Remote triaging of urgent suspected head and neck cancer referrals: our experience during the first wave of the COVID-19 pandemic.

PURPOSE: In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. METHODS: New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the 'Head and Neck Cancer Risk Calculator' (HaNC-RC v.2). RESULTS: Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed 'low risk' (60.2%), 78 were classed as 'moderate risk' (18.9%) and 86 were considered 'high risk' (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). CONCLUSION: The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.

Brain abscess due to Trueperella bernardiae.

We present the case of a brain abscess caused by a combination of rare organisms (Trueperella bernardiae and Peptoniphilus harei) in a patient with chronic suppurative otitis media that had been complicated by the presence of a cholesteatoma. The authors believe this is the first report published in the literature.

Paravertebral cervical chordoma--a case report.

Chordomas constitute <5% of vertebral column tumours and a third of these arise in the upper cervical spine and tend to be clival - usually midline, with occasional eccentric extension. We report a case of cervical chordoma presenting as a lateral neck mass and discuss its origin, diagnosis and management.

Hyperthyroidism in patients with thyroid cancer.

We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)-all women, aged 29 to 87 years (mean: 55.6; median: 50.5)-had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.

Do immediate cytology and specialist radiologists improve the adequacy of ultrasound-guided fine-needle aspiration cytology?

OBJECTIVE: To assess whether a dedicated "1-stop" neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC. STUDY DESIGN: Retrospective review. SETTING: District General Hospital in the United Kingdom. SUBJECTS AND METHODS: Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125). RESULTS: There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005). CONCLUSION: Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non-cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.

Malignant eccrine hidradenoma of neck causing acute heart failure.

Tumours of eccrine sweat glands are uncommon, with complex classification and different terms used even for the same tumour. Therefore, for practical purposes, it may be sufficient to differentiate between benign and malignant. Malignant eccrine hidradenoma has a predilection for head and neck, with high incidence of recurrence following surgical excision and also regional and distant metastases. We describe a case, which presented as a medical emergency with symptoms of severe anaemia and acute heart failure secondary to intermittent bleeding from a huge ulcerative neck lesion, which was subsequently diagnosed as eccrine hidradenocarcinoma. The tumour was successfully treated with complete surgical excision and reconstruction followed by radiotherapy. Two years postoperatively, the patient is very well with no sign of recurrence.