15 research outputs found
Submerged goiter proven to be metastatic infiltration of a neuro-endocrine Merkel cell carcinoma
BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon neuroendocrine cutaneous carcinoma. Metastases to the thyroid gland are rare and may present diagnostic difficulties. CASE PRESENTATION: A 73-year-old woman presented with a hard mass in the adipose tissue of the right inguinal area. This mass was surgically excised and the histology examination showed the existence of a MCC. CT scans revealed a sizable lesion with imaging features of a submerged goiter, invasive to the upper mediastinum. The patient received chemotherapy following by locoregional radiotherapy at the bed of the excised lesion. During the next 10 months the patient was asymptomatic, serum markers values were normal and CT scans findings were stable. However, afterwards NSE and chromogranin values raised and CT scans revealed an enlargement of the submerged goiter. The patient became symptomatic, mainly experiencing respiratory inconvenience. Surgical excision of the right lobe of the thyroid gland was decided and performed without any complications. The histopathology examination showed infiltration of the thyroid gland by a neuroendocrine carcinoma with characteristics compatible with MCC. CONCLUSIONS: The rare case of metastatic infiltration of the thyroid gland by a MCC based on histological and immunohistochemical findings was described. This case report is of clinical significance indicating that by any abnormal finding in the thyroid gland in patients with a malignant disease, the diagnostic approach should always contain consideration of metastasis from the primary tumor
Submerged goiter proven to be metastatic infiltration of a neuro-endocrine Merkel cell carcinoma
Background: Merkel cell carcinoma (MCC) is an uncommon neuroendocrine
cutaneous carcinoma. Metastases to the thyroid gland are rare and may
present diagnostic difficulties.
Case presentation: A 73-year-old woman presented with a hard mass in the
adipose tissue of the right inguinal area. This mass was surgically
excised and the histology examination showed the existence of a MCC. CT
scans revealed a sizable lesion with imaging features of a submerged
goiter, invasive to the upper mediastinum. The patient received
chemotherapy following by locoregional radiotherapy at the bed of the
excised lesion. During the next 10 months the patient was asymptomatic,
serum markers values were normal and CT scans findings were stable.
However, afterwards NSE and chromogranin values raised and CT scans
revealed an enlargement of the submerged goiter. The patient became
symptomatic, mainly experiencing respiratory inconvenience. Surgical
excision of the right lobe of the thyroid gland was decided and
performed without any complications. The histopathology examination
showed infiltration of the thyroid gland by a neuroendocrine carcinoma
with characteristics compatible with MCC.
Conclusions: The rare case of metastatic infiltration of the thyroid
gland by a MCC based on histological and immunohistochemical findings
was described. This case report is of clinical significance indicating
that by any abnormal finding in the thyroid gland in patients with a
malignant disease, the diagnostic approach should always contain
consideration of metastasis from the primary tumor
Congenital peritoneal encapsulation of the small intestine: A rare case report
Introduction: Peritoneal Encapsulation (PE) is a scarce congenital malformation, characterized by a supplementary peritoneal membrane that covers all or a part of the small intestine.
Presentation of case: PE was unexpectantly discovered in a young woman during laparotomy for bowel obstruction. There were no specific pre-operative indications of this malformation. The operation was uneventful.
Discussion: PE is a very rare congenital anatomical anomaly that is difficultly identified pre-operatively. PE is mainly asymptomatic, but in some cases, like in the presented one, PE presents with small bowel obstruction. Surgeons should be aware of this malformation and suspect it when encountering a patient with small bowel obstruction without other etiological factors.
Conclusion: Knowledge of this peculiar congenital anomaly is pivotal, so that accurate diagnosis and appropriate management of it are direct and efficient
Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report
Double pyramidal lobe is a scarce anatomical variation of the thyroid
gland. Its presence impinges on the completeness of total and subtotal
thyroidectomy and the postoperative treatment. Surgeons should be always
aware of this variation in order to perform sufficient resection of the
thyroid gland and minimize the possibility of recurrence of benign and
malignant thyroidopathies
Abnormal distance of the extralaryngeal bifurcation point of the recurrent laryngeal nerve from the cricothyroid joint
The extralaryngeal bifurcation point of the recurrent laryngeal nerve
(RLN) is typically located in a mean distance of 0-2 cm from the
cricothyroid joint (CTJ). In the presented case though, the left RLN was
unexpectedly identified bifurcating in a mean distance of 7 cm from the
left CTJ in a young woman with multinodular goiter during total
thyroidectomy. The RLN was carefully exposed throughout its course for
the avoidance of iatrogenic injury of the nerval structure. The
operation was uneventful. The present manuscript aims to highlight a
scarce anatomic variation and its implications for thyroidectomy. Rare
anatomic variations of the RLN such as the presented one encumber
thyroid surgery and represent a severe risk factor of RLN injury.
Meticulous operative technique combined with surgeons' perpetual
awareness concerning this peculiar anatomical aberration leads to an
injury-free thyroid surgery
Anomalous origin of the right colic artery from the right gastroepiploic artery during complete mesocolic excision: a rare case report
Complete mesocolic excision (CME) is a standardized surgical procedure
for colonic cancer that requires ample knowledge of the anatomical
patterns of the colic arteries. Variations of the colic vessels encumber
both surgical and endovascular techniques. In the presented case below,
the right colic artery was incidentally detected emerging from the right
gastroepiploic artery, during CME. Surgeons should be always aware of
this variation in order to perform safe abdominal surgeries and
sufficient resection of the regional lymph nodes with a view to
minimizing the probability of recurrence of disease when encountering
colonic cancer