scholarly journals Retrosternal goitre and its management

2021 ◽  
Vol 4 (2) ◽  
pp. 38-45
Author(s):  
Saurabh Varshney
Keyword(s):  
Retrospective Study ◽  
Personal Experience ◽  
Average Rate ◽  
Surgical Removal ◽  
Surgical Morbidity ◽  
Thoracic Inlet ◽  
Retrosternal Goiter ◽  
Risk Of Malignancy ◽  
Cervical Approach ◽  
Final Histological Diagnosis

 Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Retrosternal goitre is defined as a goitre with a portion of its mass ≥ 50% located in the mediastinum. Surgical removal is the treatment of choice and, in most cases, the goitre can be removed via a cervical approach. Aim of this retrospective study was to analyse personal experience in the surgical management of retrosternal goitres, defining, in particular, the features requiring sternotomy.  Retrospective study, teaching hospital-based. Retrospective analysis of 687 thyroidectomies performed between 2008 and 2019. The 47 (6.84 %) patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment.  There were 47 patients (6.84 %) with RSG, [ 34 females (72.34%), 13 males (27.66%)] (mean age: 52 years, range: 34-76)], out of 687 thyroidectomies, in a 14 -year period. The most common presentation was neck swelling (68%), followed by respiratory symptoms (46.8%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 43 (91.5 %) of the cases, only 4 cases (8.5 %) required sternotomy, (residual thyroid in mediastinum after cervical approach in one case and due to very large thyroid reaching the main bronchial bifurcation in the other three). The final histological diagnosis revealed malignancy in 8.5 % of the thyroid specimens. There was no mortality and minor complications occurred in nine patients (19.1%). The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy. Surgical removal of a retrosternal goitre is a challenging procedure; it can be performed safely, in most cases, via a cervical approach, with a complication rate slightly higher than the average rate for cervical goitre thyroidectomy, especially concerning hypoparathyroidism and post-operative bleeding. The most significant criteria for selecting patients requiring sternotomy are computed tomography features, in particular the presence of an ectopic goitre, the extent of the goitre to or below the tracheae carina. If retrosternal goitre thyroidectomy is performed by a skilled surgical team, familiar with its unique pitfalls, the assistance of a thoracic surgeon may be required only in a few selected cases

scholarly journals Cervical approach for retro-sternal goiter reaching the arch of aorta

2021 ◽  
Author(s):  
Mohamed Tarek Hafez ◽  
Mostafa M. Abdelmaksoud ◽  
Shadi Awny ◽  
Alaa Jamjoom ◽  
Abdullah Mashat ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Thyroid Tissue ◽  
Median Sternotomy ◽  
Thoracic Inlet ◽  
Cervical Incision ◽  
Academic Medical ◽  
Retrosternal Goiter ◽  
Cervical Approach

Abstract Background: Although the retrosternal goiters are characterized by the protrusion of at least 50% of the thyroid tissue below the level of the thoracic inlet, their definite definition is still controversial. Total thyroidectomy for retrosternal goiter has a great challenge and mostly requires an experienced thyroid surgeon. Excision could be possible through a cervical incision in most cases, though Sternotomy remains an option. Patients and Methods: We report fourteen patients who presented to our academic medical center between 2016 and 2019 with large thyroid goiters and retrosternal extension proven by computerized tomography scan of the neck, presented in both Mansoura University Oncology Center, Egypt and East Jeddah Hospital, Saudi Arabia from 2016 to 2019. Results: Fourteen cases with retrosternal goiter been undergone total thyroidectomy through a cervical incision without the need for median sternotomy, although the thoracic surgeon was stand-by in three cases. Six patients were found to have a malignancy in the post-operative histopathological assessment.CONCLUSION: Surgical procedures for most all retrosternal goiters can be completed successfully using a cervical approach; however, a sternotomy is required in a small number of such patients.

