ABSTRACT
Thyroid cancer is usually treated with surgical intervention followed by ablative radiotherapy if indicated to eliminate any metastases. Five-year survival rates are 99% for papillary thyroid carcinoma (PTC) and 82% for medullary thyroid carcinoma (MTC). The chances of survival decrease significantly with two simultaneous types of cancers and with male gender. PTC and MTC present as different entities. The coexistence of different types of thyroid carcinoma in a patient is a rare event. We report the case of a 45-year-old Saudi male with a rare synchronous occurrence of PTC in the thyroid gland, along with ectopic MTC with a unique prognosis over the years. Our case adds data to the literature supporting the coincidental coexistence of PTC and MTC.
ABSTRACT
BACKGROUND: Leiomyosarcoma (LMS) is a soft tissue malignant tumor that has a predilection to the abdominopelvic and limb smooth muscles. LMS of the thyroid is exceptionally rare. Papillary thyroid cancer (PTC) is the most common thyroid malignancy and originates from the thyroid epithelial layer. To our knowledge, the presence of both tumors in the same patient has not been reported previously. CASE PRESENTATION & LITERATURE REVIEW: A 42-year-old woman presented with a progressively enlarging neck mass for a few months. She underwent left thyroid lobectomy, and the histology showed high-grade primary LMS of the thyroid. She subsequently underwent a complete thyroidectomy, which identified a classical PTC on her right lobe. Our comprehensive literature review identified 39 published cases of primary LMS of the thyroid. The average tumor size was 5.88 cm and occurred more in women. The most common presentation was neck mass, followed by compressive symptoms. Recurrence and metastasis were uncommon at 15% and 10-25%, respectively. CONCLUSION: Thyroid LMS is a rare malignancy with a worse prognosis than PTC. A thorough workup must be done to rule out metastasis before labeling it as primary thyroid cancer.
ABSTRACT
Isolated duodenal transection-a rare complication of abdominal trauma-is a challenging dilemma and difficult to diagnose. As blunt duodenal injuries vary from mild hematoma or perforation to complete transection or complex pancreaticoduodenal disruption. A 21-year-old male medically free victim of motor vehicle collision was admitted to our hospital and evaluated in ER according to ATLS protocol. Patient was stable with positive fast scan so we proceeded for abdomen computed tomography, which showed duodenal injury with possible pancreatic transection and active arterial extravasation. Based on that patient was taken for exploratory laparotomy and primary repair. Duodenal injuries can be a result of different mechanism. Typically, it was the result of crush injury, however, it can be due to shear or bursting forces. With its anatomical location, reaching the accurate diagnosis might be delayed, which is associated with higher mortality rate. Due to different scales of severity and different presentation, the management varies based on the location and the involved surrounding structures. Although complete duodenal transection is rare with blunt injuries, high clinical suspicion is necessary to detect such injury early. Studies have shown that the outcomes are highly dictated by early diagnosis and prompt management.
