关键词: VATS biopsy dyspnea ectopic fine needle aspiration malignancy mediastinum thoracic surgery thyroid cancer thyroidectomy

来  源:   DOI:10.3390/cancers16101868   PDF(Pubmed)

Abstract:
We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords \"ectopic thyroid\" and \"mediastinum\" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves\'s disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.
摘要:
我们旨在分析异位纵隔甲状腺(EMT)与EMT相关的癌症和与病理报告相关的非恶性发现的管理,临床表现,成像特征,内分泌概况,结缔组织宫颈(异位)甲状腺,活检或细针穿刺(FNA)结果,手术技术和术后结果。这是一个全面的审查,基于修订任何类型的免费PubMed可访问的英语,从开始到2024年3月,包括关键词“异位甲状腺”和“纵隔”的全长原创论文。我们包括89篇指定EMT数据的原始文章。我们将它们分为四个主要组:(I)研究/病例系列(n=10;N=36例EMT患者);(II)恶性EMT(N=22例受试者;除了一名EMT中未成熟畸胎瘤的新生儿,仅报告了成人;平均年龄为62.94岁;范围:34至90岁;男女比例为0.9)。成人的组织学分析显示如下:甲状腺乳头状(N=11/21);乳头状型滤泡变异(N=2/21);Hürthle细胞甲状腺滤泡性恶性肿瘤(N=1/21);低分化(N=1/21);间变性(N=2/21);髓样(N=1/21);男性EMpho21岁的平均比例为男性(N=2/21)该小组涉及临床/亚临床甲状腺功能减退症(医源性,先天性,引起的甲状腺炎,EMT切除后的暂时性类型);甲状腺毒症(包括抑制异位腺的EMT的自主活动);自身免疫性甲状腺炎/Graves病;异位甲状腺或甲状腺切除术中的结节/多结节性甲状腺肿和癌症(在EMT检测之前)。我们提出了一个10项算法,可以帮助浏览EMT域。最后,在这个集中样本分析中(据我们所知,同类中最大的)EMT,EMT临床怀疑指数仍然很低;据报道,癌症发生率高于先前的数据(18.8%),在10-14%的EMT中发现了基于事件图像的检测;手术提供了总体良好的结果。各种各样的图像,活检/FNA和外科手术是复杂的个性化管理的一部分。
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