PMC6205148_01
Goiter (black arrows) and paraganglioma (white arrows) in a computerized tomography angiography (CTA). A) Axial view demonstrates displacement of the airway to the right, B) Three-dimensional reconstruction, C) Coronal view.
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A neck Computed tomography angiography (CTA) demonstrated a carotid body tumor (3.8 cm x 2.5 cm x 3.3 cm) classified as Shamblin II and an intrathoracic multinodular thyroid gland with a right lobe extension of 11.9 cm x 9.7 cm and the left lobe of 25.2 cm x 21.3 cm with caudal retrosternal growth and evidence of slightly trachea deviation (Fig. 1).
A) Carotid body tumor piece B) Extended Kocher incision (white arrow shows the carotid bifurcation).
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A total thyroidectomy was performed with a transverse lower neck incision (Kocher incision), posteriorly, CBT was resected by an extension of the previous Kocher incision to the anterior border of the sternocleidomastoid muscle using the retrocarotid reported previously in our group as an effective technique, also two surrounding lymph nodes were resected to rule out malignancy (Fig. 2).
A) Thyroid follicles filled with colloids with variability in their size. (B-C glomus), B) Tumor nests separated by a fibrovascular septum (Zellballen), C) Eosinophilic cells with indistinct edges, round nucleus and chromatin with "salt and pepper" appearance.
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The pathology report demonstrated a paraganglioma with negative lymph nodes invasion and a multinodular goiter (Fig. 3).