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INTRODUCTION: Hürthle cell adenoma is a rare benign lesion of the thyroid gland, however, controversies about its potential malignant behavior still remain. Among thyroid neoplasms, papillary carcinoma is the most common variant with great variety of histological subtypes demonstrating different biological behavior. AIM: To raise the awareness of possible coexistence of these two lesions and discussion about possible therapeutic approaches. CASE REPORT: A 42 year old female patient was examined because of the pain in the thyroid area. Cytological examination suggested Hürthle cell adenoma. Subsequently, right thyroid lobectomy was performed. Intraoperative frozen sections confirmed the diagnosis, yet final histological analysis revealed encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), now reclassified as noninvasive follicular thyroid neoplasm with papillary- like nuclear features (NIFTP) within the adenoma, which was not noticed through scintigraphy, ultrasound, cytological and frozen section analysis. CONCLUSIONS: Problems concerning both diagnostic and therapeutic approach to these lesions are being discussed, since opinions reported in the literature are divided, posing great challenge for the clinician in determining adequate therapeutic procedures.

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A case of eccrine carcinoma of the interdigital foot glands in a 39-yr-old female Asian elephant (Elephas maximus) from Zagreb Zoo is described. The tumor between the toenails of the right forefoot was surgically removed 3 yr before postmortem examination (2003), and the histopathologic diagnosis was compound eccrine carcinoma characterized with glandular tubular and papillary proliferations, mild cellular pleomorphism, proliferation of the myoepithelial cells with mucoid secretions, and necrosis. Immunohistochemistry revealed strong immunoreactivity to S-100 protein, estrogen, and high-molecular weight cytokeratin. This elephant also had chronic renal fibrosis with uremia.

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Differentiated thyroid carcinomas, particularly papillary carcinoma, are the tumors with good prognosis, but sometimes have a tendency to spread into the surrounding tissue. The spread of these tumors usually involves muscle, cartilage and upper aerodigestive tract. During two years (2008-2009) at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Center Zagreb, 233 patients with differentiated thyroid carcinoma were treated. Among them there were 23 cases of locally invasive papillary thyroid carcinoma. In this paper we present our experience in treating 23 patients with locally invasive papillary thyroid carcinoma with special reference to extrathyroid spread, surgery and postoperative treatment. Our recommendations for the treatment of such patients are total thyroidectomy and selective neck dissection, removal of macroscopically visible tumors, radical surgery for tumors with intraluminal expansion in the upper aerodigestive tract and postoperative adjuvant therapy.

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We are reporting a case of a 42-yr-old female with a history of right breast carcinoma. She was surgically treated (breast quadrantectomy with axillary dissection) and receiving a third cycle of adjuvant chemotherapy when a feeling of a constant pressure in the front of the neck and lack of air occurred. Subsequent work-up revealed a node in the right thyroid lobe with enlarged paratracheal bilateral and right mid and lower jugular lymph nodes. Fine-needle aspiration cytology, repeated within a 20 days window and analyzed by two different cytologists, showed a medullary thyroid carcinoma with a cervical lymph nodes metastasis so the patient underwent total thyroidectomy with selective and paratracheal neck dissection. Histology and immunohistochemistry revealed the specimen to be metastasis of breast carcinoma. During regular follow-up of our patient, eighteen months after initial diagnosis, no new metastases were found. To our best knowledge, this is the first described case of a thyroid metastasis of breast carcinoma that was cytologically misdiagnosed as a medullary thyroid carcinoma.

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Neuroendocrine tumors (NET) of the larynx are rare and heterogenous group, with much confusion about nature and classification of these neoplasms in the past. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. A classification in 4 different types; paraganglioma, typical carcinoid, atypical carcinoid and small cell neuroendocrine carcinoma (SCNC) is a current consensus. Thorough diagnostic and a proper classification of neuroendocrine neoplasms are of paramount importance--prognosis and treatment differ significantly. We present two cases: 63-year old patient with SCNC of the larynx and a 53-year old patient with atypical carcinoid of the larynx. OctreoScan is useful tools for diagnostics and follow up of the patients and it is predictive for effectiveness of octreotide therapy.

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Orofacial granulomatosis (OFG) is an uncommon disease, usually presenting as recurrent or persistent swelling of the soft tissues in the orofacial region, predominantly lips (cheilitis granulomatosa). The cause of this illness is unknown. OFG may also be part of the triad of Melkersson-Rosenthal syndrome (MRS) and some consider it a monosymptomatic form of MRS. We describe a case of a Croatian male patient with recurrent swelling limited to the upper lip for the past 6 years. After establishing the diagnosis, we performed intralesional triamcinolone injections (16 mg, twice on a weekly schedule), resulting in complete remission. OFG differential diagnosis and treatment modalities are discussed.

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Inflammatory myofibroblastic tumor (IMT) is a pseudosarcomatous lesion occurring in soft tissue and organs. It is known under a wide number of terms, such as inflammatory pseudotumor, plasma cell granuloma, pseudosarcomatous myofibroblastic proliferation. IMT is most commonly located in the lung, while laryngeal location is rarely described. Due to its biology it can be misdiagnosed as a malignant tumor. We present a case of IMT of larynx, recognized in time and treated with laser ablation. Our case demonstrates the importance of timely IMT recognition in order to avoid overtreatment. This diagnosis should also alert clinicians to close follow-up of these patients.

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Thymoma is an uncommon neoplasm derived from thymic epithelium. It is located in the anterosuperior mediastinum. Thymoma may be associated with different types of additional primary malignancies; however, colorectal adenocarcinoma and thyroid cancer appear to be most common. A case is presented of a 63-year-old woman with type A thymoma and two other primary carcinomas of the breast and colon that were previously diagnosed. The patient underwent surgery due to metastatic colon cancer of the lung and yet another primary tumor was found in the mediastinum, later diagnosed as thymoma. A normal diploid pattern was found in the samples of thymoma and colon carcinoma, whereas those of breast carcinoma and metastatic tumor of the lung showed aneuploidy. On the basis of previous studies and our case, it is concluded that the occurrence of extrathymic malignancies does not correlate with the biologic behavior and DNA ploidy of thymoma.

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Primary orbital liposarcoma is a very rare orbital tumor and dedifferentiation in the liposarcomas occurs rarely. Dedifferentiation is defined by development, in a well-differentiated tumor, of poorly differentiated, high-grade areas. The dedifferentiated liposarcomas (DDLS) have a better prognosis than pleomorphic sarcomas as a whole. The treatment of DDLS patients proves to be complicated due to the fact that the histopathological diagnosis usually becomes evident only after the surgery. In the present paper, the clinical presentation, histopathological features, radiological characteristics and clinical treatment of one case of well-differentiated liposarcoma with dedifferentiated areas, abruptly delimited from the well-differentiated adipocytic component, are reported.

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