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.

Post COVID-19 Vaccination-Associated Neurological Complications.

PURPOSE: Neurological sequelae after COVID-19 vaccination are rare. We investigated the possible pathogenesis behind the development of neurological complications within a short period after Saudi residents received a COVID-19 vaccine. PATIENTS AND METHODS: We evaluated 18 patients who recently received a COVID-19 vaccine (Comirnaty and Vaxzevria vaccines) and presented with neurological complications to the Saudi German Hospitals in Jeddah, Saudi Arabia. Neurologists assessed the patients' clinical presentation, radiological investigations, and laboratory findings. RESULTS: Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty. CONCLUSION: Neurological complications after COVID-19 vaccinations are very rare, and only a few cases have been reported worldwide. The shared pathophysiological basis between COVID-19 viral infection and COVID-19 vaccines stands behind the very rare neurological complications resulting from the hypercoagulable state triggered by the general inflammatory condition. We suspect some differences in the pathogenesis of ischemic stroke caused by COVID-19 infection and COVID-19 vaccines, which render COVID-19 vaccine-associated ischemic stroke more responsive to treatment. To date, no definitive association between the vaccine and GBS has been proven by any strong evidence, but it has recently been added as a very rare side effect of the Janssen COVID-19 vaccine. No possible links of Miller Fisher syndrome to COVID-19 vaccines have been reported before the one reported in this study.

Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia.

Background: SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic, with more than 147 million being affected globally as of this writing. People's responses to COVID-19 range from asymptomatic to severe, and the disease is sometimes fatal. Its severity is affected by different factors and comorbidities of the infected patients. Living at a high altitude could be another factor that affects the severity of the disease in infected patients. Methods: In the present study, we have analyzed the clinical, laboratory, and radiological findings of COVID-19-infected patients in Taif, a high-altitude region of Saudi Arabia. In addition, we compared matched diseased subjects to those living at sea level. We hypothesized that people living in high-altitude locations are prone to develop a more severe form of COVID-19 than those living at sea level. Results: Age and a high Charlson comorbidity score were associated with increased numbers of intensive care unit (ICU) admissions and mortality among COVID-19 patients. These ICU admissions and fatalities were found mainly in patients with comorbidities. Rates of leukocytosis, neutrophilia, higher D-dimer, ferritin, and highly sensitive C-reactive protein (CRP) were significantly higher in ICU patients. CRP was the most independent of the laboratory biomarkers found to be potential predictors of death. COVID-19 patients who live at higher altitude developed a less severe form of the disease and had a lower mortality rate, in comparison to matched subjects living at sea level. Conclusion: CRP and Charlson comorbidity scores can be considered predictive of disease severity. People living at higher altitudes developed less severe forms of COVID-19 disease than those living at sea level, due to a not-yet-known mechanism.