Superior vena cava syndrome caused by a benign intrathoracic goiter

Intrathoracic goiters are defined as the extension of the thyroid gland into the mediastinum. Superior Vena Cava (SVC) syndrome due to the compression of major vessels can be seen in these patients. Most cases of SVC syndrome occur as a complication of malignancy. A 75-year-old female, non-smoker, was admitted with complaints of the midline neck swell ing for the past 45 years, mild puffiness of face, breathlessness on lying down and dry cough for last 5 years. On clinical examination, there was a massive grade IV thyromegaly. Neck computed tomography revealed a heterogeneous, hyper -trophic, nodular thyroid gland with multiple calcification and mediastinal extension with narrowed trachea. Intraoperatively, there was a huge retrosternal thyroid gland compression of the right brachiocephalic vein, the brachiocephalic trunk from behind the vessel and the right carotid artery along with the right internal jugular vein. Pathological examination showed a nodular colloid goitre without signs of malignancy. When SVC syndrome is secondary to benign thyroid disease, total thyroidectomy should be performed. Abstract Objective: To evaluate the changes in the number of Langerhans Cells (LC) observed in the epithelium of smokeless tobacco (SLT-induced) lesions. Methods: Microscopic sections from biopsies carried out in the buccal mucosa of twenty patients, who were chronic users of smokeless tobacco (SLT), were utilized. For the control group, twenty non-SLT users of SLT with normal mucosa were selected. Th e sections were studied with routine coloring and were immunostained for S-100, CD1a, Ki-67 and p63. Th ese data were statistically analyzed by the Student’s t-test to investigate the di ff erences in the expression of immune markers in normal mucosa and in SLT-induced leukoplakia lesions. Results: Th ere was a signi fi cant di ff erence in the immunolabeling of all markers between normal mucosa and SLT-induced lesions (p<0.001). Th e leukoplakia lesions in chronic SLT users demonstrated a signi fi cant increase in the number of Langerhans cells and in the absence of epithelial dysplasia. Conclusion: Th e increase in the number of these cells represents the initial stage of leukoplakia.