ABSTRACT
Tracheal obstruction and superior vena cava (SVC) syndrome are rare complications of retrosternal goiter. These two conditions present a difficult diagnostic and therapeutic challenge. Malignancy is the most common cause of SVC syndrome. Determining whether SVC syndrome is due to a benign or malignant process is imperative before instituting treatment, but this determination may be difficult. We present a case of a patient presenting with upper airway obstruction and SVC syndrome with a large mediastinal mass. The mass was determined to be a multinodular goiter. The patient was managed by surgical removal of the goiter with complete resolution of symptoms. This case illustrates the need for careful preoperative evaluation and the importance of establishing a histologic diagnosis prior to initiating treatment for SVC syndrome.
Subject(s)
Airway Obstruction/etiology , Goiter, Nodular/complications , Goiter, Substernal/complications , Superior Vena Cava Syndrome/etiology , Tracheal Diseases/etiology , Female , Follow-Up Studies , Humans , Middle AgedABSTRACT
The treatment of patients with differentiated carcinoma of the thyroid is a controversial subject. This article discusses the authors' approach in the clinical practice. A description of the various types of papillary and follicular carcinoma is presented. Diagnostic tests, biologic behavior, and management are reviewed.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Papillary/surgery , Thyroid Neoplasms/surgery , Thyroidectomy/methods , Adenocarcinoma/diagnosis , Adolescent , Adult , Age Factors , Carcinoma, Papillary/diagnosis , Diagnosis, Differential , Female , Humans , Iodine Radioisotopes/administration & dosage , Lymphatic Metastasis , Male , Middle Aged , Neck Dissection/methods , Postoperative Care , Radiotherapy Dosage , Sex Factors , Thyroid Gland/pathology , Thyroid Gland/surgery , Thyroid Neoplasms/diagnosisABSTRACT
The benign lymphoepithelial lesion of the salivary glands has been labeled with multiple, confusing terms. We recommend the abandonment of the vague term of Mikulicz disease. The histopathologic findings of lymphoid infiltration, intraductal proliferation, epimyoepithelial islands, and acinar atrophy are presented. The relationship between this lesion and autoimmune diseases, including Sjögren syndrome, is noted. Difficulty of histopathologic differentiation between this lesion and malignant lymphoma can occur. The association of the benign lymphoepithelial lesion with the simultaneous presence or future development of lymphoma is discussed.