Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.

Metastasis of esophageal squamous cell carcinoma to the thyroid gland with widespread nodal involvement: A case report

BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and multifocal thyroid lesions alone are extremely rare.CASE SUMMARY In this case report,we present a case of a 69-year-old male with esophageal MTG.The patient visited our hospital for a routine body check-up,which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes.A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes.The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes,and a total thyroidectomy was performed.The histology showed MTG and therefore,a diagnostic work-up was implemented to determine the primary tumor.A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck,chest,and abdomen were involved.An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma.The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.CONCLUSION This case report highlights the difficulty in diagnosing esophageal MTG.Patients may have no malignancy history and be asymptomatic.Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology,and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.

A Case Report of Thyroid Gland Squamous Carcinoma with Multiple Metastases

The patient was a female, 65 years to feel intermittent discomfort in old. Early in 1996, she began her neck, accompanied with hoarseness. In June, 2000, when she entered our hospital and accepted a physical examination, we found a 3 cm×2 cm tumor at the lower pole of the thyroid gland. Neck CT showed that the mass was located at the inferiorposterior right part of the thyroid gland with a diffuse boundary. MRI showed that the right thyroid cartilage wall was incomplete. Fine-needle aspiration cytology indicated a suspected papillary tumor.

The Number of Lymph Nodes and Relationship with Presence of Thyroiditis and Thymic Tissue in the Central Neck Dissection Materials for Thyroid Papillary Carcinoma: Pathologic Analysis

Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.

Skull metastasis in papillary carcinoma of thyroid:A case report

Papillary thyroid carcinoma with metastasis to the skull is extremely rare.We report a case of unsuspected papillary thyroid carcinoma with skull metastasis.A 48-year-old female patient presenting with painless,pulsatile,progressively increasing swelling in the occipitoparietal region of the scalp approached for an X-ray of the skull.Ultrasound of palpable swelling in the neck revealed a heteroechoic lesion with increased vascularity.Foci of calcification were seen involving both lobes of the thyroid.Ultrasound of scalp showed a destructive mass in the skull with increased vascularity.Biopsy of thyroid lesions revealed branching papillae having a dense fibrovascular core covered by cuboidal epithelial cells with nuclei having a clear ground glass appearance.This case illustrates how isolated extensive skull metastasis can be found in papillary carcinoma patients without causing significant morbidity.Therefore,in the clinical course of thyroid papillary carcinoma,skull metastasis should be considered,and the patients should be meticulously investigated and followed up.

Study on the mechanism of Haizao Yuhu Decoction in inhibiting pro-liferation of thyroid papillary carcinoma cells

Objective: To clarify the inhibitory mechanism of Haizao Yuhu Decoction on BRAFV600E mutation-driven papillary thyroid carcinoma cells. Methods: Prepare seaweed Yuhu Decoction medicated serum, select human normal thyroid cells Nthy-ori3-1 as the normal control group, and PLX4032 as the positive control drug. The experiment was divided into normal control group, model control group, PLX4032 group, Haizao Yuhu Decoction group (referred to as HYD group), Haizao Yuhu Decoction group + PLX4032 (referred to as HYD+PLX4032 group), and high iodine water group, at 8h and 24h respectively. At 72h, the cell proliferation of each group was detected by MTT method;at 24h, the expression of ERK and p-ERK protein in each group was detected by Western blot. Results: The longer the time, the more obvious the inhibitory effect of Haizao Yuhu Decoction-containing serum on the proliferation activity of BCPAP cells: Compared with the normal control group, the BCPAP cell proliferation activity of the model control group was significantly enhanced at 24h and 72h (P <0.05);At 24h, the PLX4032 group, HYD group, and HYD+PLX4032 group all showed a tendency to inhibit the proliferation of BCPAP cells, but there was no statistical difference;at 72h, compared with the model control group, the PLX4032 group The cell proliferation activity of the HYD group and HYD+PLX4032 group was significantly inhibited (P <0.05), and there was no difference between the high iodine water group and the model control group (P>0.05). In inhibiting the proliferation of BCPAP cells, the medicated serum of Shanghai Zaoyuhu Decoction has a synergistic effect with PLX4032 (F=10.87, P=0.005). Western blot results showed that there was no difference in the expression of ERK1/2 protein between the groups, but there were significant differences in the expression of p-ERK1/2 protein between the groups: Compared with the normal control group, the expression of p-ERK1/2 protein in the model group increased significantly (P < 0.05);Compared with the model control group, the expression of p-ERK1/2 protein in the PLX4032 group, the HYD group, and the HYD+PLX4032 group decreased significantly (P <0.05), and there was no difference between the high iodine water group and the model control group (P> 0.05). Conclusion: The medicated serum of Haizao Yuhu Decoction has an inhibitory effect on the proliferation of BCPAP cells, and its mechanism may be inhibiting the proliferation of BCPAP cells by inhibiting ERK1/2 protein phosphorylation, a protein post-translational modification process;the medicated serum of Haizao Yuhu Decoction may have Help enhance the effect of PLX4032 curative effect.

