Collision tumor of the thyroid – a challenge during the COVID-19 pandemic

Some of the patients with anaplastic thyroid carcinomas have a coexistent differentiated thyroid cancer, sustaining the hypothesis that this cancer may develop from more differentiated tumors. We describe a case with a collision tumor of the thyroid, defined as a neoplastic lesion composed of two distinct cell populations, with distinct borders. The patient presented during the COVID-19 pandemic with dysphonia, dyspnea, multinodular goiter and a painless, rapidly enlarging, left cervical swelling. She had been first time diagnosed with left nodular goiter in 2007, with an indication for surgery, which she declined. After partial excision of the left latero-cervical adenopathy, the pathological analysis showed massive lymph node metastasis from anaplastic thyroid cancer. A total thyroidectomy was done; the postoperative pathological exam identified a papillary thyroid microcarcinoma in the right lobe and an anaplastic thyroid cancer in the left lobe. Postoperatively, levothyroxine treatment was started and the patient was referred to radiotherapy. This case highlights the importance of urgent management of some cases with compressive multinodular goiter, even during the COVID-19 pandemic.

Unusual Anterior Neck Swelling: Cervical Spinal Cord Schwannoma

Schwannomas are typically solitary, well-encapsulated, benign tumors running along or attached to a nerve. An intradural-extramedullary cervical spinal schwannoma, which first manifests as a swelling in the anterior neck, has not been reported to the best of our knowledge. We present the case of a 69-year-old patient complaining of a gradually worsening painful left cervical swelling for over 8 years. First, a posterior spinal midline approach was performed for the resection of the tumor and the tumor portion in the vertebral canal was totally removed. The second operation, the anterolateral approach, was planned to be executed in a second surgical session. The patient was discharged from the hospital without neurological deficits. Histopathological diagnosis was a schwannoma. The first aim of surgery is to treat neurological deficits in patients with cervical intraspinal schwannomas with/without extension into the extra-vertebral paravertebral neck regions. The surgical strategy combines the posterior midline and the anterolateral cervical approaches in the same session or at different times.

An Isolated Dextrogastria Simulating Diaphragmatic Rupture in a Post-Traumatic Context

We report a case of isolated dextrogastria discovered in imaging a 34-years-old woman who was in the emergency department for vomiting and fluctuating right chest pain following a road accident. It was a collusion between 2 motorcycles, the patient being a rear passenger, performing a whiplash mechanism with a brief initial loss of consciousness. The day after the accident, she complained of left cervical swelling, painful with dysphagia to solids. Physical examination revealed bilateral palpebral oedema. There was a decrease in right vesicular murmurs with symmetrical tympanism towards the base of the lung. The rest of the examination was normal. The chest x-ray showed digestive loops above the liver that appeared to be located in the right intra-thoracic, suggesting in this context a diaphragmatic rupture. The OGDT and the thoraco-abdominal CT made possible to correct the diagnosis of type II dextrogastria by showing the stomach and part of the colon located on the right, above the liver, under the diaphragmatic dome which is disembowelled, pushing back the lung homolateral up. There was also a deviation of the ipsilateral thoracic esophagus in continuity with the stomach. The liver, in the right quasi-lateral position, is forced downward, extending to the lower edge of the ipsilateral flank. The other viscera kept their usual topographies. KEY WORDS: Dextrogastria, Isolated dextrogastria, Chest pain, Dysphagia.

A Case of Spontaneous Cervical Hematoma caused by Parathyroid Adenoma

Spontaneous cervical hematomas could lead to life-threatening complications, and aneurysms, retopharyngeal abscesses, parathyroid adenomas, laryngeal cysts, and neurogenic tumors should be distinguished as possible underlying causes. Symptoms accompanying spontaneous cervical hematoma include cervical swelling, ecchymosis, dysphagia, dyspnea and hoarseness. We recently experienced a case of spontaneous cervical hematoma in a 52-year-old woman, who initially presented with cervical swelling after severe coughing two days ago. Resultingly parathyroid adenoma was finally confirmed after mass excision. Therefore, we present this unique case with a review of the literature.

