Outcomes of incidentally discovered thyroid nodules referred to a high-volume head and neck surgeon.

BACKGROUND: Incidental thyroid nodules are commonly found by radiological studies done for other indications. The yearly incidence of thyroid cancer is increasing, in part because of detection of nonpalpable nodules on imaging performed for unrelated issues. METHODS: All new patients referred to a high-volume thyroid surgeon for thyroid nodules were reviewed between February 2009 and January 2011. Data regarding patient demographics, risk factors, referring physician, radiologic findings, fine-needle aspiration (FNA) results, and management were reviewed. RESULTS: One hundred thirty-three of 729 patients (18.2%) had a thyroid nodule or nodules incidentally found on ultrasound, MRI, CT, nuclear imaging, or chest x-ray. Fifty-five patients (41.4%) were managed surgically, with 35 (63.6%) of those having thyroid cancer on final surgical pathology. CONCLUSION: Based on radiologic findings, risk factors, and FNA results, many incidental thyroid nodules can be observed. Incidental thyroid nodules should be evaluated in the same fashion as a palpable thyroid nodule.

Outcomes of combined oncologic resection and carotid endarterectomy in patients with head and neck cancer.

BACKGROUND: Patients with head and neck cancer have similar risk factors to patients with carotid disease. Patients with head and neck cancer should be screened with vascular consultations obtained as indicated. Identification of significant carotid artery disease before surgical treatment of head and neck cancer is important in order to prevent perioperative and future strokes. METHODS: Eleven patients underwent carotid duplex ultrasound followed by vascular consultation for significant asymptomatic and symptomatic carotid stenosis. Carotid endarterectomy was performed during an oncologic resection of head and neck cancer between the years of 1996 and 2011. RESULTS: There were no local or regional recurrences. There were no perioperative deaths or strokes. Two-year and 5-year survival were 70% and 29%, respectively, with a median survival of 51 months. CONCLUSION: Collaboration of head and neck surgeons with vascular surgeons provides the patient with an oncologic resection and revascularization with a low perioperative risk of stroke. This improves the patient's quality of life by lessening the possibility of a stroke postoperatively.

Carotid resection and reconstruction associated with treatment of head and neck cancer.

Patients with head and neck cancer may experience carotid artery involvement. We present a series of 10 patients, all with stage IVB disease, who required carotid resection and reconstruction to achieve a complete resection. Nine of the 10 patients had previous radiation treatment to the neck. Six died of distant disease, and three died of other causes with no local or regional recurrences. Carotid resection and reconstruction can be done safely, achieving local and regional control.

Parathyroid adenoma on the ipsilateral side of thyroid hemiagenesis.

We present a case of a parathyroid adenoma on the ipsilateral side of thyroid hemiagenesis-which, to our knowledge, is the third reported case of this entity. A 41-year-old man with nephrolithiasis was found to have elevated calcium and intact parathyroid hormone levels. Both ultrasound and technetium sestamibi scintigraphy with single photon emission computed tomography confirmed left thyroid hemiagenesis and an adenoma in the left inferior thyroid bed. The patient underwent left neck exploration, which confirmed left thyroid hemiagenesis and a left inferior parathyroid adenoma. The left inferior parathyroid gland was resected. The patient was discharged home the same day of surgery and has remained normocalcemic for 14 months without evidence of hyperparathyroidism.

Plantar fibromatosis masquerading as metastatic melanoma.

We present the evaluation and treatment of a 59-year-old male with a medical history significant for multiple recurrences of malignant melanoma. The patient was found to have increased focal uptake of his right foot on fluorodeoxyglucose positron emission tomography. Given the patient's clinical history, the increased uptake was suspected to be recurrence of his disease. The nodule was surgically excised and was later pathologically diagnosed as benign plantar fibromatosis. To our knowledge, only one other case report of plantar fibromatosis demonstrating increased fluorodeoxyglucose positron emission tomography uptake exists. Given the distinct prognostic differences between plantar fibromatosis and recurrent malignant melanoma, clinicians should be aware of the possibility of such false-positives with fluorodeoxyglucose positron emission tomography during oncologic surveillance.

Cervicothoracic neuroblastoma arising from the stellate ganglion in children: the use of muscle and bone sparing transmanubrial transcostal approach.

Cervicothoracic neuroblastoma arising from the stellate ganglion in children has always been a challenge to the pediatric surgeon. Localized thoracic neuroblastoma in children has a very good prognosis if excised completely even without adjuvant therapy. Several approaches have been described to resect cervicothoracic neuroblastoma arising from the stellate ganglion with limited success. The muscle and bone sparing transmanubrial transcostal approach which spares the clavicle and the sternomastoid muscle provides excellent exposure for the complete excision of the tumor and excellent functional outcome. We report a 2-year-old girl with cervicothoracic neuroblastoma who had an excellent outcome with this approach.