scholarly journals Primary Intrathoracic Goiter

2009 ◽  
Vol 1 (1) ◽  
pp. 43-46
Author(s):  
Dorin T Colibaseanu ◽  
Jon A van Heerden ◽  
David R Farley ◽  
Stephen D Cassivi
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Gland ◽  
Surgical Resection ◽  
Mediastinal Mass ◽  
Treatment Options ◽  
Radiographic Imaging ◽  
Intrathoracic Goiter ◽  
Transcervical Approach ◽  
Substernal Goiter ◽  
Mediastinal Goiter

ABSTRACT The differential diagnosis of a middle mediastinal mass is fairly broad. Though relatively rare, the diagnosis of primary intrathoracic goiter is a clinically important consideration that should not be overlooked. The nature of this clinical entity and its diagnostic implications are discussed. Relevant radiographic imaging is evaluated demonstrating the key findings. Indications for intervening and treatment options are reviewed. Specifically, the presence of a growing substernal goiter in an otherwise fit patient is generally an indication for surgical resection. The nature of a primary intrathoracic goiter usually obviates the more common transcervical approach since by definition the mediastinal goiter is discontinuous with the cervical thyroid gland. Other transthoracic approaches are therefore necessary.

scholarly journals Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
William Yoon ◽  
Kari Paulson ◽  
Paul Mazzara ◽  
Sweety Nagori ◽  
Mohammed Barawi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Resection ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Preoperative Imaging ◽  
Mesenchymal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Submucosal Mass ◽  
Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

Management of Substernal and Intrathoracic Goiters

1986 ◽  
Vol 94 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Hyun T. Cho ◽  
Jason P. Cohen ◽  
Max L. Som
Keyword(s):  
Preoperative Evaluation ◽  
Surgical Removal ◽  
Team Approach ◽  
Vascular Compression ◽  
Intrathoracic Goiter ◽  
Transcervical Approach ◽  
Respiratory Embarrassment ◽  
Selection Of Patients ◽  
Mediastinal Goiter ◽  
Selection Of

Goiters that descend into the mediastinum can cause respiratory embarrassment, dysphagia, vascular compression, vocal cord paralysis, and sudden death. Although many such goiters remain clinically silent, their ability to produce sudden and unpredictable respiratory distress is well known. The condition was not considered uncommon in the first half of the twentieth century; some authors reported series of hundreds of thyroidectomies for Intrathoracic goiter. Though seen less frequently today, the only effective treatment for mediastinal goiter is surgical removal. We report our experience with the management of 70 consecutive patients with substernal or intrathoracic goiters. The clinical presentation, preoperative evaluation, operative technique, and results and complications of therapy are discussed. Consideration is also given to the pathogenesis of Intrathoracic extension. The transcervical approach for resection is emphasized—even goiters extending to the aortic arch were safely removed without requiring sternotomy. A multidlsciplinary team approach, including the surgeon, anesthesiologist, and endocrinologist, is essential. Because of more conservative trends in the selection of patients for thyroidectomy, the Incidence of mediastinal goiter may be increasing.

scholarly journals Co-Clinical Trials: An Innovative Drug Development Platform for Cholangiocarcinoma

2021 ◽  
Vol 14 (1) ◽  
pp. 51
Author(s):  
Brinda Balasubramanian ◽  
Simran Venkatraman ◽  
Kyaw Zwar Myint ◽  
Tavan Janvilisri ◽  
Kanokpan Wongprasert ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Targeted Therapy ◽  
Drug Development ◽  
Surgical Resection ◽  
Treatment Options ◽  
Standard Of Care ◽  
Time Data ◽  
Current Standard ◽  
Innovative Drug ◽  
Curative Intent

Cholangiocarcinoma (CCA), a group of malignancies that originate from the biliary tract, is associated with a high mortality rate and a concerning increase in worldwide incidence. In Thailand, where the incidence of CCA is the highest, the socioeconomic burden is severe. Yet, treatment options are limited, with surgical resection being the only form of treatment with curative intent. The current standard-of-care remains adjuvant and palliative chemotherapy which is ineffective in most patients. The overall survival rate is dismal, even after surgical resection and the tumor heterogeneity further complicates treatment. Together, this makes CCA a significant burden in Southeast Asia. For effective management of CCA, treatment must be tailored to each patient, individually, for which an assortment of targeted therapies must be available. Despite the increasing numbers of clinical studies in CCA, targeted therapy drugs rarely get approved for clinical use. In this review, we discuss the shortcomings of the conventional clinical trial process and propose the implementation of a novel concept, co-clinical trials to expedite drug development for CCA patients. In co-clinical trials, the preclinical studies and clinical trials are conducted simultaneously, thus enabling real-time data integration to accurately stratify and customize treatment for patients, individually. Hence, co-clinical trials are expected to improve the outcomes of clinical trials and consequently, encourage the approval of targeted therapy drugs. The increased availability of targeted therapy drugs for treatment is expected to facilitate the application of precision medicine in CCA.

