Isolated Mediastinal Goiter (Substernal Goiter Type III)

  • Although rare, thyroid glands within the mediastinum may exist without connection to the normal cervical orthotopic gland:
    • Such purely isolated mediastinal goiters represent only 0.2% to 3% of all goiters requiring surgical treatment
  • Such lesions are important to recognize because unlike all other types of substernal goiters:
    • Blood supply of the isolated mediastinal goiter may be through purely mediastinal arteries (including the aorta, subclavian, internal mammary, thyrocervical trunk, and innominate) and veins:
      • This is extremely important in planning their surgical resection
  • This entity is best termed isolated mediastinal goiter:
    • Other terms have been used, including aberrant mediastinal and ectopic mediastinal goiter
  • Three explanations exist for isolated mediastinal goiter:
    • Embryologic fragmentation of the thyroid anlagen with hyperdescent, likely associated with cardiac and great vessel descent, may explain some cases of isolated mediastinal goiter
    • Alternatively, isolated mediastinal goiter may form as an exophytic nodule, through progressive attenuation of the nodule-thyroid stalk
    • Finally, the isolated mediastinal goiter may form as a parasitic nodule representing a thyroid tissue fragment implant in the upper mediastinum from past goiter surgery:
      • I have seen such implants also within the peri-thyroid area and posterior to the upper cervical segment of the carotid artery

#Arrangoiz #ThyroidSurgeon #ThyroidExpert #HeadandNeckSurgeon #CancerSurgeon #HeadandNeckSurgeon #MultinodularGoiter #SubsternalGoiter #CASO #CenterforAdvancedSurgicalOncology

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