Intraductal carcinoma of the salivary glands is a rare, not well-characterized tumor. We reviewed the literature and report the first case of a high-grade unicystic intraductal carcinoma of the parotid. Formalin-fixed/paraffin-embedded blocks were sectioned and stained for hematoxylin and eosin and immunostains (CAM5.2, EMA, CK5, p53, p63, SMA, S100 protein, DOG1, mammaglobin, AR, ER, PR, Her-2, and Ki67). A 72-year-old man showed a painless nodule (2 cm) in the right parotid region. A 'tumor of uncertain malignant potential' (low grade) was diagnosed by fine-needle aspiration cytology (FNAC). Preoperative magnetic resonance imaging revealed a well-delimited, oval cyst without evidence of parenchymal invasion (T1-scans: homogeneously isointense with hypointense thin peripheral ring; T2-scans: strongly hyperintense). Histological examination confirmed a unilocular cyst lined by a multistratified epithelium arranged in solid, pseudopapillary, cribriform, and 'incomplete cribriform/microcystic' patterns. Tumor cells were CAM5.2+, EMA+, mammaglobin+, AR+, p63+ (focal), CK5+ (focal), p53 (+, 20%), ER-, PR-, S100 protein-, DOG1-, and Her-2-. A continuous peripheral layer of p63+/CK5+/SMA+ myoepithelial cells proved the 'in situ' nature of the tumor. The evidence of focal severe nuclear atypia, high mitotic index (12 mitoses/10HPFs), and high proliferation index (40%) favored a high-grade intraductal carcinoma. Preoperative FNAC and clinic-pathologic correlation are very helpful. Discrepancy in dysplasia grade between FNAC and resected specimen can occasionally occur (especially in case of focal high-grade features). Total sampling should exclude invasive areas or other cystic malignancies.

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4.

The pseudo-aneurysm is a hematoma of post-traumatic origin, and capsulated button which is in communication with the lumen of the artery of relevance. Singular occurrence in the district ENT, if not recognized early the pseudo-aneurysm can result in dramatic events such cataclysmic bleeding or acute occlusion of the upper airway. In literature there are outstanding references to the pseudo-aneurysm of the superior thyroid (ATS). We present a rare case of pseudo-aneurysm occurred after the ATS trans-esophageal echocardiography (TEE) and external cardioversion. KeywordsPseuduoaneurysm; ENT Complication; Endovascular Coil Embolization homogeneously enhancing mass, 9.5 x 3.2 cm diameter in left neck spaces extending superiorly to parapharyngeal spaces, inferiorly to hypopharynx displacing hyoid bone , thyroid cartilage, posterior to crycoid cartilage displacing cervical esophagus and laterally to subcutaneous tissue displacing sternocleidomastoid muscle (Figure 1). The mass was suggestive for hematoma. The angiography revealed a pseudoaneurysm with active bleeding of the terminal tract of superior thyroid artery (STA) (Figure 2). An endovascular procedure was performed with a superselctive microcateter and a endovascular occlusion by coil embolizzation of STA with exclusion of the pseudoaneurysm demonstrated at the end of the procedure (Figure 3). The symptoms resolved after one day from the endovascular procedure. The patient was discharged after two days without evidence of bleeding and an endoscopic control after 4 weeks revealed a disappearance of swelling. DiscussionPseudoaneurysm, also called "false aneurysm", is an 2/3A fast development of an expanding mass under the angle of the mandible or in lateral pharyngeal wall after surgical procedure of the neck, percutaneous biopsy and neck trauma should always raise the suspect of an extra cranial arterial pseudoaneurysm.In our knowledge only three cases of pseudoaneurysm of superior thyroid artery have been reported previously. The first case was a pseudoaneurysm occurred after ultrasonographically guided chemical parathyriodectomy [15]. The diagnosis was made by angiography and treated by selective coil embolization. The second case reported a pseudoaneurysm occurred in a patient with hypopharyngeal squamous cell carcinoma during simultaneous radiotherapy and chemotherapy [13]. The diagnosis was made by a CT scan and treated by selective coil embolization. The third case reported a pseudoaneurysm after ultrasonographically guided biopsy of a thyroid nodule [10]. The diagnosis was made after ultrasonography and color Doppler examination and treated waiting spontaneous thrombosis.In our patient the pseudoaneurysm occurred after a transesophageal echocardiography guided cardioversion (TEEguided). The diagnosis was made by a computed tomography scan and treated by selective coil embolization. Transesophageal echocardiography guided cardioversion with short-term anticoagulation can be considered a safe and clinically effective for patients with atrial fibrill...

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