scholarly journals Case Report: Modified Thoracoscopic-Assisted Cervical Resection for Retrosternal Goiter

2021 ◽  
Vol 8 ◽  
Author(s):  
Cédric Nesti ◽  
Benny Wohlfarth ◽  
Yves M. Borbély ◽  
Reto M. Kaderli
Keyword(s):  
Endocrine Surgery ◽  
Thyroid Lobe ◽  
Thoracic Inlet ◽  
Thoracoscopic Approach ◽  
Mediastinal Dissection ◽  
Retrosternal Goiter ◽  
Cervical Approach ◽  
Posterior Mediastinal ◽  
The Right ◽  
Mediastinal Extension

Introduction: The treatment of choice for retrosternal goiters (RSG) is surgical resection to relieve symptoms and rule out malignancy. Although the majority of RSG can be removed by a cervical approach only, an extracervical approach (e.g., sternotomy, thoracotomy or thoracoscopy) may be required. Herein, we describe a refined thoracoscopic-assisted cervical two-team RSG resection without thoracoscopic mediastinal dissection.Technique: A 57-year-old man presented with a large RSG with posterior mediastinal extension (PME) and extensive peritumoral vascularization. Due to its extension below the aortic arch and its small connection with the right thyroid lobe, a combined cervical and thoracoscopic approach was intended. The endocrine surgery unit performed the cervical mobilization of the right thyroid lobe, while the thoracic surgery unit gently pushed the mediastinal tumor through the thoracic inlet without performing mediastinal dissection. This allowed a safe visualization of the inserting vessels by the endocrine surgery team at the neck, followed by a stepwise division of the vessels and resection of the retrosternal nodule through the cervical access.Comment: The described approach is indicated for RSG with posterior mediastinal extension, anteroposterior dimension smaller than the thoracic inlet and inaccessibility from a cervical approach only. This minimally invasive approach is associated with a faster recovery, decreased morbidity and postoperative pain, shorter hospital stay and better cosmetic results.

Spontaneous subcapsular and perirenal haemorrhage with retroperitoneal haematoma in a patient with ovarian melanoma metastases

2021 ◽  
Vol 14 (1) ◽  
pp. e238983
Author(s):  
Stefania Malmusi ◽  
Mirvana Airoud ◽  
Manuela Bellafronte ◽  
Maria Cristina Galassi
Keyword(s):  
Transvaginal Ultrasound ◽  
Flank Region ◽  
Signs And Symptoms ◽  
Surgical Removal ◽  
Retroperitoneal Haematoma ◽  
Amelanotic Malignant Melanoma ◽  
Contrast Enhanced Ct ◽  
Video Laparoscopy ◽  
Final Histological Diagnosis ◽  
Kidney Metastasis

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.

scholarly journals Thymomas in Domestic Animals

1976 ◽  
Vol 13 (5) ◽  
pp. 353-364 ◽  
Author(s):  
G. A. Parker ◽  
H. W. Casey
Keyword(s):  
Retrospective Study ◽  
Domestic Animals ◽  
Anterior Mediastinum ◽  
Mixed Population ◽  
Capsular Invasion ◽  
Thoracic Inlet ◽  
Metastatic Lesions ◽  
Clear Cytoplasm ◽  
Lymphocyte Populations

A retrospective study of 15 thymomas in domestic animals showed four animals had antemortem signs of dyspnea and grossly visible lumps in the thoracic inlet. The neoplasms were single, multilobulated, encapsulated masses in the anterior mediastinum or thoracic inlet. Cells with clear cytoplasm comprised the bulk of two canine thymomas, whereas the remaining neoplasms had a mixed population of ovoid and spindle-shaped cells. There were lymphocyte populations of varying density in all thymomas. Three thymomas contained structures similar to hyalinized cells and Hassall's corpuscles of normal thymus. Metastatic lesions were not seen but there were implantations on the pericardium in one cat. There was capsular invasion in the ovine thymomas.

Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Kyle Lindsey McCormick ◽  
Nikita Alexiades ◽  
Paul C McCormick
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Surgical Removal ◽  
Intramedullary Spinal Cord ◽  
Dural Closure ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Microsurgical Resection

Abstract This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

scholarly journals Management of Adnexal Mass During Cesarean Section

2018 ◽  
Vol 12 (2) ◽  
pp. 48-51
Author(s):  
Monica Gurung ◽  
Gehanath Baral
Keyword(s):  
Retrospective Study ◽  
Cesarean Section ◽  
Adnexal Mass ◽  
Cystic Teratoma ◽  
Mature Cystic Teratoma ◽  
Surgical Removal ◽  
Cesarean Sections ◽  
Operation Theatre ◽  
Adnexal Masses ◽  
The Masses

Aims: To find out the prevalence of adnexal mass during Cesarean Section, its management and histological profile.Methods: This is a retrospective study conducted for 4 years from 2013 to 2017 at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. There were 18993 Cesarean Sections out of 72263 total births screened for adnexal masses from operation theatre register and record section.Results: The incidence of adnexal mass during cesarean section was 0.31% (58 out of 18993). Among them 15.52 % diagnosed antenatally and 84.48 % were incidentally diagnosed during cesarean section. Among 58 cases, 6 (10%) were bilateral amounting to 64 adnexal masses among which 35 (54.69%) masses had cystectomy, 20 (31.25%) masses had oophorectomy, 6 (9.37%) had aspiration/ drilling done and 3(4.69 %) masses were left without intervention. Among those cases only 48 histopathological reports were available. All the masses were benign and the most common was benign mature cystic teratoma (34; 69.38 %) and the least common was fibroma (1; 2.04%).Conclusions:  Adnexal masses during cesarean section should undergo surgical removal.

Prevalence of Appendiceal Lesions in Appendicectomies Performed During Surgery for Mucinous Ovarian Tumors: A Retrospective Study

2016 ◽  
Vol 26 (8) ◽  
pp. 1386-1389 ◽  
Author(s):  
Luiza Moore ◽  
Ketan Gajjar ◽  
Mercedes Jimenez-Linan ◽  
Robin Crawford
Keyword(s):  
Retrospective Study ◽  
Ovarian Neoplasms ◽  
Final Diagnosis ◽  
Ovarian Neoplasm ◽  
Ovarian Tumors ◽  
Surgical Removal ◽  
Mucinous Tumor ◽  
Single Institution ◽  
Metastatic Tumors ◽  
Mucinous Ovarian Tumors

ObjectivesThe aim of this study was to assess the frequency of appendiceal pathology in women undergoing surgery for mucinous ovarian neoplasm and to evaluate whether appendicectomy is necessary.MethodsThis single-institution retrospective study reviewed prevalence of appendiceal lesions in all patients operated on at our institution from 2002 to 2013 with the final diagnosis of mucinous tumor of the ovary. Clinicopathological data were analyzed.ResultsOne hundred twenty-three cases were identified. These included 45 (37%) benign mucinous ovarian neoplasms, 63 (51%) borderline, and 11 (9%) invasive mucinous ovarian tumors. In addition, 4 (3%) cases of metastatic tumors to the ovary were also identified. Appendiceal pathology was found in association with all types of mucinous ovarian tumors (benign, borderline, and malignant). In 24% of cases, appendix was macroscopically abnormal at the time of the surgery, prompting the surgical removal. Regardless of the gross findings, microscopic abnormality in the appendix was seen in 24% of all cases. The prevalence of significant occult microscopic appendiceal pathology, that is, when the appendix was grossly normal, was 6%.ConclusionsGiven the prevalence of coexisting appendiceal pathology found in this study and the reported low rates of complications associated with the procedure, an appendicectomy is recommended in the management of all mucinous ovarian neoplasms.

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