Substernal Goiter with Carinal Involvement Presenting as Mediastinal Mass

2020 ◽  
Vol 56 (5) ◽  
pp. 322
Author(s):  
Vahit Mutlu ◽  
Yener Aydın ◽  
Hayri Ogul
Keyword(s):  
Mediastinal Mass ◽  
Substernal Goiter

scholarly journals Appendiceal intussusception from endometriosis: endoscopic and laparoscopic approach

2017 ◽  
Vol 99 (1) ◽  
pp. e1-e2
Author(s):  
TJ Birriel ◽  
E Smith ◽  
D Eyvazzadeh
Keyword(s):  
Differential Diagnosis ◽  
Treatment Options ◽  
Gastrointestinal Symptoms ◽  
Laparoscopic Approach ◽  
Time Of Surgery ◽  
Appendiceal Intussusception ◽  
Rare Diagnosis

Appendiceal intussusception is an rare diagnosis that may be found on imaging or at the time of surgery, as seen in this case of a 33-year-old female presenting with gastrointestinal symptoms. Images are presented with differential diagnosis as well as treatment options.

Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S74-S82 ◽  
Author(s):  
R. Webster Crowley ◽  
Andrew F. Ducruet ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Endovascular Treatment ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Brain Arteriovenous Malformations ◽  
Short Period ◽  
Cerebral Avms ◽  
Brain Avms ◽  
The Brain ◽  
The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

scholarly journals Mediastinal Thyroid Carcinoma and Graves’ Disease: A Rare Presentation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sara Lomelino Pinheiro ◽  
Inês Damásio ◽  
Ana Figueiredo ◽  
Tiago Nunes da Silva ◽  
Valeriano Leite
Keyword(s):  
Thyroid Gland ◽  
Thyroid Carcinoma ◽  
Mediastinal Mass ◽  
Kinase Inhibitor ◽  
Palliative Radiotherapy ◽  
Endobronchial Ultrasound ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Rare Presentation ◽  
The Right

Background. Mediastinal thyroid carcinoma is extremely rare, with few cases reported in the literature. Case Report. A 73-year-old man presented with weight loss for 6 months. Imaging by computed tomography (CT) documented a large mediastinal mass below the thyroid gland and pulmonary metastases. Neck ultrasound found two spongiform nodules in the right thyroid lobe, and fine-needle aspiration citology (FNAC) of these nodules revealed they are benign. Endobronchial ultrasound-guided needle biopsy of the mediastinal mass was compatible with papillary thyroid cancer. A few weeks later, the patient developed overt hyperthyroidism due to Graves’ disease, which was treated with antithyroid drugs. 99mPertechnetate scintigraphy showed increased diffuse uptake in the thyroid parenchyma but the absence of uptake in the paratracheal mass and in the lung nodules. The patient was not considered eligible for surgical intervention or therapy with tyrosine kinase inhibitor due to tracheal and mediastinal vessel invasion and was treated with palliative radiotherapy. Two months later, restaging PET-FDG showed an intense uptake in the right lobe of the thyroid gland, lymph nodes, lungs, bone, muscle, myocardial, kidney, and adrenal gland. Conclusion. In this case, thyroid carcinoma presented as a mediastinal mass with concurrent hyperthyroidism due to Graves’ disease. Although uncommon, the clinicians should be aware of these situations. Obtaining a prompt histological examination of an intrathoracic mass is crucial to ensure an early diagnosis and treatment.

scholarly journals Obturator Prosthesis Rehabilitation after Maxillectomy: Functional and Aesthetical Analysis in 25 Patients

2021 ◽  
Vol 18 (23) ◽  
pp. 12524
Author(s):  
Massimo Corsalini ◽  
Giuseppe Barile ◽  
Santo Catapano ◽  
Annamaria Ciocia ◽  
Assunta Casorelli ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Classification System ◽  
Subjective Evaluation ◽  
Treatment Options ◽  
Chewing Gum ◽  
Common Complication ◽  
Aesthetic Appearance ◽  
Number Of Patients ◽  
Obturator Prosthesis

The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery.

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