<p>We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our first case was a 72 years old male presented with profuse bleeding from the left ear. On examination, proliferative, pink, friable mass was present in the left external auditory canal. On eliciting the detailed history, it was found that patient had renal cell carcinoma in the left kidney four years back and underwent left radical nephrectomy. Patient underwent left lateral temporal bone resection with cul-de-sac closure. Histopathological examination of the specimen showed metastatic renal cell carcinoma. Our second case was a 64 years old male presented with complaints of growth in the oral cavity of 1 month duration. On examination, 5×3 cms proliferative growth was present in the hard palate. Biopsy from the growth in the hard palate showed metastatic renal cell carcinoma. Patient gave history of renal cell carcinoma in the past for which he did not receive treatment. Our third case was a 45 years old male who presented to us with a diffuse swelling in the left temporal region of 2 months duration. On examination, 3×2 cms swelling was present in the left temporal region. Patient had history of renal cell carcinoma of left kidney and underwent left nephrectomy one year prior to the presentation of the left temporal swelling. Ultrasonography guided biopsy of the left temporal region showed metastatic renal cell carcinoma.</p>
Obstructive sleep apnoea (OSA) is a common problem affecting almost 4% of the population. Although continuous positive airway pressure (CPAP) is considered the standard of care, the patient compliance for long term use is poor. Clinicians have explored surgical options for cure with varying success. Uvulopalatopharyngoplasty was considered as a standard of surgical care but long-term results were not satisfactory. Surgical researchers have explored newer techniques to improve outcomes in the past decade with less morbidity and better quality of life outcomes. One of such development is Barbed Reposition Pharyngoplasty (BRP). We would like to discuss the technique of BRP for OSA patients step by step.
<p>Hidradenocarcinoma of the scalp is a rare skin adnexal tumour accounting for less than 0.001% of all tumors. In this study, we describe a rare presentation of the hidradenocarcinoma of the scalp in a 64 years old man. Patient presented with a right side scalp lesion in the occipital area, for which biopsy was done which showed hidradenocarcinoma. Patient underwent wide local excision of the posterior scalp lesion and posterolateral neck dissection and the patient was advised to receive adjuvant chemotherapy and radiotherapy, but the patient refused to undergo adjuvant therapy. Six months postsurgery patient had local recurrence in the posterior margin resection area and lung metastasis, which could have been prevented by adjuvant therapy. Malignant hidradenocarcinoma is a rare aggressive malignant tumour. Patients with this tumour should undergo surgical excision followed by adjuvant therapy.</p>
A 20-year-old female presented with a slowly growing solitary left thyroid nodule for 1 year. USG and CECT neck showed a 4 × 3 cm solid-cystic nodule in the left lobe of thyroid, with notable absence of the right lobe. FNAC from the nodule was Bethesda V. Operative findings confirmed right thyroid lobe agenesis with corresponding absence of right superior thyroid vessels. The right sided RLN, ESBLN, superior and inferior parathyroids, and inferior thyroid vasculature were in their anatomical positions. She underwent standard left hemithyroidectomy. Histopathological examination revealed follicular variant of papillary carcinoma.
The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent years, especially tumours of size less than 2 cm in diameter. In this study, we have analysed the patterns of behaviour of small-sized thyroid carcinomas (<2 cm, T1 tumours) in comparison with large-sized thyroid carcinomas. This is a retrospectively analysed data of patients with thyroid carcinoma. The following parameters were analysed: distribution with regard to age, sex and the presence of metastasis based on radioiodine scan. The following histopathological details were collected: maximal tumour diameter, extrathyroidal extension and lymphovascular invasion. Out of 152 patients, 39 patients were excluded due to the non-availability of complete details. Among the 113 patients of thyroid carcinomas, 43 patients (28%) were presented with small-sized tumours (measuring less than 2 cm). In small-sized thyroid tumours, 21.6% showed extrathyroidal extension. 2.7% of the small-sized thyroid carcinomas showed perineural invasion as compared to 6.3% of the large-sized thyroid carcinomas. Twenty percent of the small-sized thyroid carcinomas showed lymphovascular emboli. 51.2% of the small-sized thyroid carcinomas were presented with nodal metastasis as compared to 40% of the large-sized thyroid carcinomas. 57.5% of the small-sized thyroid carcinomas showed extracapsular extension as compared to 57.8% of the large-sized thyroid carcinomas. Despite small size, thyroid carcinomas have properties to behave aggressively as comparable to large-sized thyroid carcinomas. Taking the above facts into account, the small thyroid cancers should be treated with considerable caution as large thyroid cancers, especially since we have limited tools to predict the preoperative poor prognostic factors.
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