Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach.

BACKGROUND: In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function. METHODS: This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients. RESULTS: The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited. CONCLUSION: Although the evidence base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.

The use of hydroxyapatite cement and a pericranial/deep temporal fascia graft for cranioplastic reconstruction of translabyrinthine craniectomy defects.

Most translabyrinthine temporal bone defects are reconstructed with free abdominal fat grafts, with or without the use of hydroxyapatite cement. However, these procedures are associated with considerable morbidity at the graft donor site, with a 6 to 15% incidence of cerebrospinal fluid (CSF) leaks, and with postoperative headaches. We have developed a new technique for reconstructive cranioplasty that involves the use of hydroxyapatite cement and a pericranial/deep temporal fascia graft. This technique obviates the need for an abdominal fat graft and therefore circumvents the morbidity associated with it; it may also significantly reduce the incidence of CSF leaks and postoperative headaches. We describe the results of our use of this technique in a series of 10 patients. Based on our early findings, we believe that this technique holds great promise for reconstructive cranioplasty following translabyrinthine craniectomy.

Malignant peripheral nerve sheath tumor of the paranasal sinuses.

Malignant peripheral nerve sheath tumors of the nose and paranasal sinuses are extremely uncommon. We report the case of a 65-year-old woman who presented with a rapid emergence of "nasal polyps" that completely obstructed her nasal passages. Six years earlier she had been assessed elsewhere for nasal polyps. At presentation, the patient exhibited gross polyposis, with lesions protruding from both nostrils. Histology confirmed a diagnosis of a malignant peripheral nerve sheath tumor This case demonstrates that symptoms of nasal obstruction are not always secondary to simple causes. We discuss the clinical picture of nasal and paranasal malignant peripheral nerve sheath tumor, its pathology, and its treatment.

Extra-abdominal fibromatosis: a case report.

Head and neck fibromatosis is a rare disease with a variable clinical picture. We report the case of a 40-year-old woman who had a 1-week history of a painless mass overlying her right neck. Histology confirmed a diagnosis of extra-abdominal fibromatosis. Two unusual features of this case were the site of the lesion and its rapid growth. In this article, we discuss the clinical picture of head and neck fibromatosis, its etiology and pathology, and current opinion regarding its treatment.

Cervical chordoma managed with multidisciplinary surgical approach.

BACKGROUND: This paper describes the interdisciplinary management of a 62-year-old man who presented with a cervical chordoma of C2/3. This is a rare neoplasm of the axial skeleton which is usually treated surgically. This is technically challenging due to the surrounding anatomy and requirement for wide exposure. A number of surgical approaches have been described to access the clivus and upper cervical spine. METHODS: This case involved both the Orthopaedic and Otolaryngology Head and Neck Surgery departments. Trotter's surgical technique was used to gain access for excision of the cervical chordoma and there was collaboration with an Orthopaedic Biotechnology Company in which a bio-model of the spine was created and a corpectomy cage specific to the patient developed. RESULTS: This approach allowed excellent visualisation of the tumour and the unique cage and plate achieved immediate stability and long term fusion. CONCLUSION: An interdisciplinary approach should be used in the management of upper cervical chordomas to facilitate tumour resection and reduce the potential for recurrence.

Primary carcinosarcoma of the parotid gland.

Carcinosarcoma is a rare malignant 'mixed' tumour in the head and neck region. We present a case of carcinosarcoma in a long standing parotid lump and share our experience in the management of the disease together with a review of recent English literature on the subject.

Ectopic cervical thymus: case report and review of pathogenesis and management.

OBJECTIVE: Ectopic cervical thymus is a rare anomaly, and 50 per cent of cases occur in children. The aim of this report was to remind clinicians of this rare condition, which is part of the differential diagnosis of a paediatric neck lump. METHOD: Case report together with literature review of the pathogenesis and management of ectopic cervical thymus. RESULTS: The ectopic cervical thymus is a rare cause of a benign neck mass, and is thus usually misdiagnosed as lymphadenopathy or neoplasia. We discuss its embryology, aetiology, presentation, histopathology, radiology and management, with reference to the reported case. CONCLUSION: Ectopic cervical thymus should always be considered in the differential diagnosis of a paediatric neck lump. The diagnosis can often be confirmed by cytology and radiology prior to surgical excision.