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.
本研究旨在分析异位纵隔甲状腺（EMT）的管理，重点关注与EMT相关的恶性肿瘤及病理报告、临床表现、影像学特征、内分泌谱、与颈部（正位）甲状腺的连接组织、活检或细针穿刺（FNA）结果、手术技术以及术后结局相关的非恶性发现。这是一项基于PubMed数据库的全面综述，检索了自建库至2024年3月所有包含关键词“异位甲状腺”和“纵隔”的免费英文全文原创论文。共纳入89篇明确提供EMT数据的原创文章。我们将其分为四个主要组别：（I）研究/病例系列（n = 10；N = 36例EMT患者）；（II）恶性EMT（N = 22例；除1例新生儿为EMT内未成熟畸胎瘤外，其余均为成人；平均年龄62.94岁；范围：34至90岁；男女比例为0.9）。成人组织学分析显示：乳头状癌（N = 11/21）；乳头状癌滤泡亚型（N = 2/21）；Hürthle细胞甲状腺滤泡恶性肿瘤（N = 1/21）；低分化癌（N = 1/21）；未分化癌（N = 2/21）；髓样癌（N = 1/21）；淋巴瘤（N = 2/21）；以及黏膜相关淋巴组织（MALT）淋巴瘤（N = 1/21）；（III）无甲状腺异常的良性EMT（N = 37例；平均年龄56.32岁；范围：30至80岁；男女比例为1.8）；（IV）伴有甲状腺异常的良性EMT（N = 23例；男女比例为5.6；平均年龄52.1岁）。该组涉及临床/亚临床甲状腺功能减退（医源性、先天性、甲状腺炎诱发及EMT切除后暂时性类型）、甲状腺毒症（包括EMT自主活动抑制正位腺体）、自身免疫性甲状腺炎/格雷夫斯病、正位甲状腺或既往甲状腺切除术（EMT发现前）的结节/多结节性甲状腺肿及癌症。我们提出了一个包含10个项目的流程图，可能有助于在EMT领域进行导航。总之，通过这项针对EMT的聚焦样本分析（据我们所知，此为同类研究中规模最大者），EMT的临床怀疑指数仍然较低；癌症报告率高于既往数据（18.8%）；10-14%的EMT为影像学偶然发现；手术总体预后良好。广泛的影像学检查、活检/FNA及外科手术是这一复杂个体化管理的一部分。
肿瘤(癌症)患者之家