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Many associations of congenital anomalies of the respiratory system have been reported, but the combination of tracheal diverticulum and cystic adenomatoid malformation (CCAM) is unique. We present a patient with these two anomalies and analyze their embryological correlation.

Twelve weeks of cetuximab maintenance therapy after concomitant cetuximab + RT in locally advanced oropharyngeal carcinoma is feasible and improves clinical outcomes measured at 1 year. This improvement is not maintained after the second year suggesting that epidermal growth factor receptor blockade is not sufficient to completely eliminate the minimal residual disease.

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We read with interest the article by Dr Richman and colleagues, "Thyroid Nodules in Pediatric Patients: Sonographic Characteristics and Likelihood of Cancer," in the August 2018 issue of Radiology (1) in which they describe the nodule characteristics in a large pediatric population. American Thyroid Association (ATA) guidelines in pediatric patients are basically the same as those for the evaluation of adult nodules. Dr Richman and colleagues demonstrated that these guidelines are not completely applicable for the evaluation of pediatric thyroid nodules. In their study, they found that 16.9% of malignant nodules corresponded to diffuse sclerosing papillary carcinomas, a type of thyroid cancer that shows an enlarged gland with extensive speckled calcifications without a discrete mass or a defined nodule (1). These characteristics are not applicable to ATA or Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, generating the necessity of creating a new classification system or modifying an existing classification system for pediatric patients with thyroid nodules. Dr Richman and colleagues stated that nodule biopsy was performed by a pediatric endocrinologist with US guidance from the radiologist (1). We have not found anything in the literature that supports or contradicts this way of performing a thyroid nodule biopsy; however, the vast majority of thyroid biopsies are performed by one operator. We wonder if this approach could increase the length of the procedure, generating longer anesthesia times and making it less cost-efficient, and if they have faced an increase in nondiagnostic results or safety issues. These issues are not clearly described in the article, so we would like to know their experience and if they will keep performing the pediatric thyroid biopsies in this way. The authors stated that, according to protocol, they only included nodules with definitive results and sonographic images available for review. We wonder how frequently they found nondiagnostic biopsies because they did not include these patients in the study, with a probable selection bias. Did the two-operator technique have a high percentage of inadequate biopsies? In other cohorts, nondiagnostic biopsies can be as high as 26% of total nodule biopsies (2). In addition, we would like to know if the authors are using genetic testing for indeterminate thyroid cytologic findings (3). Disclosures of Conflicts of Interest: G.T. disclosed no relevant relationships. S.V. disclosed no relevant relationships. A.J.M. disclosed no relevant relationships.

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