Between 1972 and 1984, we treated 66 patients with foreign bodies (FBs) in the tracheobronhial tree. Twenty-six patients (39.4 percent) were between one and two years old; 52 (78.8 percent) were under age ten. Forty-four FBs (67 percent) were fruit and vegetable seeds and nuts. Soft organic material (meat, cucumber peels) was found in four patients, chicken bones in six, pins and needles in six, other nonorganic materials (toys, stone, broken thermometer) in six. In 55 patients, the FB was removed at bronchoscopy; three patients coughed up the FB shortly after bronchoscopy. Eight patients were operated on because the impacted FB could not be removed at repeat bronchoscopy trials. In this group, the FB was removed through a bronchotomy in two patients, but in six, pulmonary resection was necessary because of severe bronchiectasis (FBs had been impacted from ten months to 12 years). Stiff bronchoscope was used in all patients. In several cases, the flexible bronchoscope was used initially but proved inadequate. There were three complications, two related to hypoxia, but no deaths. Infants and little children should be prevented from reaching peanuts and seeds. When presence of a FB is suspected, and in children with unresolving pneumonic process, early bronchoscopy is mandatory. Expert anesthesia is essential, and hypoxia must be avoided.

As with all pediatric cancer, the public health burden of pediatric H&N cancer continues to rise. The proportion of H&N malignancy to all pediatric cancer is stable. With the incidence increasing, however, work to identify treatment strategies remains crucial.

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Background. Epithelioid hemangioendothelioma (EHE) is a rare tumor usually presenting in soft tissue. EHE is a vascular malignancy of intermediate clinical behavior, with a histologic appearance of endothelial cells growing in nests or cords. Although EHE often originates from a vessel, it is relatively rare for a primary vascular EHE to originate from a large vein or artery. Occurrence in the mediastinum is exceptionally rare. There are no known associations with other malignancies. Case Presentation. We present a case of mediastinal invasive EHE in a 39-year-old female with concurrent papillary thyroid cancer. She initially presented with a thyroid mass found by her primary care provider, with preoperative imaging concerning for extension into the superior mediastinum. Operative exploration revealed a mediastinal mass distinct from her thyroid carcinoma with invasion into the great vessels, requiring off-pump interposition graft bypass for en bloc resection. Final pathology confirmed pT3N1b multifocal papillary thyroid carcinoma with a separate grade 1 pT1b EHE. Review of the literature describes the demographics, updated pathologic outcomes, histologic findings, and reported incidence of EHE. Conclusions. This is the first reported case of thyroid malignancy with separate and concurrent EHE. Surgeons should remain aware of this entity given its variable behavior. Although initially described as an indolent neoplasm, tumors with poor prognostic factors have been shown to be locally aggressive.