Transnasal devascularisation of a sinonasal hypervascular tumour (glomangiopericytoma) with direct injection of liquid polymer agent (Squid®)

The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity. A primary attempt at trans-arterial embolisation through selective ophthalmic artery catheterisation was unsuccessful due to unfavourable anatomy. An extensive devascularisation of the nasal fossa lesion was obtained using a single injection of low-density polymeric embolic agent (SQUID®). Post-operative eradication was uneventful. Final histopathology exam revealed vascular tumour consistent with a rare sinonasal glomangiopericytoma. To our knowledge, this is the first reported case of a rare sinonasal glomangiopericytoma treated by direct TN injection, utilising the liquid polymer agent SQUID®.

Disease Free Margins Assessment Using Enhanced Methylene Blue Video Contact Endoscopy with SPIES Filters in Vocal Fold Malignancies

Vocal fold carcinomas represent a pathology that has an important incidence. Recent studies showed that 70% of the dysplastic lesions can skip the phases of mild and severe dysplasia directly to carcinoma. For that reason early detection of a malignancy of the vocal fold is mandatory. If the lesion is discovered in an early stage it must be aggressively treated using CO2 LASER surgery and disease free margins must be obtained. Because frozen sections are not always available in all medical centers we are proposing a new protocol to assess disease free margins during CO2 LASER assisted laryngoscopy. Methylene blue contact endoscopy is not a new method, as it was introduced in laryngology by professors Oscar Diaz and Mario Andreea in 1994. We are proposing a protocol designed to assess disease free margins using an enhanced video contact endoscopy with SPIES software filters. The SPIES filters technology is a relatively new technology proposed by Karl Storz in 2013. A critical analysis of the method will be done comparing the results with paraffin histopathology exam.

Unusual Presentation of Differentiated Thyroid Cancer Metastasis

Introduction The rates of thyroid cancers are on a rise, especially well-differentiated thyroid cancers. This could be partly due to newer diagnostic modalities, like high-resolution ultrasound, that can pick up smaller lesions. Differentiated thyroid cancers with distant metastases are not common, and even rarer is the initial presentation with complaints not related to the neck. Objectives The objective of this series was to study and report the unusual cases of patients with differentiated thyroid cancer with distant metastasis. There is a lack of data in the literature on these cases, and due to the rarity of such metastases, no definite treatment protocol has been defined. Methods A retrospective chart review of 1,200 cases of thyroid surgeries was performed. A total of 10 cases of well-differentiated thyroid cancer on the final histopathology exam that had initially presented with usual complaints to departments other than the Otolaryngology Department were identified. Results A total of 6 patients had papillary carcinoma, whereas 4 patients had follicular carcinoma on final the histopathology exam. Two patients presented with iliac crest lesions, 2 with vertebral lesions one each with parapharyngeal mass, supraclavicular mass, labia majora swelling and bleeding, lung, rib and neck of femur lesion. Conclusion There are still no specific guidelines on how to address these patients with differentiated thyroid cancer with distant metastasis (except for the cases of bone and lung lesions) and on which treatment should be offered in case of recurrence. More studies on the subject are required.

Uterine Adenocarcinoma with Pulmonary, Liver and Mesentery Metastasis in a Holstein Cow

The clinical and pathology features of a cow with uterine adenocarcinoma and multiple metastasis are described. Weight loss, inappetence, mild respiratory signs, and reduced milk yield were evident on clinical examination. Grossly deformed uterus, enlarged iliac lymph nodes, and rosary arranged nodules in the mesentery were felt by rectal palpation. Right side laparotomy revealed numerous small masses covering the omentum, and mesentery. Euthanasia was performed. Necropsy and histopathology exam revealed a uterine adenocarcinoma with multiple pulmonary, liver and mesentery metastasis. Uterine adenocarcinoma with metastasis should be included in the differential diagnosis of cows showing weight loss and mild respiratory distress and palpation of numerous firm nodules in the mesentery should be suggestive of neoplasias' metastasis.