ABSTRACT
@#The cell origin, histopathologic features, and prognosis of medullary and papillary thyroid carcinoma are different and to have them occur simultaneously in a single patient is a rare occurrence. This is a case of a 38-year-old female who presented with an enlarging anterior neck mass whose fine needle aspiration biopsy could not rule out a papillary lesion. Thus, she was advised to undergo total thyroidectomy, and her final histopath showed a simultaneous medullary and papillary thyroid carcinoma. Her initial serum calcitonin was elevated at 252 pg/ ml, and it remained persistently elevated over the course of 7 months. A repeat ultrasound revealed solid nodules with coarse calcifications and enlarged lymph nodes at both submandibular regions. This warranted a repeat surgery with neck dissection with the finding of eight lymph nodes positive for metastatic carcinoma. On follow up after her second surgery, the calcitonin decreased to 42.70 pg/ml. Knowledge of this simultaneous occurrence of medullary thyroid carcinoma and papillary cancer is important for its prognostic implications and therapeutic plan
Subject(s)
Thyroid Neoplasms , Thyroid Cancer, PapillaryABSTRACT
@#Granulomatous hypophysitis is an extremely rare condition, with no established definitive treatment. An elderly Asian woman was diagnosed to have recurrent granulomatous hypophysitis 5 years after transsphenoidal surgery. No other intervention was done post-operatively. Since another surgery was not advisable due to the high probability of recurrence, she was started on a trial of oral glucocorticoids. After 3 months of steroid therapy, complete resolution of symptoms and sellar mass were achieved.
Subject(s)
Autoimmune Hypophysitis , GlucocorticoidsABSTRACT
@#Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) are rare potential adverse effects of bisphosphonates and RANKL antibody therapy. The pathogenic mechanisms of both conditions are known to be independent of each other. Here, we report both conditions sequentially occurring in the same patient.An 81-year-old, obese, diabetic, female was admitted due to hypertensive urgency and persistent jaw pain after tooth extraction. The patient has postmenopausal osteoporosis for fourteen years and was on intermittent, unsupervised treatment with alendronate, denosumab and ibandronate. Upon presentation, the patient was noted with tenderness intraorally of tooth number 35 periapical region. This was associated with elevated erythrocyte sedimentation rate and C-reactive protein. Imaging study showed presence of bony sclerosis which represent a sequestrum in the molar area of the left hemi-mandible. Antibiotic infusion and excision and debridement of left posterior mandible were done. Histopathologic finding was consistent with a diagnosis of osteonecrosis of the jaw. The same patient, upon review, had suffered sequential fracture of both femurs during the eighth and eleventh year of treatment with antiresorptive agents. The fractures were transverse, non-comminuted, at the proximal femoral shaft. Each occurred after a minor trauma and was managed with open reduction and internal fixation. Both fractures were consistent with atypical femoral fractures.ONJ and AFF can occur both in the same patient during prolonged treatment with bisphosphonates and denosumab and may suggest a common pathogenic mechanism.