title: Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma.
abstract: Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.
authors.affiliation: Department of General Surgery, Universiti Teknologi MARA, Selangor, Malaysia.
authors.forename: Zainal
authors.initials: Z
authors.lastname: Adwin
authors.affiliation: Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Ayub
authors.initials: A
authors.lastname: Nur
authors.affiliation: Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Shahrun
authors.initials: S
authors.lastname: Suhaimi
authors.affiliation: Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Ramzisham
authors.initials: R
authors.lastname: Rahman
keywords: Follicular Thyroid Carcinoma; Free Tissue Flaps; Mediastinum; Thyroid Cancer
references.citation: J Surg Oncol. 1995 Dec;60(4):282-5
references.pmid: 8551740
references.citation: Cancer. 1998 Dec 15;83(12):2638-48
references.pmid: 9874472
references.citation: Curr Probl Surg. 2008 Mar;45(3):156-250
references.pmid: 18346477
references.citation: World J Surg. 1988 Oct;12(5):623-9
references.pmid: 3245216
references.citation: Surg Today. 2012 Sep;42(9):895-8
references.pmid: 22576227
references.citation: Arch Surg. 2003 Dec;138(12):1362-6
references.pmid: 14662540
references.citation: J Clin Endocrinol Metab. 1999 Nov;84(11):4043-9
references.pmid: 10566647
references.citation: Int J Surg Case Rep. 2013;4(2):156-9
references.pmid: 23276755
references.citation: J Surg Oncol. 2003 Jan;82(1):10-8
references.pmid: 12501164