uniform small round cells, with small round nuclei and pink cytoplasm, with no pleomorphism and no
necrosis, with rosette-like formation.
A.Y. Taha et al. / Journal of the Egyptian Society of Cardio-Thoracic Surgery xxx (2017) 1e4 3
Please cite this article in press as: Taha AY, et al., Retrosternal goiter and thymic carcinoid: A rare co-existence, Journal of the
Egyptian Society of Cardio-Thoracic Surgery (2017), https://doi.org/10.1016/j.jescts.2017.11.004
4. asymptomatic or have compression symptoms such as chest pain, dyspnea, cough and superior vena cava obstruction.
Cushing's syndrome may be seen in half the patients [7]. Large carcinoid tumor may cause flushing, cyanosis, and hyper-
tension ‘carcinoid syndrome’ due to secretion of serotonin [4]. Many TCs are small (<2 cm) and compose of epithelial cells
with small uniform nuclei and acidophilic or vacuolated cytoplasm [3]. They grow slowly and frequently invade the lung and
pericardium [5]. FNAC may be diagnostic. However, these tumors are usually diagnosed by surgical exploration or media-
stinoscopy [6]. Complete resection of the tumor remains the most important prognostic factor [8]. Despite extensive
resection, recurrence may occur years later [6].
TMC has morphological and behavioral characteristics similar to carcinoid [5]; Clague JE et al. had reported the case of a 21
year old man in whom multifocal bronchial carcinoid was diagnosed initially, but at necropsy metastatic TMC was found [9].
Ectopic thyroid tissue may be found in the thymus; Kesici et al. described a 3 Â 4 cm ectopic thyroid tissue in the thymus gland
in a 49-year old lady after total thyroidectomy [10]. Noteworthy, the presented patient has neither TMC nor ectopic thyroid.
4. Conclusions
Co-existence of RSG and the rare thymic carcinoid tumor is very rare. Surgery is thought to be curative in the present case.
Author contributions
1. Abdulsalam Y Taha: received and surgically managed the case together with Dr. Nezar A Almahfooz, reviewed the liter-
ature and wrote the manuscript.
2. Nezar A Almahfooz: joined Prof. Abdulsalam Y Taha in doing surgery, approved the manuscript.
3. Hassanain H Khudair did the histopathological exam and approved the manuscript.
References
[1] Sheng YR, Xi RC. Surgical approach and technique in retrosternal goiter: case report and review of the literature. Ann Med Surg 2016;5:90e2.
[2] Coskun A, Yildirim M, Erkan N. Substernal goiter when is a sternotomy required? Int Surg 2014;99:419e25. https://doi.org/10.9738/INTSURG-D-14-
00041.1.
[3] Anastasiadis K, Ratnatunga C, editors. The thymus gland: diagnosis and management. Berlin Heidelberg New York: Springer; 2007.
[4] Hughes JP, Ancalmo N, Leonard GL, et al. Carcinoid tumor of the thymus gland: report of a case. Thorax 1975;30:470e5.
[5] Rao U, Takita H. Carcinoid tumor of possible thymic origin: case report. Thorax 1977;32:771e6.
[6] Wang DY, Chang DB, Kuo SH, et al. Carcinoid tumors of the thymus. Thorax 1994;49:357e60.
[7] Ahn S, Lee JJ, Ha SY, et al. Clinicopathological analysis of 21 thymic neuroendocrine tumors. Korean J Pathol 2012;46:221e5. https://doi.org/10.4132/
KoreanJPathol.2012.46.3.221.
[8] Bushan K, Sharma S, Verma H. A review of thymic tumors. Indian J Surg Oncol 2013;4(2):112e6. https://doi.org/10.1007/s13193-013-0214-2.
[9] Clague JE, Pearson MG, Sharma A, et al. Medullary carcinoma of the thyroid presenting as multifocal bronchial carcinoid tumor. Thorax 1991;46:67e8.
[10] Kesici U, Koral O, Karyagar S, et al. Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter. UlusCerrahiDerg 2016;32:
67e70. https://doi.org/10.5152/UCD.2015.2916.
A.Y. Taha et al. / Journal of the Egyptian Society of Cardio-Thoracic Surgery xxx (2017) 1e44
Please cite this article in press as: Taha AY, et al., Retrosternal goiter and thymic carcinoid: A rare co-existence, Journal of the
Egyptian Society of Cardio-Thoracic Surgery (2017), https://doi.org/10.1016/j.jescts.2017.11.004