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Diabetes mellitus (DM) and cancer are disorders of global importance. Multiple epidemiologic studies show that diabetic patients have an increased risk of developing cancer of different types. Myelodysplastic syndromes (MDS) are among the most common hematologic malignancies and include a heterogeneous group of hematopoietic neoplasms characterized by dysplastic changes, low blood counts, and an increased risk of progression to acute myeloid leukemia. Potential epigenetic and metabolic interferences between DM and MDS have been reported but are poorly understood. DM and MDS share some predisposing risk factors such as obesity. Patients with MDS and DM can experience worsening of diabetic control due to multiple factors that exacerbate hyperglycemia and insulin resistance such as stress, infections, adjunct drugs (e.g. steroids to control nausea), and others. In addition, accurate assessment of glucose control in diabetic patients who have MDS can be complicated. Alternatively, DM when associated with end-organ damage can complicate management of MDS, increase risks of complications, and limit the applicability of intensive therapeutic interventions. Here we review the current knowledge of the interactions between DM and MDS at the pathogenetic, clinical and epidemiologic levels, discuss how this knowledge could be used therapeutically to improve the outcome of patients affected by both conditions, and delineate important unmet needs that should be addressed in future research.

Secondary tumors of the thyroid are quite rare with an estimated prevalence of < 1%. Herein, we describe the incidental discovery of metastatic small cell lung cancer in a non-toxic multinodular goiter. A 57-year-old lady has had a non-toxic multinodular goiter for over 10 years. She has had two thyroid fine needle aspirations (FNAs) in the past, which were reported benign. As the goiter was increasing in size and causing compression, she underwent a total thyroidectomy. Pathology revealed multi-centric high grade carcinoma with small cell/neuroendocrine features with the largest focus being 1.1 cm. Calcitonin staining was negative. Further imaging revealed a 68 × 37 × 51 mm soft tissue mediastinal mass and an 18 × 10 mm left upper lobe pulmonary nodule. She was then initiated on chemotherapy and radiation therapy for extensive stage small cell cancer of the lung. After two cycles of chemotherapy, restaging chest computed tomography (CT) showed interval improvement in lung masses. This rare presentation of small cell lung cancer with multi-centric metastasis to the thyroid highlights the need to obtain nodule directed FNAs, as the two non-directed FNAs done prior to surgery were benign. It also points out to clinicians that rapidly growing goiters are a cause for concern, and should be evaluated, even if patients are not symptomatic.

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