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Case Reports
. 2022 Jul 25:6:29.
doi: 10.21037/acr-22-23. eCollection 2022.

Incidental paratracheal lymph node lung adenocarcinoma in a patient with goiter: a case report

Hyunjee V Kwak  1 , Kian C Banks  1 , Diana S Hsu  1 , Peter M Debbaneh  2 , Kevin H Wang  2 , Jeffrey B Velotta  3
Affiliations
Case Reports

Incidental paratracheal lymph node lung adenocarcinoma in a patient with goiter: a case report

Hyunjee V Kwak et al. AME Case Rep. .

Abstract

Background: Paratracheal lymph nodes can be sites of metastasis for a variety of malignancies, but these metastases are treated differently depending on the tissue of origin. We describe a patient who underwent combined thoracoscopic and cervical resection of a multinodular goiter who was found to have incidental lung adenocarcinoma in an adjacent paratracheal lymph node despite having no pulmonary nodules.

Case description: A 62-year-old male with longstanding substernal multinodular goiter presented to his primary care doctor with continued growth of his goiter. After repeatedly declining surgery, he became amenable to resection and underwent right video-assisted thoracoscopic and cervical approaches. An incidentally found separate large right paratracheal lymph node was also discovered and completely resected. Final pathology of the thyroid mass revealed hyperplastic thyroid nodules consistent with a benign goiter. However, the separate right paratracheal lymph node revealed a thyroid transcription factor 1-positive (TTF-1) specimen concerning for lung adenocarcinoma in the absence of pulmonary nodules on imaging.

Conclusions: Noteworthy to this case is the minimally invasive thoracoscopic approach preventing the need for median sternotomy and preventing any increased morbidity for the patient's incidentally found TxN3M0 lung adenocarcinoma. The patient could have been spared resection of the lymph node given its pulmonary origin as the standard of care for stage IIIB non-small cell lung cancer is definitive chemoradiation and adjuvant immunotherapy.

Keywords: Substernal goiter; case report; lung adenocarcinoma; paratracheal metastasis; thoracoscopic surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-22-23/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Computed tomography imaging two months before resection. (A) Multinodular thyroid gland measuring 14.6×6.1×14.5 cm3. (B) Heterogeneous nodule (measuring 3.2×4.0×4.7 cm3) along the right paratracheal station initially thought to be related to the goiter.
Figure 2
Figure 2
Intraoperative thoracoscopic photographs. (A) Blue arrow marking goiter. Black arrow marking superior vena cava. Black star marking lymph node. Red arrow marking right internal mammary artery. Green arrow marking azygos vein. (B) Blue arrow marking goiter. Black arrow marking lymph node. Green circle marking azygos vein.
See this image and copyright information in PMC

Comment in

  • Surgical approach for substernal goiter.
    Okamoto K. Okamoto K. AME Case Rep. 2022 Oct 30;6:32. doi: 10.21037/acr-22-51. eCollection 2022. AME Case Rep. 2022. PMID: 36339909 Free PMC article. No abstract available.

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