Multinodular goiter of unusual shape and location.

A50-year-old man presented to us in January 2005 with a pre-sternal mass of suspected thyroid origin. At physical examination (Fig. 1), the patient had an elongated neck mass, which was about 10 cm in length, descending subcutaneously up to the mid region of the sternum. The skin surrounding the distal portion of the mass was thin and had a red-brown appearance due to venous congestion. The patient stated that the mass had been enlarging for at least 5 years and was accompanied by mild local discomfort. At neck ultrasound, the right lobe was of normal size (111350mm) with normoechoic pattern. The pre-sternal mass had originated from an enlarged left thyroid lobe. The maximal diameter of the left lobe including the pre-sternal mass was 15 cm, and ultrasound feature consisted of multiple nodules with micro- and macrocalcifications, ranging between 2 and 3 cm in diameter of solid and cystic appearance. The trachea was compressed and dislocated toward the right side. No lymph node enlargement was present. A computed tomography scan of the neck, mediastinum, and thorax confirmed the features noted at ultrasound examination, excluding the presence of intrathoracic extension or pulmonary lesions. The material recovered by fine needle aspiration of four prevalent nodules showed the presence of hemorrhagic contamination, colloids, macrophages, and groups of epithelial cells with no atypias. Thyroid function tests were normal with negative anti-thyroid antibodies, and thyroid-stimulating hormone was suppressed due to levothyroxine therapy that was instituted 2 years before by his general practitioner. No other abnormality was noted on physical examination and biochemical tests. The patient was submitted to total thyroidectomy and eradication of the pre-sternal mass through cervical and pre-sternal incisions. The surgical specimen is visible in Figure 2. The histological examination revealed the presence of multinodular goiter withmacro and micro follicles, and chronic inflammationwith areas of sclerosis and calcifications. The presternal mass was mainly composed of colloid fluid. The postsurgical outcome was uneventful and the patient was discharged. Now he is receiving levothyroxine replacement therapy.