Liquid based cytology and immunohistochemistry on cytosmears based diagnosis of letterer-siwe disease in a 40 year male

: Histiocytes with coffee bean like nucleus are the diagnostic hallmark of Langerhans cell histiocytosis (LCH) supported with immunohistochemical (IHC) demonstration of fascin, CD1a and S-100. We report a case of Letterer-Siwe disease in a 40year male diagnosed on cytology and IHC on cytosmears along with cytomorphology in Liquid based cytology (LBC) smears. Forty year male presented with complains of low grade fever and reduced appetite from two years with a cervical swelling and discomfort from five months. Fine needle aspiration(FNA) from cervical lymph node showed sheets of histiocytes in background of mixed inflammatory cells. LBC smears highlighted fine chromatin, delicate nuclear outline with coffee bean like morphology. On IHC tumor cells were positive for S-100 and CD1a. CT thorax revealed consolidation in left lower lung, bone lesions were found on skeletal survey. Hence diagnosis of Letterer-Siwe disease was given. Patient responded well to systemic chemotherapy.

Pulsatile tinnitus as the first manifestation of a jugular paraganglioma

We present the case of a 59 year old male patient with pulsate tinnitus, referred as the first manifestation of a jugular parganglioma. The patient examined at the outpatient ENT Department of our hospital with a left lateral cervical swelling, difficulty in swallowing and pulsatile tinnitus. Tinnitus was the first reported symptom that appeared one month before. The patient had no medical history. The clinical examination showed an asymmetric swelling of the left tonsil, a left vocal cord paralysis, a retrotympanic mass otoscopically and conductive hearing loss in the left ear. The patient underwent a head-and-neck computed tomography that raised the suspicion of a paraganglioma. The magnetic resonance imaging and the magnetic angiography with the administration of a contrast agent set the diagnosis of a jugular paraganglioma. After the tumor embolization, the patient unerwent primary resection of the tumor. This is the first case of a patient with a jugular paraganglioma and pulsatile tinnitus as the first reported symptom.

Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that is reportedly linked to coronavirus disease 2019. Affected patients present with gastrointestinal symptoms and cardiovascular dysfunction, in addition to Kawasaki disease-like features, suggesting the potential for overlapping disease mechanisms. Kawasaki disease has been reported among individuals of East Asian ethnicities, whereas there is minimal clinical literature regarding the occurrence of MIS-C among individuals of Asian ethnicities. A few reports thus far have described changes in cytokine kinetics during the course of disease in patients with MIS-C. We followed the temporal cytokine kinetics in a 9-year-old Japanese girl who exhibited a classical trajectory of MIS-C. The patient exhibited right cervical swelling and pain, abdominal pain, vomiting, and lip reddening, which developed 31 days after she was diagnosed with severe acute respiratory syndrome coronavirus-2 infection. The patient was diagnosed with Kawasaki disease on her fifth day of illness; because she fulfilled the criteria for MIS-C, she was also diagnosed with this disease on her fifth day of illness. Her fever rapidly resolved upon administration of intravenous immunoglobulin, aspirin, and prednisolone. On the patient's sixth day of illness, she developed acute myocarditis, which was treated with two diuretics and one vasodilator; the myocarditis ameliorated within a few days. Analyses of temporal kinetics for 71 serum cytokines revealed several patterns of cytokine changes that were consistent with the patient's clinical course of disease. Importantly, there was a clear distinction between cytokines that did and did not decrease rapidly following post-treatment fever resolution. These findings may be useful for the assessment of disease status and selection of therapy in patients with similar symptoms; they may also provide insights for basic and clinical research regarding MIS-C.

Burkitt’s Thyroid Lymphoma Revealed in a Pregnant Woman With Acute Dyspnea

Extraganglionic Burkitt’s lymphoma is rare. Primary thyroid localization accounts for 1% to 5% of malignant tumors of the thyroid gland. The association of Burkitt’s lymphoma and pregnancy is even rarer. Our patient was pregnant at 36 weeks. She was brought to the emergency department with anterior cervical swelling, rapidly increasing in volume and becoming compressive for 15 days, in addition to dysphonia and inspiratory dyspnea. Cervical ultrasound and computed tomography scan revealed a compressive and plunging goiter. Surgery attempted after fetal extraction proved impossible due to massive tumor infiltration into adjacent structures shielding the cervical region. Accordingly, the act was limited to a glandular biopsy. The newborn was healthy. Histological examination confirmed the diagnosis of Burkitt’s lymphoma. Given the poor general condition of the patient, chemotherapy was not administered and the patient died after 15 days of stay in intensive care unit.