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Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome.We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum.Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy.

We report the case of a 63-year-old woman with occult breast cancer who presented with a hard metastatic nodule in the left axilla. Although histology identified a metastatic carcinoma in the lymph nodes, numerous tests failed to detect the primary tumor. Resected lymph node was positive for both estrogen and progesterone receptors, suggesting the breast as the site of the primary tumor. Left modified radical mastectomy was performed. Pathology revealed an invasive lobular carcinoma (2.5 x 2 mm in size) with extensive lymphatic involvement, which strongly expressed both vascular endothelial growth factor-C (VEGF-C) and VEGF-D.Riportiamo il caso di metastasi ascellare sinistra da carcinoma occulto della mammella in donna di 63 anni. Nonostante la FNAC deponesse per metastasi da carcinoma, nessun accertamento pre operatorio è riuscito a determinarne la provenienza. L’istologia del linfonodo asportato, ha dimostrato la presenza di recettori per gli estrogeni ed il progesterone nel tessuto metastatico. Sottoposta a mastectomia radicale modificata sinistra, l’accurato esame del pezzo operatorio ha rivelato la presenza di carcinoma lobulare infiltrante (2,5 x 2 mm) con ampio coinvolgimento linfatico e con sopra espressione del fattore di crescita endoteliale vascolare (VEGF-C e VEGF-D).