Leiomyoma of the sternothyroid muscle.

BACKGROUND: Leiomyomas are benign cutaneous tumors of smooth muscle origin. Only a small percentage of leiomyomas arise in the head and neck region. We present the first case of leiomyoma arising in the sternothyroid muscle of the neck. CASE REPORT: We analyze the clinical presentation, pathology, and histology for a single case study. The histologic findings of the tumor located in the sternothyroid muscle support the diagnosis of leiomyoma. DISCUSSION: This is the first case of leiomyoma arising in the sternothyroid muscle, and only the second reported case of leiomyoma in the strap muscles of the neck. CONCLUSION: Leiomyoma should be included in the differential diagnosis of soft tissue tumors in the head and neck region. A histological analysis is essential in determining both tumor type and subtype, which will inform the proper course of treatment.

Case of Cerebral Amyloid Angiopathy-Related Inflammation - Is the Absence of Cerebral Microbleeds A Good Prognostic Sign?

OBJECTIVE: The aim of this study is to describe a case of pathologically proven cerebral amyloid angiopathy-related inflammation (CAA-I) without cerebral microbleeds (CMBs) and its clinical course. BACKGROUND: CAA-I is an uncommon variant of cerebral amyloid angiopathy. Keys to diagnosis rely on the physician's awareness of this entity, CMBs on magnetic resonance imaging (MRI), an often favorable response to immunosuppression, and ultimately brain biopsy. CAA-I with no CMBs is rarely reported. RESULTS: A 76-year-old woman presented with 4 weeks of headaches and was found to have visual neglect on the left part of the visual field. MRI of the brain showed sulcal/gyriform hyperintensity with associated leptomeningeal enhancement in the right occipital lobe on fluid-attenuated inversion recovery (FLAIR) imaging. No CMBs or large parenchymal FLAIR lesions were seen on MRI. Biopsy was consistent with CAA-I. The patient's headaches resolved spontaneously and no immunosuppression was initiated. The patient remained asymptomatic for the 18 months of follow-up. CONCLUSIONS: To the best of our knowledge, there has been only one previous case of pathology-proven CAA-I without CMBs reported and this was associated with a good prognosis. Lack of CMBs and/or large parenchymal FLAIR lesions may be a prognostic factor in this disease.

Pathologic reporting of lymph node metastases in differentiated thyroid cancer: a call to action for the College of American Pathologists.

Lymph nodes in differentiated thyroid cancer have many different histomorphologic features. The current AJCC staging system does not distinguish between different lymph node characteristics and is based entirely on the presence of metastatic disease to upstage pN0 to pN1. However, clinicians involved in the management of thyroid cancer recognize that there is a difference in the clinical significance of finding macroscopic versus microscopic nodes. There appears to be a difference in disease biology that allows lymph nodes to reach different sizes and to manifest disease extension outside the capsule, which has led clinicians, and even clinical practice guidelines, to stratify nodal metastases on the basis of these features. The inherent presumption is that all lymph node metastases in differentiated thyroid cancer do not have the same clinical significance with respect to the risk of recurrence and the risk of death. However, the College of American Pathology (CAP) has not mandated that pathologists include these findings as part of their standard reporting protocol in thyroid cancer. In order to arm clinicians with the tools to design clinical trials and to make important patient management decisions in the presence of lymph node metastases, it is imperative that the CAP adopt a strategy for more detailed reporting that is similar to the protocol currently utilized in breast cancer pathologic reporting.