A Rare Case Report of Thyroglossal Duct Cyst Carcinoma Coexisting with Thyroid Carcinoma in an Adolescent.

Background: Thyroglossal duct cysts (TDC) represent approximately 70% of all congenital neck masses, and up to 1% of them contain thyroid tissue malignancies. Clinical presentation of TDC carcinomas is usually indistinguishable from benign tumors preoperatively, and differential diagnosis can be challenging. We present a rare case of TDC carcinoma concurrent with thyroid cancer in an adolescent. Case Presentation. A 16-year-old Caucasian female, otherwise healthy, was referred with a painless, gradually expanding lump on the neck. Physical examination revealed a well-circumscribed, moderately hard, tender mass of the anterior neck midline anteroinferior to the hyoid bone. Imaging findings suggested TDC as the most likely diagnosis. The patient had a Sistrunk procedure under general anesthesia. Histopathological findings diagnosed a BRAFV600E-positive papillary thyroid carcinoma (PTC) in a TDC. A thyroid gland and neck ultrasound revealed a highly suspicious finding for malignancy right level VI lymph node, which was not confirmed by fine needle aspiration cytology (FNAC). Under general anesthesia, total thyroidectomy and central compartment lymph node neck dissection were performed. Histopathological findings revealed a thyroid parenchymal locus of PTC, as well as three lymph nodes infiltrated by PTC. The patient received adjuvant radioactive iodine ablation (RAI) therapy and is closely followed. Conclusion: TDC carcinomas in conjunction with thyroid carcinomas in young patients are rare. Preoperative diagnosis can be challenging, as the vast majority of neck masses in young patients are benign in nature, and most malignant tumors lack specific clinical features. The diagnostic accuracy of FNAC is considered unsatisfactory due to its frequently cystic nature. Definitive diagnosis is based on histopathological findings. Clinicians should maintain a high level of suspicion for coexisting thyroid malignancies. Although surgical extirpation of the malignancy is considered standard of care, the treatment of TDC cancer should always be individualized by a multidisciplinary team.

Medullary thyroid carcinoma diagnosed with liquid-based cytology and immunocytochemistry.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy that arises from the parafollicular cells (C cells) secreting calcitonin. This study summarizes our experience in the diagnosis of MTC with ultrasound-guided thyroid FNA, subsequently processed with liquid-based cytology (LBC) and immunocytochemistry (ICC). We searched our laboratory archives for thyroid FNA cases with an interpretation of positive or suspicious for MTC, during the period 2004-2018. A total of 20 cases (18 thyroid FNAs; two lymph node FNAs) were selected and included in this study. These displayed high cellularity and a discohesive pattern, with a few loose syncytial groups. There was some variation in the cell size and shape both across and within our cases. Most MTCs (n = 15) exhibited a predominant plasmacytoid/epithelioid cell morphology, whereas five of our cases showed a spindle cell pattern. Of interest, none of eight MTC microcarcinomas (≤1 cm) showed a spindle cell morphology. Amyloid was found in 11/20 cases (55%), while binucleation/multinucleation in 17/20 (85%), and nuclear pseudoinclusions in 3/20 MTC cases (15%). Nuclei exhibited a granular, "salt and pepper" chromatin in all cases. ICC was performed in 18/20 cases (90%). Calcitonin, CEA, TTF1, and Chromogranin were positive wherever applied, whereas thyroglobulin and CK19 were negative. In conclusion, ultrasound-guided thyroid FNA - processed with LBC and ICC - is a reliable modality to detect MTC preoperatively, facilitating the management of such patients.

Ligneous conjunctivitis associated with type I plasminogen deficiency: A rare case.

Ligneous conjunctivitis is a rare form of chronic, recurrent conjunctivitis characterized by wood-like, fibrinous pseudomembranes, which may be associated with systemic disease manifestations. It has been associated with congenital plasminogen (PLG) deficiency that is inherited with an autosomal recessive pattern due to mutations in the PLG gene and a variety of other genes, leading to disturbed wound healing. In this case report, we present the clinical, laboratory, and histopathological findings of a 36-year-old female patient who presented at the ophthalmology department with complaints of redness, irritation for the previous few weeks, and appearance of membranous lesions mainly on the tarsal conjunctivae. During biomicroscopic examination we found thick, yellowish-white pseudomembranes, and conjunctival proliferation with ligneous induration on the conjunctiva, located on the upper eyelids. Histopathological evaluations showed up ligneous conjunctivitis and laboratory evaluation confirmed a severe plasminogen deficiency (PLG < 2%). The patient was treated with topical fresh frozen plasma (FFP), topical steroids, heparin eye drops, and artificial tear drops daily, without systemic therapy.

