[Cancer of the thyroid gland with mediastinal extension]

Thyroid carcinomas with upper mediastinal invasion are rare: 24 out of 1,204 thyroid carcinomas operated in the Cancer Center Hospital of Shanghai (2%). For this reason, the report of our experience seems useful.

The 24 patients (13 male and 11 female) had a mean age of 45 years. Ten patients presented symtoms, nine had a palpable cervical mass and in five, the lesion was discovered by an upper mediastinal scan. The operation was performed through an upper partiel sternotomy (n = 12) associated with resection of the internal part of the clavicle (n = 8) and of the first two costal cartilages (n = 4). Tumoral removal was complete in 15 patients and incomplete in nine.

There were no peroperative and postoperative deaths. During the procedure, the "brachio-cephalique" vein was injured and sutured in three patients. During the postoperative period, a pneumothorax was observed in three patients and a mediastinal infection in two. When the tumor removal was incomplete (n = 9), postoperative radiotherapy was performed. The only patients with papillary thyroid carcinoma (n = 16) have survived more than 5 years. For the entire group of patients, the 5-year and 10-year survival rate was respectively 65% and 47%. After incomplete tumoral resection followed by radiotherapy, two patients survived with a 28-year follow-up.

This experience demonstrates that patients may survive beyond 10 years, even after incomplete resection of thyroid carcinoma with upper mediastinal invasion, if the carcinoma is differentiated.