External auditory canal sebaceous carcinoma.

The incidence of sebaceous carcinoma (SC) in the outer one-third of the external auditory canal is considered extremely rare, and only eight case reports have been published. We present a case of a male patient in his late 70s known case of hypertension on indapamide. His medical history included a postspinal tumour that had been treated with surgery and radiation more than 40 years ago and current complaints of right ear pain and purulent discharge. A right ear soft granular tissue mass was found. Complete debulking of the right ear mass was done in conjunction with middle ear exploration, moderately differentiated SC diagnosis was made based on the histopathological analysis. The patient was free of recurrence but then died of an unrelated pulmonary infection. SC should be suspected in elderly patients who present with long-term complaints of a mass with or without otalgia, and these patients should be examined for the presence of such tumours especially if they report a history of radiation. Additionally, more research is warranted to investigate the association of diuretics with SC.

Preoperative Clinical Prediction of Parathyroid Carcinoma: Two Rare Case Presentations and a Review of Literature.

BACKGROUND Parathyroid carcinoma represents about 0.005% of all malignancies and accounts for less than 1% of primary hyperparathyroidism cases. Precise preoperative diagnosis of parathyroid carcinoma is challenging, and it is usually diagnosed postoperatively by histological examination. Early suspicion of parathyroid carcinoma can lead to a more extensive surgical approach to reduce the risk of carcinoma recurrence. CASE REPORT The first case involves a 58-year-old woman who presented with severe back pain. An incidental finding on cervical magnetic resonance imaging of a soft-tissue-density mass at the right para-tracheal zone. The large size and the noticeable mass effect pushing the trachea and esophagus to the left side suggested the need for further investigations to rule out malignancy. Initially, it was thought to be a thyroid nodule investigated by fine-needle aspiration that revealed follicular thyroid cancer. After a histopathological examination, it was determined to be a parathyroid carcinoma. The second case involved a 30-year-old woman with a lower-limb tingling sensation. The significantly enlarged mass seen during thyroid ultrasound warranted surgical excision and histopathological analysis to rule out malignancy. Excision of what was considered a parathyroid adenoma revealed a histopathological finding of carcinoma, prompting a hemithyroidectomy. Both patients had high calcium and parathyroid hormone levels preoperatively. CONCLUSIONS Preoperative high calcium, intact parathyroid hormone, creatinine, and alkaline phosphatase, in addition to the lymphocyte-to-monocyte ratio and tumor diameter, are suggested to be predictive of parathyroid carcinoma diagnosis and should be carefully analyzed in all patients presenting with primary hyperparathyroidism.

Coexistence of Oncocytic (Hürthle cell) carcinoma with foci of anaplastic carcinoma and a metastasizing papillary carcinoma in one thyroid gland: Rare case report.

INTRODUCTION AND IMPORTANCE: Anaplastic thyroid cancer is considered one of the most fatal aggressive malignancies with a survival duration estimated in months. When compared to anaplastic thyroid cancer, a well-differentiated thyroid tumor has a better prognosis and a longer survival duration even if it metastasized. Left untreated, the transformation of well-differentiated thyroid carcinoma to aggressive anaplastic malignancy has been considered one of the most devastating complications. CASE PRESENTATION: A 60-year-old male presented with a complaint of anterior neck swelling and hoarseness examination revealed a huge left thyroid swelling that was mobile, not tender, not attached to the underlying structures. Ultrasonographic examination of the thyroid gland showed a massively enlarged left thyroid lobe. Fine needle aspiration revealed undifferentiated (anaplastic) thyroid carcinoma. Preoperative CT excluded invasion or metastasis, and patient underwent total thyroidectomy and level 6 lymph node dissection. Histopathology showed anaplastic carcinoma foci within a background of Oncocytic (Hürthle cell) carcinoma and an incidental papillary thyroid carcinoma metastasizing into one lymph node. CLINICAL DISCUSSION: The predominance of an anaplastic thyroid tumor with a few foci of well-differentiated thyroid malignancy, although rare, is the known commonly observed histopathological finding. However, it is extremely rare to find Oncocytic (Hürthle cell) thyroid carcinoma within the anaplastic component. It's presumed that patients who have coexisting well-differentiated thyroid cancer with the anaplastic component are at an overall survival advantage when compared to those who have pure anaplastic thyroid cancer. Our patients had a predominantly well-differentiated component, with a ratio of 80/20, the lesser being anaplastic, which might explain his 10 months cancer free outcome. CONCLUSION: It's extremely rare to encounter a predominant Oncocytic (Hürthle cell) carcinoma with foci of anaplastic tumor and a separate papillary carcinoma that metastasized to one lymph node. This rare histopathological finding supports that theory of anaplastic transformation from a pre-existing well differentiated thyroid tumor.