Ileocolic Intussusception in a Woman: A Case Report and Literature Review.

BACKGROUND Intussusception is a rare pathological entity in adults and remains a diagnostic challenge for clinicians, as it shares many clinical signs and symptoms with other morbid conditions (including appendicitis, abdominal hernias, colic, volvulus, and Meckel diverticulum). High clinical suspicion and use of appropriate imaging techniques are essential for early diagnosis and treatment of intussusception. Surgical intervention is the treatment of choice in cases of sustained and persistent invagination. CASE REPORT We present the case of a 65-year-old woman with a medical history of Crohn's disease, diabetes mellitus type II, hypertension, and rheumatoid arthritis. She was hospitalized for diarrhea, fatigue, and anemia. Computerized tomography of the abdomen and a colonoscopy revealed telescoping of the ileum, ileocecal valve, and part of the ascending colon inside the terminal segment of the ascending colon. The antegrade ileocolic intussusception was treated by performing a right hemicolectomy. The pathologic examination of the excised intestine showed mucosal lesions compatible with Crohn's disease, an inflammatory fibroid polyp at the terminal section of the ileum, and a low-grade appendiceal mucinous neoplasm. CONCLUSIONS Regardless of the etiology, when the normal motility of the intestine is altered, it can lead to invagination. Although intussusception is rare, it must always be part of the differential diagnosis for a patient presenting with constant abdominal pain.

Gastric glomus tumor: a case report and review of the literature.

INTRODUCTION: Gastric glomus tumor is a rare mesenchymal neoplasm. There are only a few cases of the tumor showing malignancy, and there are no specific guidelines for the management of this entity. CASE PRESENTATION: We present the case of a 53-year-old Caucasian male who was hospitalized for anemia. Computerized tomography of the abdomen depicted a mass between the pylorus of the stomach and the first part of the duodenum. Preoperative diagnosis was achieved with pathology examination of the biopsies taken via endoscopic ultrasound and upper gastrointestinal endoscopy. An antrectomy with Roux-en-Y anastomosis and appendicectomy, due to suspicion of appendiceal mucocele, were performed. The patient had an uneventful postoperative recovery and was discharged 5 days later. DISCUSSION: Preoperative diagnosis of a gastric glomus tumor is difficult owing to the location of the tumor and the lack of specific clinical and endoscopic characteristics. Furthermore, it is exceptional to establish diagnosis with biopsies taken through endoscopic ultrasound or upper gastrointestinal endoscopy, prior to surgical resection. Although most glomus tumors are benign and are not known to metastasize, there are rare examples of glomus tumors exhibiting malignancy. Treatment of choice is considered wide local excision with negative margins. However, long-term follow-up is required as there is the possibility of malignancy. CONCLUSION: The aim of this report is to enlighten doctors about this uncommon pathologic entity. Surgical resection is considered the golden standard therapy to establish a diagnosis and evaluate the malignant potential.

A Rare Pancreatic Tail Metastasis from Squamous Cell Lung Carcinoma Diagnosed by EUS-FNB and a Small Review of the Literature.

Differential diagnosis of pancreatic lesions is really challenging, especially when the patient is diagnosed with primary cancer at another site. In this case report, we managed to histologically confirm pancreatic metastasis from squamous cell lung carcinoma, which is a very rare entity, using endoscopic ultrasound fine needle biopsy.

O diagnóstico diferencial de lesões pancreáticas é desafiante, especialmente quando o doente é diagnosticado com cancro primário noutro local. Neste caso clínico foi possível confirmar histologicamente o diagnóstico de metástase pancreática de carcinoma de células escamosas do pulmão, que se trata de uma entidade muito rara, através de punção com agulha fina ecoguiada por ecoendoscopia.

