Unusual sites of metastasis of papillary thyroid cancer: Case series and review of the literature.

Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. It typically spreads via lymphatic extension. The rate of regional PTC metastasis to the neck is relatively high, while metastases outside the deep cervical chain are rare. Distant metastases are found in only 1% of patients with PTC at the time of surgery; the two most common sites are the lung and bone. We report 4 cases of PTC metastasis to unusual sites: (1) the occipital skull and internal jugular vein, (2) the parapharyngeal space, (3) the sternocleidomastoid muscle, and (4) the right atrium of the heart. It has been well documented that aggressive distant metastasis is a characteristic of PTC, and it is known to be an indicator of a poor prognosis. Some of our patients' sites of metastatic disease have not been previously reported. Patients in this series exhibited aggressive histologic findings, including columnar cell and follicular variants of papillary disease. In addition, all 4 patients demonstrated "PET-avid" disease with decreased iodine avidity.

Perioperative care in functional endoscopic sinus surgery: a survey study.

BACKGROUND: Functional endoscopic sinus surgery (FESS) is largely viewed as the standard of care in the treatment of chronic rhinosinusitis (CRS) refractory to medical treatment. While there is an understanding regarding the importance of some form of routine postoperative FESS care, no consensus currently exists regarding what the specific management routine should include. The authors of this survey study did not intend to examine the efficacy of such treatment protocols, but rather to determine and report on the current practice patterns of perioperative FESS care among otolaryngologists. METHODS: This survey study was designed in accordance with and approved by our institutional review board. The online-based survey was designed using the online product SurveyMonkey®. A total of 859 otolaryngologists were identified and email addresses were obtained from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website directory. Responses were collected anonymously. RESULTS: Our survey response rate was 32%. Multiple parameters of the otolaryngologists' perioperative care were collected. Among the data, some consistent patterns emerged: 93.2% of respondents use nasal saline irrigations postoperatively; 86.8% of otolaryngologists surveyed prescribe antibiotics in the immediate postoperative period; and office-based endoscopic sinus debridements are performed by a majority (87.9%) of those surveyed. CONCLUSION: This survey study demonstrates that current practices in perioperative FESS care can vary widely among otolaryngologists, and are not uniformly based on evidence-based outcomes research. Despite the lack of absolutes regarding the specific perioperative care in FESS, practice patterns emerge from the data regarding typical perioperative management among current otolaryngologists.