2014 JOURNAL OF MEDICAL RESEARCHVol.1 No.1Vol.1Jul.–Dec. 2014ERA’S JOURNAL OF MEDICAL RESEARCHJul.–Dec. No.1ERA’S
FINE NEEDlE ASPIRATIoN CYToloGY oF AN UNUSUAl
Jain M1, Kapoor S2, Professor1, Senior Consultant2, Department of Pathology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Address for Correspondence
We describe a case of long standing goiter with retropharyngeal space mass. FNAC established the Dr. Manoj Jain,
diagnosis of retropharyngeal mass as extension of the goiter into the retropharyngeal space. Long Professor, Deptt. of Pathology
standing large goiter usually grows downwards through the thoracic inlet. This case highlights the Sanjay Gandhi Postgraduate
nstitute of Medical Sciences,
rare possibility of extension of the goiter into the retropharyngeal space and presenting clinically ILucknow, India.
as retropharyngeal mass.E–mail: email@example.com
Key Words: Retropharyngeal mass, FNAC,GoiterP
Retropharyngeal masses usually occur as a result of
infections spreading into the retropharyngeal space either
from the lateral pharyngeal space or through the lymphatics
from cephalad sites like posterior sinuses, adenoids or
the nasopharynx into the retropharyngeal lymph nodes.
Neoplastic lesions can also present as masses of which
sqaumous cell carcinoma is the commonest. Occasionally,
however a long standing goiter can grow upwards into the
retropharyngeal space. Retrovisceral or retropharyngeal
space in the neck extends from the base of the skull to down
to the level to the sixth cervical and the fourth thoracic
vertebra the alar fascia fuses with visceral fascia, behind the
pharynx is known as the retropharyngeal space and behind
the esophagus it is the retroesophageal space.1 We present
one such case of a long standing goiter with retropharyngeal Figure 2 : FNAC smear form retropharyngeal mass showing
mass extending into the oropharynx.follicular epithelial cells and thin collond.
A 53 year old man with asymptomatic enlargement of the
thyroid for the last thirty years presented to the ENT OPD
with onset of difficulty in swallowing and coughs for the last
four months gradually increasing in intensity. Intraoral mirror
examination revealed a large oropharyngeal submucosal mass
(Fig 1). The patient was referred for a fine needle aspiration of
the oropharyngeal mass to know the nature of swelling. On
fine needle aspiration of the submucosal oropharygneal mass
4 ml of thin brownish coloured fluid was aspirated. Air–dried
and wet–fixed smears were prepared for May–Grunwald
Geimsa (MGG) and Papanicolaou stains. Microscopic
examination revealed loose clusters of thyroid follicular cells
lying against a background of abundant thin colloid.EJMR
Figure 1 : Intraoral examination showing large Subsequently, CT scan was done and which showed a
submucosal bulge in the posterior wall of Pharynx.huge nonhomogenous thyroid mass involving all portions
of the gland. There was extension of the mass into the
mediastinum and extensive retrotracheal spread. Surgical
extirpation of the thyroid mass was done subsequently
3233 2014 JOURNAL OF MEDICAL RESEARCHVol.1 No.1Vol.1Jul.–Dec. 2014ERA’S JOURNAL OF MEDICAL RESEARCHJul.–Dec. No.1ERA’S
which histopathologically was a multinodular goiter. The This case is presented to highlight the rare possibility of
retropharyngeal mass subsided after the surgery. The patient extension of the goiter into the retropharyngeal space
had an uneventful postoperative recovery.and presenting clinically as retropharyngeal mass and
DISCUSSIoNoccasionally extending in to the oropharynx. This is the
only case of thyroid gland swelling also presented as large
Visceral spaces and compartments span the entire length of retropharyngeal mass in at our institute during last 20 years
the neck and consist of loose connective tissue surrounding in which FNAC was performed. Majority of these patients
the thyroid gland, trachea and esophagus. There are two also have large mediastinal component, a common mode of
compartments, the anterior pretracheal space which surrounds goiter extension, which is the cause of respiratory distress. In
the trachea and is located against the anterior wall of differential diagnoses of the retropharyngeal mass, possibility
esophagus and the Posterior retrovisceral/retropharyngeal of extension of goiter should also be considered.
retroesophageal space. Between the larynx and the level of
the inferior thyroid artery, the retrovisceral space freely REFERENCE
extends around the sides of the esophagus and trachea into 1. J anfaza P and Fabian RL – Fasciae and fasical spaces of the
the anterior pretracheal space. The thyroid gland is situated Head and Neck. In: Janfaza P, Nadol Jr JB, Galla RJ, Fabian RL
in the pretracheal space. The thyroid gland usually grows and Montermery WW.editors– Surgical Anatomy of Head and
outwards due to its anterior location in the neck. When Neck Ist ed. Philadelphia. Lippincott Williams and Wilkins,
there is a large goiter it usually grows downwards through 2001:691–693.
the thoracic inlet, sometimes causing the ‘thyroid cork’ 2. Lamke LO, Bergdahl L, Lamke B – Intrathoracic goiter : review
phenomenon of the inlet. The downward extension have of 29 cases. Acta Chir Scand. 1979;145(2):83–6.
been reported in a number of studies and extension into the
mediastinum, usually into the anterior mediastinum which 3. Soboroff BJ – An unusual retropharyngeal mass. Trans Am
is the cause of compressive symptoms.2 However the upward Acad Ophthalmol Otolaryngol 1977;84:136–8.
extension of the goiter into the retrophargyngeal space is rare 4. Kenyon GS, Robb PJ – Hashimoto’s disease presenting as an
and it is especially unusual to have the extension upto the unusual retropharyngeal mass. Clin Oncol 1983;9:159–64.
oropharyngeal level. Few cases of such goitrous enlargement 5.
have been reported.3,4,5,6 This upward extension is usually a Berenholzoropharyngeal LP, Segalmasss: S, anKessler unusual A – Goiter finding in presentingthe elderly. as J
late phenomena occurring in those cases where the neck mass Laryngol Otol 1999; 113(2):170–1
is not detected, usually obese patients or in those who have
medically neglected themselves for years. Below the level of 6. Govindaraj S, Rezaee R, Pearl A, Som PM, Urken ML
the inferior thyroid artery, the pretracheal space is separated – Thyroid goiter presenting as a retropharyngeal mass.
by fascia from the retrovisceral space continues caudally into RadiologySep;129(9):1013–4. quiz case. Arch Otolaryngol Head Neck Surg. 2003
the thorax which blends with fibrous pericardium. Thus,
when one considers the totality of the visceral space, it is clear 7. Som PM, and Shugar JMA – Retropharyngeal Mass as a Rare
how a thyroid mass in the pretracheal space can grow into the Presentation of a Goiter CT findings. J Comput Assist Tomgr.
retroesophageal and then the retropharyngeal spaces, since 1991;5:823–825.
in reality, they are all one space.7