Disseminated metastatic cutaneous melanoma to pancreas and upper gastrointestinal tract diagnosed by endoscopic ultrasound: an unusual case.

There is a wide variety of pancreatic neoplasms identified, but the great majority of them are of primary origin. Metastatic disease in the pancreatic parenchyma is quite rare (2-5% of pancreatic malignancies) and most often is quite difficult to differentiate from other primary lesions. Most of the imaging studies fail to give certain discriminating features for metastatic pancreatic neoplasms, contrary to endoscopic ultrasound and tissue sampling, which can provide an accurate diagnosis. In this report, we present a case of a male middle aged man who was admitted to our hospital with painless jaundice and finally was diagnosed with a cutaneous scalp melanoma dispersedly metastasized to the pancreas and upper gastrointestinal tract (stomach and duodenum).

Wnt1 silences chemokine genes in dendritic cells and induces adaptive immune resistance in lung adenocarcinoma.

Lung adenocarcinoma (LUAD)-derived Wnts increase cancer cell proliferative/stemness potential, but whether they impact the immune microenvironment is unknown. Here we show that LUAD cells use paracrine Wnt1 signaling to induce immune resistance. In TCGA, Wnt1 correlates strongly with tolerogenic genes. In another LUAD cohort, Wnt1 inversely associates with T cell abundance. Altering Wnt1 expression profoundly affects growth of murine lung adenocarcinomas and this is dependent on conventional dendritic cells (cDCs) and T cells. Mechanistically, Wnt1 leads to transcriptional silencing of CC/CXC chemokines in cDCs, T cell exclusion and cross-tolerance. Wnt-target genes are up-regulated in human intratumoral cDCs and decrease upon silencing Wnt1, accompanied by enhanced T cell cytotoxicity. siWnt1-nanoparticles given as single therapy or part of combinatorial immunotherapies act at both arms of the cancer-immune ecosystem to halt tumor growth. Collectively, our studies show that Wnt1 induces immunologically cold tumors through cDCs and highlight its immunotherapeutic targeting.

Large adrenal cyst masquerading as a pancreatic cystic tumor: a rare diagnosis based on endoscopic ultrasound.

Adrenal cystic lesions constitute a rare finding and usually are diagnosed incidentally as retroperitoneal cysts during imaging studies. A major issue, especially for the large-sized ones, is their preoperative diagnosis and management, as imaging modalities often fail to detect their exact origin prior to surgery. We report a case of a big adrenal cyst that was mistakenly diagnosed and followed up as pancreatic cystic tail tumor. Our thorough workup, which included endoscopic ultrasound (EUS), managed to delineate an adrenal gland-originated cyst and altered further management of the patient. According to our knowledge, this is the first report in literature in which EUS proved its superiority over other imaging studies in clarifying the origin of an ambiguous big retroperitoneal cyst. We believe that for cases of large retroperitoneal cystic lesions, EUS consists the optimal diagnostic and sampling tool.

Innovative biocatalytic production of soil substrate from green waste compost as a sustainable peat substitute.

In the present work, a new simple and quick eco-friendly method is discussed to handle effectively the green wastes and produce a sustainable peat substitute of high quality on the large scale. Principal physicochemical parameters, i.e., temperature, moisture, specific weight, pH, electrical conductivity and, also, microorganisms, organic matter, humic substances, total Kjeldahl nitrogen and total organic carbon, C/N ratio, ash, metal content and phytotoxicity, were monitored systematically. Humic substances content values were interrelated to both C/N ratio and pH values and, similarly, bulk density, TOC, TKN, C/N, GI, ash and organic matter were found interconnected to each other. A novel biocatalyst, extremely rich in soil microorganisms, prepared from compost extracts and peaty lignite, accelerated the biotransformation. Zeolite was also employed. The compost does not demonstrate any phytotoxicity throughout the entire biotransformation process and has increased humic substances content. Both humic substances content and germination index can be employed as maturation indices of the compost. Addition of compost, processed for 60 days only, in cultivations of grass plants led to a significant increase in the stem mass and root size, annotating the significant contribution of the compost to both growth and germination. The product obtained is comparable to peat humus, useful as peat substitute and can be classified as a first class soil conditioner suitable for organic farming.