A rare case of orbital involvement in Riedel's thyroiditis.

We report a case of Riedel's thyroiditis in a 59-yr-old Caucasian female. She presented hypothyroidism and a stony hard, painful goiter. Due to fever, a high sedimentation rate and a high C-reactive protein (CRP), as well as high levels of anti-thyroid peroxidase antibodies (anti-TPOab), differential diagnostic considerations included acute and subacute thyroiditis as well as Hashimoto's thyroiditis and thyroid malignancy. At the same time the patient had clinical and radiological features of bilateral orbital pseudotumor with lacrimal gland involvement. During L-thyroxine therapy orbital symptoms and signs improved and thyroid size decreased. This case report serves as a reminder of differential diagnostic considerations in the etiology of goiter as well as ophthalmopathy. Although extremely rare, orbital sclerosing fibrosis can be seen in conjunction with Riedel's thyroiditis as part of multifocal fibrosclerosis.

Esthesioneuroblastoma--what is the optimal treatment?

A retrospective review was conducted on 13 patients with esthesioneuroblastoma (ENB), treated at our institution from 1977 to 1997. According to the Kadish classification, one patient was in stage A, 5 patients were classified as stage B and 7 patients were in stage C. Five-year disease-specific survival was found to be 51%. Forty-six percent of the patients experienced relapse and despite intensive salvage therapy, median survival after recurrences was only 12 months. This indicates the need for good primary control in local as well as distant disease. The role of pre- versus postoperative radiotherapy to secure good local control is discussed and compared with the literature, and treatment guidelines are proposed. The tumours were graded according to the Hyams' classification and its importance as a prognostic factor is briefly discussed.

Mucinous adenocarcinoma of the sublingual gland.

A case of mucinous (colloid) adenocarcinoma of the sublingual gland is reported. Adenocarcinomas associated with large pools of extracellular mucin are extremely rare in the major salivary glands. Analysis of the tumor for cytokeratin expression, estrogen and progesterone receptors was performed. Predominantly, the tumor expressed cytokeratins 7, 8, 18 and 19 that are commonly found in simple epithelia, and to a lesser degree cytokeratins 4 and 13 which are usually found in complex epithelia. Staining for estrogen and progesterone receptors was negative. No other cancer has been detected for three years after the first examination. The tumor is considered to be a primary mucinous adenocarcinoma of the sublingual gland.

[Milker's nodules]. / Malkerknuder.

Milker's nodule is a parapox virus infection seen mostly on the hands of dairy farmers. We saw 15 cases over a period of two years in the County of North Jutland. Clinically, milker's nodule goes through a papular, a nodular and a crusted stage. Most patients were seen when the infection was in the nodular stage, an often painful condition requiring treatment. Three patients developed an erythema multiformelike secondary eruption. Lesions from nine patients were removed for histological examination. The histology of all lesions was consistent with milker's nodule. In three of seven patients parapox virus was demonstrated by electron microscopy. Treatment was commonly curettage followed by cauterization.

Primary pulmonary leiomyosarcoma. Review of the literature and report of a case.

In a review of the literature, 38 cases of pulmonary leiomyosarcoma were found. An additional case with highly progressive course is reported and the diagnostic and therapeutic possibilities are discussed. Prognostic signs are evaluated. The importance of radical surgery is emphasized.

Epiermoid cyst in the kidney.

Epidermoid cyst of the kidney is a rare entity. In the case here presented, epidermoid cyst was an incidental finding at urography performed in a 67-year-old man in connexion with splenectomy for polycythaemia. The cyst was interpreted as an old tuberculous focus. Two years later partial nephrectomy was performed because of repeated attacks of renal colic and signs of recurrent pyelonephritis. The diagnosis of epidermoid cyst was not made preoperatively in this case, or in the cases described in the literature.

Carcinoma occurring in branchial cleft cysts.

In order to find histological data in the differentiation between branchial cleft carcinomas and metastatic carcinomas, the specimens from 154 patients with branchial cleft cysts and 7 patients with an isolated tumour in the neck with unknown primary tumour were reviewed and compared with 10 normal lymph nodes. Absence of lymph node structures as peripheral lobulation, internodular trabeculae and perinodular sinuses in branchial cleft cystc, are found valuable for distinguishing primary carcinoma of branchial cleft cysts from metastases. A correct diagnosis of this rare tumour is important in order to avoid overtreatment of these patients, who have a good prognosis if treated with surgical excision only.