SSDD may be the most common identifiable cause for PT from venous origin and is potentially treatable. Temporal bone CT scans should be included in a complete evaluation of PT.

The incidence of thyroid cancer is rising in the United States with papillary thyroid cancer (PTC) being the most common type. We performed a retrospective study of 49 patients with PTC who underwent 57 lateral neck dissections (NDs). The extent of NDs varied, but 29 of 57 (51%) consisted of levels II–V. Twelve of 57 (21%) NDs consisted of levels I–V. Twelve of 57 (21%) NDs consisted of levels II–IV. One of 57 (1.8%) necks involved only levels I–IV. One of 57(1.8%) necks involved only levels I–V. One of 57(1.8%) necks involved only levels III–V. Two (3.5%) double-level (III–IV) neck surgeries were also performed. Metastatic PTC adenopathy was confirmed pathologically in 2%-level-I, 45%-level-II, 57%-level-III, 60%-level-IV, and 22%-level-V necks. Level-V was positive in 21% of primary and 24% of recurrent groups (P = 0.76). Comparing primary and recurrent disease, there was no difference in nodal distribution or frequency for levels I, II, III, and V. Level-IV was more common in the recurrent cases (P = 0.05). Based on the pathologic distribution of nodes, dissection should routinely include levels II–IV and extend to level-V in primary and recurrent cases. Our data does not suggest routine dissection of level-I.

Objective: Malignant teratomas of the thyroid are very rare, with less than 30 cases reported in adults. Presentation of a recent patient and a review of the literature have provided insight into the usual clinical presentation and histopathologic characteristics of malignant teratomas of the thyroid gland in adults and the available management options for this disease process. Methods: A healthy 33-year-old woman presented with a rapidly growing right neck mass. Fine-needle aspiration demonstrated poorly differentiated carcinoma favoring thyroid origin. The patient underwent total thyroidectomy, bilateral central compartment neck dissection, and right lateral neck dissection. Histopathologic analysis confirmed the diagnosis of malignant teratoma of the thyroid gland with metastases to the neck bilaterally. Results: Malignant teratomas are exceedingly rare tumors of the thyroid gland. These masses are typically diagnosed after thyroidectomy by histopathologic criteria. Fine-needle biopsy generally does not allow for sufficient sampling of the tumor. Historically, malignant thyroid teratoma has a poor prognosis. No standard treatment protocol has been widely accepted given the rarity of the disease, but surgical excision is recommended, followed by radiation and/or chemotherapy. Length of survival from this disease has increased since earlier reported cases, possibly due to a trend towards more aggressive adjuvant treatment in recent years. Conclusion: Malignant thyroid teratoma is a rare and aggressive disease process that requires multimodal treatment. (AACE Clinical Case Rep. 2016;2:e284-e289

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associated with increased risk of recurrence and intracranial involvement. METHOD: A retrospective chart-review was completed for all patients diagnosed with scalp or forehead cutaneous scc at a single institution between 1999 and 2009. The diagnosis of scc was confirmed based on pathology reports. Intracranial and/or cavernous sinus involvement was confirmed based on biopsy or imaging. RESULTS: Five male patients with cutaneous scc of the scalp or forehead that developed intracranial metastases were identified. The median age at diagnosis was 68 (53 -89) years. All patients were previously treatment for scc with wide local excision. The average tumor size at diagnosis was 4.9 cm. The mean time from initial diagnosis to intracranial extension was 5.4 months. The most common presenting symptoms were headache, pain, skin paresthesia and imbalance. Patients with cavernous sinus involvement presented with diplopia secondary to abducens nerve palsy. Mean survival time from diagnosis of intracranial involvement with and without cavernous sinus involvement was 3.5 and 9.7 months, respectively. The addition of radiation therapy did not influence disease free or overall survival. CONCLUSION: Cutaneous scalp and forehead scc are highly aggressive. Despite initial treatment with wide local excision and radiation therapy, local recurrence is common. Male gender, age greater than 50, tumor size greater than 2 cm, and moderate to poor or poor histologic differentiation are associated with increased risk of tumor recurrence and intracranial involvement.