Surgical management of intrathoracic goiters: 20 years experience

Background: Surgery is necessary for intrathoracic goiters (ITG) even in asymptomatic forms considering the risks of compression and malignancy. The major problem is the adequate approach.  Intrathoracic goiter’s removal can be performed via a cervical approach, whereas sternotomy might be required intraoperatively in some cases.Methods: A retrospective analysis of twenty years on 122 cases of intrathoracic goiters in a referral centre for thoracic surgery was carried out.  We included secondary substernal goiters and ectopic thoracic goiters.Our aim was to define the specifities of this surgery and its outcomes. Postoperative data were examined as well as morbidity and mortality factors.Results: The most common symptoms included dyspnea, cough and dysphagia. Whereas Twenty-two patients were asymptomatic. One hundred sixteen patients underwent a successful transcervical incision without thoracic approach. Six cases of primary goiters were noted, of whom 3 were extracted via a cervical approach. Two cases showed unilateral recurrent nerve paralysis and two cases a hypoparathyroidism.Conclusions: Surgical management of intrathoracic goiter was correlated with low morbidity and mortality The cervical approach was performed in the vast majority of cases without an extra cervical procedure.  Intrathoracic approaches were restricted to some selected indications.

Posterior mediastinal angiomyxolipoma with spinal canal extension

Angiomyxolipoma is a benign tumor considered as a variant of lipoma and that occurs mainly in the subcutis. The mediastinal location hasn't been previously reported. To describe the radiological features of this tumor in its posterior mediastinal location and to confront them to the pathological features. We report the case of a 49-year-old woman who was admitted for chest wall pain and neurologic disturbance of her two lower limbs. The chest X-ray showed a posterior mediastinal opacity. On CT examination, this mass contained some small areas of fat and enhanced intensily. Microscopic examination of the excised mass confirmed the diagnosis of posterior mediastinal angiomyxolipoma. Mediastinal location of angiomyxolipoma hasn't been previously reported. Clinicians and radiologists should be aware that this diagnosis should be suggested, among others, when there is a posterior mediastinal mass that contains fat and that intensely enhances with a possible spinal cord extension