Ectopic thymic carcinomas are rarely diagnosed in the thyroid gland, let alone in extrathyroid tissues. In the currently available literature, only five cases of extrathyroidal malignancies with thymic differentiation have been reported as arising in the major salivary glands. A 69-year-old female presented with a slow-growing palpable mass in the left parotid gland. Fine needle aspiration biopsy suggested metastatic cancer, whereas core needle biopsy revealed high-grade squamous cell carcinoma. The patient underwent left radical parotidectomy with selective ipsilateral lymph node dissection and subsequent radiation therapy. The surgical specimen was taken for histopathological examination. Microscopically, the tumor resembled thymic carcinoma. It was composed of large nests of squamoid cells with smooth contours, focally with a syncytial growth pattern, and accompanied by abundant lymphocytes with reactive lymphoid follicles. This appearance resembled a micronodular thymic carcinoma with lymphoid hyperplasia. Moreover, the tumor displayed expression of squamous markers (p40 and p63) and markers of thymic carcinoma (CD5 and CD117). Therefore, the final diagnosis of intrasalivary thymic carcinoma was rendered. The molecular analysis including next-generation sequencing demonstrated no variants of the strong, potential, or unknown clinical significance. The patient remains disease-free at 1-year follow-up. In the current case, we comprehensively present a clinical, microscopic, molecular, and radiological picture of CD5-positive squamous cell carcinoma of the parotid. We postulate that similar cases should be designated as intrasalivary thymic carcinoma analogically to similar thyroid tumors. Our case and the limited literature data indicate they should be distinguished from conventional squamous cell carcinoma of major salivary glands due to their rather favorable prognosis.
Introduction:The internet allows patients to access a vast amount of health information. We aimed to evaluate the credibility of YouTube videos that members of the public are accessing on brain aneurysms, and to evaluate what characteristics drive audience engagement. Material and methods:The first 50 videos for each of the following search terms were taken for analysis: 'brain aneurysm' , 'cerebral aneurysm' and 'intracranial aneurysm' . The quality of each video was evaluated by two neurosurgeons and two medical students independently using the Journal of the American Medical Association (JAMA) and the DISCERN instruments. Qualitative and quantitative video data was analysed for quality and audience engagement. Inter-rater agreement was ascertained.Results: Out of a total of 150 videos, 70 met the inclusion criteria. The mean total DISCERN score was 36.5 ± 8.4 (out of 75 points), indicating that the videos were of poor quality. The mean JAMA score was 2.7 ± 0.7 (out of 4 points). Inter-rater agreement between the four raters was excellent (intraclass correlation coefficient 0.90 for DISCERN and 0.93 for JAMA). Most videos were uploaded by hospitals (50%) or educational health channels (30%). Videos had a higher number of average daily views when they included animation (P = 0.0093) and diagrams (P = 0.0422). Conclusions:YouTube is a poor source of patient information on brain aneurysms. Our quality and audience engagement analysis may help content creators (i.e. hospital staff and physicians) to create more holistic, educational and engaging medical videos concerning brain aneurysms. Physicians could usefully refer their patients to the highest quality videos that we have found.
Aim of study. We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs).Clinical rationale for study. The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA.Materials and methods. 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single--centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy was compared to the extent of the actual clinoidectomy.Results. 21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs. Conclusions.The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures.Clinical implications: Currently, the role of 3D-CTA planning is restricted to educational purposes only.
The pathologist is frequently called "the doctor's doctor." However, there are many uncertainties about the role of a pathologist among patients and policymakers and even among other medical specialties. The aim of the current study is to analyze the misconceptions of who a pathologist is among inpatients and Internet users, to find where the lack of understanding is originating from, and to confirm the need to educate the general public about pathologists. The survey of Internet users was conducted among Facebook users, utilizing the snowball sampling method. Inpatients were randomly recruited in the Department of Surgical Oncology. Seventy-eight inpatients and 320 Internet users were enrolled in the study. Significantly, more hospital patients than Internet users answered that the pathologist is not an MD (p = 0.00953). A portion of participants stated that pathologists do not make diagnoses (n = 28, 7.03%) and do not influence the treatment plan (n = 37, 9.30%) and that the other specialists do not gain anything from the pathologist's work (n = 67, 16.83%). Only 15.07% of respondents had their information about pathologists from other doctors. The findings from this study should show that even the most basic knowledge of a pathologist being an MD is not known. Pathologists are not recognized for being involved in the diagnosis of diseases. This should provide an incentive to pathologists to teach future doctors, policymakers, and patients about the perplexity of the pathology specialty. It shows obvious gaps in the knowledge of the treatment process as a whole.
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