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April 11, 2019

Follicular Thyroid Carcinoma Presenting as a Manubrium Mass

Author Affiliations
  • 1Department of Surgery, Maimonides Medical Center, Brooklyn, New York
  • 2Department of Otolaryngology, Maimonides Medical Center, Brooklyn, New York
  • 3Division of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York
  • 4Department of Pathology, Maimonides Medical Center, Brooklyn, New York
JAMA Otolaryngol Head Neck Surg. 2019;145(6):581-583. doi:10.1001/jamaoto.2019.0327

We describe a case of an elderly man who presented with swelling over the manubrium 12 years after substernal left hemithyroidectomy for benign goiter. Subsequent manubrium resection showed follicular cell thyroid carcinoma. Revision of the previously resected goiter specimen revealed no malignant tumor. To our knowledge, this is the first case of follicular cancer presenting in a prior sternotomy following resection of a benign goiter.

A man in his 70s presented with swelling of the manubrium 12 years after resection of a large left substernal thyroid lobe through a midline sternotomy approach. The swelling was slightly tender and had increased in size markedly over the month prior to presentation. Computed tomographic (CT) images showed a lytic lesion replacing the manubrium measuring 2.7 × 4.4 × 5.8 cm and residual right goiter (Figure 1). Image guidance was used to perform fine-needle aspiration, which revealed follicular thyroid cells in the goiter and the manubrial lesion. The patient underwent resection of the manubrium, clavicular heads and adjacent sternoclavicular joints, bilateral rib 1 to 3 heads, and completion thyroidectomy. Reconstruction was performed with methyl methacrylate, prolene mesh, and pectoralis major muscle flaps. Recovery was uneventful. Pathologic diagnosis of the resected specimen determined that this was a case of follicular carcinoma invading the manubrium, based primarily on the gross finding of replacement of the marrow-containing spaces of the manubrium by thyroid cells (Figure 2).

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