Tsila Hefer

Highly aggressive behaviour of occult papillary thyroid carcinoma

Occult papillary thyroid carcinoma is generally associated with an excellent prognosis. Distant metastasis of this tumour is extremely rare. A case of occult papillary thyroid carcinoma with metastases to the lungs, cervical lymph nodes, skeleton, and the brain is reported. The tumour expressed itself in extremely aggressive clinical behaviour and responded only partially to aggressive therapy. The controversial methods of treatment for occult papillary thyroid carcinoma are also discussed.

Metastatic follicular thyroid carcinoma to the maxilla

We present a unique case of metastatic follicular thyroid carcinoma to the hard palate and the maxillary sinus, a case that to our knowledge has not been reported before. Various malignant tumours that metastize to the maxilla are reviewed, and the therapeutic approach to follicular thyroid carcinoma metastasis to that area is also discussed. Follicular thyroid carcinoma should be included in the list of tumours that metastasize to the maxilla.

Are the morphology of papillary thyroid carcinoma and the tumour's behaviour correlated?

Six cases of papillary thyroid carcinoma showing clinically highly aggressive behaviour by invading the upper airway and digestive tract structures were retrospectively reviewed to evaluate the morphological variants of the tumours. Four of them were found to be pure papillary and one was a mixed-papillary and follicular-variants regarded as non-aggressive. Only one case was found to be tall cell variant-regarded as an aggressive variant of papillary thyroid carcinoma. The findings suggest that the prognosis of papillary thyroid carcinoma cannot be predicted from its morphological variant and attention should be given to other clinical parameters.

T cell lymphoma of the ear presenting as mastoiditis

Mastoiditis is a complication of otitis media characterized by suppuration and destruction of air cell septa in the mastoid and petrous pyramid. Diagnosis is made by clinical findings and computerized tomography (CT) of the temporal bone. We present a patient initially diagnosed by CT as having chronic mastoiditis who was subsequently shown to have an unusual large-cell malignant lymphoma of T cell type.

Hyoid bone syndrome and its treatment with nonsteroidal anti-inflammatory drugs

PURPOSE Nonspecific cervical pain is a common complaint in primary ear, nose, and throat clinic patients. In some cases, hyoid bone syndrome has been recognized as the cause of the complaint. Our study describes this common but unrecognized syndrome and suggests a treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), a method of treatment not previously reported for this syndrome. PATIENTS AND METHODS Patients with suspected hyoid bone syndrome (38) were treated with oral NSAIDs and/or with an NSAID ointment for topical application. RESULTS Symptomatic relief was obtained in 66% of our patients and in 71% of the patients treated by NSAID tablets. Symptomatic relief was obtained in 91% of the patients with symptom durations of less than 6 weeks. CONCLUSION We recommend a course of NSAID therapy as the first method of treatment for this syndrome before treatment with invasive procedures, especially for patients with symptom durations of less than 6 weeks. Better recognition of the hyoid bone syndrome will result in a more effective treatment and will avoid an unnecessary investigation.

Metastatic renal cell carcinoma to the nose

A rare case of metastasis of a renal carcinoma to the nasal cavity is presented.

A Possible Otological Complication Due to Maxillary Expansion in a Cleft Lip and Palate Patient

OBJECTIVE We present a possible negative side effect of a sudden onset of secretory otitis media in a 12-year-old boy with unilateral cleft lip and palate who underwent maxillary expansion. The secretory otitis media caused a temporary hearing loss developed during the activation of the expander appliance. The possible causes for this complication are discussed. CONCLUSIONS Clinicians should be aware of the possible association between maxillary expansion and secretory otitis media.

Co2 Laser Repair of Permanent Tracheostomy Stricture

We present our experience in treating postlaryngectomy patients with respiratory disturbance caused by stricture of the permanent stoma by CO2 laser surgery. Laser surgery is a simple procedure that can be performed with the patient under local anesthesia without bleeding and with minimal damage to the adjacent strictures resulting in a minimal postoperative edema and contracture. In our opinion the CO2 laser is a useful surgical tool for enlargement of the airway lumen and for improvement of respiratory disturbance in postlaryngectomy patients with stomal stricture, and this procedure should be considered for treatment of selected patients.

Highly invasive papillary thyroid carcinoma.

Papillary carcinoma is the most common malignant tumour of the thyroid gland, accounting for at least two-thirds of newly diagnosed carcinomas. This tumour may be occasionally multicentric in origin. It frequently spreads to regional lymph nodes in the neck and mediastinum, but uncommonly metastasizes outside these regions. Local invasion of this tumour to the upper airway or digestive tract structures is infrequent. However, when that occurs, it is a source of significant morbidity and mortality. In the last two years four patients suffering from invasive papillary carcinoma to the aerodigestive tract were treated in our department. A short case history of one of them is presented and current trends in management of the disease are reviewed.

More about pain in the neck: thyroid cartilage and mastoid process syndromes

Eight patients with cervical pain were examined. The only positive finding was an impressive tenderness over the thyroid cartilage (in seven patients) or over the area of the insertion of the sternocleidomastoid muscle to the mastoid process (in one patient). The diagnosis of thyroid cartilage syndrome and mastoid process syndrome were suggested and the patients were treated with oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) which reduced the symptoms. These syndromes are rare. The thyroid cartilage syndrome has been previously reported only once in the literature and this is the first report on the mastoid process syndrome. These syndromes, although rare, should be included in the list of causes for cervical pain and better recognition of the syndromes will save patients from undergoing unnecessary investigation and inappropriate treatment.