Metastatic Follicular Carcinoma Thyroid Masquerading as a Primary Jaw Tumor.

Metastatic tumours of the oral cavity are rare constituting approximately one percent of all oral malignancies. These tumors are clinically significant as their appearance may be the first indication of an undiscovered malignancy at a distant primary site or the first evidence of dissemination from a known primary tumor. Thyroid cancer metastasizing to the jaw bones is a rare occurrence and very few cases have been described in literature. We present an additional case which in fact masqueraded as a primary jaw tumor. Metastasis to jaw bones is generally associated with poor prognosis with a majority of the patients dying within 6 months of diagnosis. Thyroid cancers however seem to be an exception to this, resectable solitary jaw bone metastasis from differentiated thyroid cancers is associated with a much better prognosis and therefore should be considered for metastatectomy.

Nodular Fasciitis of the Orofacial Region: An Uncommon Differential.

Nodular fasciitis is a benign proliferative spindle-cell lesion that presents as a rapidly growing mass arising from the subcutaneous fascia, leading it to be erroneously diagnosed as a sarcoma. These lesions commonly present in individuals in their third to fifth decades of life with no definite gender predilection. They are frequently located on the extremities and the trunk and infrequently in the head and neck region. Lesions in the orofacial region are uncommon. We describe an interesting case of orofacial nodular fasciitis in a 21-year-old boy that essentially summarises the clinical features and management of this pseudosarcomatous reactive proliferative lesion. Clinicians and more so maxillofacial surgeons need to be aware of the distinctions between nodular fasciitis and its malignant mimic (sarcomas) in order to limit overtreatment and the resultant treatment-related morbidities.

Malignant chondroid syringoma of the pinna.

Chondroid syringoma (CS) represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands. The malignant counterpart of CS, termed as "malignant CS" is a malignant eccrine neoplasm which lacks distinctive clinical features, often delaying initial diagnosis. Unlike its benign counterpart which often localizes in the head and neck region, malignant CS most often encountered in the trunk and the extremities. We report a rare case of an aggressive malignant CS of the left pinna with cervical lymph node metastasis. Our patient, to the best of our knowledge, possibly is the first case of malignant CS of the pinna and the fourth to arise in the head and neck region. The diagnostic challenges with an added emphasis on the role of positron emission tomography-computed tomography in aiding the management of this rare tumor are discussed.

Palliative thyroidectomy in the setting of a metastatic renal cell carcinoma.

A secondary neoplasm of the thyroid gland is a distinctly uncommon cause of thyroid enlargement. These tumors mimic primary thyroid gland tumors and often lead to diagnostic difficulties. We report an interesting case of secondary thyroid tumor coexisting with a micropapillary carcinoma in an elderly male patient following a radical nephrectomy done 15 years prior for a renal cell carcinoma (RCC). Interestingly, the previously described coincidental association of thyroid and pancreatic metastases in a metastatic RCC was also noted in our patient as was demonstrated in the positron emission tomography-computed tomography which was done as part of the metastatic workup. This association needs to be further explored as also the role of palliative thyroidectomy in the setting of a metastatic RCC. The possibility of metastatic RCC should be kept as a differential during the course of the evaluation of clear cell renal tumor of the thyroid gland.