Sudden massive neck swelling due to hemorrhage of a thyroid adenoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sudden swelling of the neck is an emergency situation that can be life-threatening for the patient. Therefore, an understanding of the possible underlying pathology is of great importance. Sudden massive swelling of the neck because of intralesional bleeding of a thyroid adenoma is seldom encountered but must be considered. Such massive swelling caused by spontaneous bleeding of a thyroid adenoma has not yet been described in the literature.</p> <p>Case presentation</p> <p>We report the case of a 71-year-old Caucasian man with sudden massive neck swelling due to intralesional bleeding of a thyroid adenoma. We present his clinical history, physical examination results, computed tomography (CT) scans, and histological findings after surgery. He presented with sudden massive swelling of the left side of his neck after sneezing while working with his hands over his head. An ear, nose, and throat examination showed a painless swelling of the left side of his neck and a displacement of his larynx to the right. CT scans revealed a mass originating from the left lobe of his thyroid gland and the mass displaced his larynx and trachea. A surgical exploration showed a greatly enlarged left lobe of his thyroid gland. A histopathological examination showed a hemorrhagic infarction of a follicular thyroid adenoma.</p> <p>Conclusions</p> <p>Sudden intralesional bleeding of a thyroid adenoma is a rare condition but one that should be considered in cases of sudden and massive swelling of the neck.</p

Supplementary Figure 6 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 6. Posttreatment CD163 (by QIF) increase in three patients with concurrent increase in the CD163 transcripts. Representative images from a patient’s tumor tissue sample showing pre and post treatment (Durvalumab-Olaparib Arm) CD163 expression. Nuclei (blue), Cytokeratin (green), CD163 (yellow) and CSF1R (red).</p

Supplementary Materials and Methods from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

The details for the assays and image analysis are summarized in the Supplementary Materials and Methods.</p

Supplementary Figure 3 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 3. A. No significant differences in stromal TILs were found between pre- and post-treatment samples in all arms. In Arm D TILs were increased post-treatment in most of the samples (5 out of 7). Figures B and C show representative images of TILs in pre- and post-treatment samples respectively from one patient in Arm D, measured by QuPath v0.3.0. Figures show tissues before (left) and after (right) QuPath annotations. Color legend; red, tumor cells; purple, lymphocytes; green, fibroblasts; yellow, other; Cisplatin-Olaparib, C-O; Olaparib, O; Durvalumab-Olaparib, D-O</p

Supplementary Figure 4 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 4. Relative fold change (2-ΔΔCq) of PD-L1 in respect to Β2Μ (reference gene) in the CTC fraction for individual samples of HNSCC patients before (blue) and after (orange) therapy.</p

Supplementary Figure 5 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 5. Map showing the distribution of mutations per gene per tumor. Light and dark purple, green and orange indicate pre- and post-treatment samples for patients treated with cisplatin and olaparib, olaparib and durvalumab and olaparib only, respectively. Blues correspond to samples before and after second biopsy/surgery for patients who did not receive treatment.</p

Supplementary Figure 2 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Figure 2. Differentially expressed signatures in Responders relative to no-Responders. Response is based on physical examination, pathology or imaging. Responders had higher scores in Inflammatory Chemokines and Exhausted CD8 Signatures, as well as PD-1, Cytotoxicity and CD45. The significance (p-value, P and adjusted p-value, Padj) is represented relative to Fold Change (FC) in the x-axis.</p

Supplementary Table 4 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Table 4a. Fold-change values for each signature between Response and No Response based on physical examination, pathology or imaging Table 4b. Fold-change values for significantly differentially expressed genes between Response and No Response based on physical examination, pathology or imaging</p

Supplementary Table 5 from Phase II window study of olaparib alone or with cisplatin or durvalumab in operable Head and Neck Cancer

Supplementary Table 5. Incidence of adverse events by maximum grade in the safety population.</p