Thyroid Papillary Carcinoma in a Branchial Cleft Cyst—A Case Report

Objective: Report a rare case of a thyroid papillary carcinoma situated within a branchial cleft cyst. Case presentation: A 40-year-old male was referred to our department for a lateral neck mass assessment. Physical examination revealed a solitary palpable, painless, moveable neck mass. Assessment included complete nasal, pharynx and larynx endoscopy, neck computed tomography, and fine needle aspiration biopsy. Treatment was surgical excision of the neck mass. Histopathology confirmed a branchial cleft cyst with papillary thyroid carcinoma growth at a site. A neck and thyroid ultrasound showed presence of thyroid gland nodules (one of which with micro calcifications). Thyroid fine needle aspiration biopsy performed, was high suspicious for malignancy (BETHESDA V). Patient underwent total thyroidectomy and histopathology revealed papillary thyroid carcinoma. Conclusion: Although rarely, it is possible to face an unexpected malignancy within a clinically benign neck lesion. A thorough diagnostic work-up enables early identification of aforementioned potential malignancy. A diagnostic dilemma that arises in such cases is between primary or metastatic disease and a thyroid carcinoma arising from ectopic thyroid tissue.

A Case Report of the Association Renal AA Amyloidosis and Thyroid Papillary Carcinoma

AA amyloidosis is often secondary to chronic inflammatory diseases but can rarely occur in patients with malignant neoplasms. A 33 years old woman with papillary carcinoma of thyroid was hospitalized in our department of Nephrology for nephrotic syndrome. Renal histology finds AA amyloidosis. To our knowledge, this is the first report of a patient with papillary carcinoma of thyroid and secondary (AA) amyloidosis with amyloid deposition in the kidneys causing nephrotic syndrome.

Effect of Hashimoto’s Thyroiditis on Efficacy of 131I Ablation Therapy in Intermediate- and High-Risk of Thyroid Papillary Carcinoma

Objective: The purpose of this study was to investigate the effect of Hashimoto’s thyroiditis on efficacy of 131I ablation in intermediate- and high-risk of thyroid papillary carcinoma patients. The findings will help to develop a personalized treatment plan for patients with thyroid papillary carcinoma complicated with Hashimoto’s thyroiditis. Material and Methods: From January 2016 to December 2020, patients who were diagnosed with intermediate- and high-risk PTC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastasis, positive TGAb, TSH Results: A total of 525 patients (166 males and 359 females) were included in the study, including 368 patients in ER group (70.1%) and 157 patients in NER group (29.9%). Eleven factors including combining Hashimoto’s thyroiditis, pre-ablative Tg levels, sex, tumor diameter, extraglandular invasion, multifocal, bilateral lesions, central lymph node metastasis, lateral lymph node metastasis, lymph node metastasis rate, thyroglobulin were statistically different between ER group and NER group with significance at P Conclusion: Hashimoto’s thyroiditis, Ps-Tg level and lateral lymph node metastasis are potential predictors for short-term efficacy of 131I treatment in intermediate- and high-risk thyroid papillary carcinoma. Hashimoto’s thyroiditis, high Ps-Tg level and increased number of lateral lymph node metastasis reduce the efficacy of 131I therapy in patients with intermediate and high risk thyroid papillary carcinoma.

Association Study of Thyroid Papillary Carcinoma with Depression and BDNF Expression

Objective: To analyze the correlation between Val66Met gene of brain-derived neurotrophic factor (BDNF) and papillary thyroid carcinoma (PTC) complicated with depression. To evaluate the clinical value of papillary thyroid carcinoma. Methods: Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the correlation of BDNF in the blood of patients with depressive disorder of thyroid papillary carcinoma using polymerase chain reaction PCR. The relationship between BDNF gene polymorphism and the incidence of thyroid papillary carcinoma was analyzed, and the susceptibility factors of thyroid papillary carcinoma complicated with depression were explored. Results: Compared with normal control group, T3 and T4 of PTC in non-depressed group were decreased, while TSH and TPOAb were increased (P < 0.05). Compared with normal control group, T3, T4 and TPOAb were increased and TSH was decreased in PTC depression group (P < 0.05). PTC depression score was higher than that of healthy control group (P < 0.05), and PTC combined depression score was higher than that of normal control group (P < 0.05). The depression rate of PTC combined with depression was 86.7%, which was higher than that of other groups (P < 0.05). The distribution of RS6265 locus genotype of BDNF gene was significantly different between PTC with depression group and PTC without depression group (P Conclusion: There is a significant difference between PTC with depression and PTC without depression, which is related to SNP rs6265 of BDNF gene. AG and GG are both risk sites of PTC with depression, and GG type is more prone to PTC with depression.

Esthesioneuroblastoma, Thyroid Gland Carcinoma and Gastrointestinal Stromal Carcinoma

Olfactory neuroblastoma (esthesioneuroblastoma, ЕNB) is a rare tumor arising from the olfactory neuroepithelium. We report a case of ЕNB located in inferior nasal concha, combined with thyroid gland carcinoma and gastrointestinal stromal carcinoma in a 77-year-old man. The tumor was resected endonasally. When the final diagnosis of olfactory neuroblastoma was confirmed by histopathologic examination and immunohistochemical staining, the PET/CT examination was performed. The imaging revealed a small focus of a moderately increased cancer activity in the thyroid region. A gastrointestinal stromal carcinoma was detected one year after the resection of the thyroid gland. We discuss the clinical appearance of ENB, staging systems, diagnosis and management. During the endonasal surgery, ENB was removed entirely. Seven days after operation, in order to monitor the postoperative result, PET/CT was performed and a papillary thyroid cancer was detected. One year after the thyroid surgery, gastroendoscopy showed a neoplastic formation in the stomach. In conclusion, we state that when identified as aggressive tumors such as ENB, it is necessary to provide regular examinations in order to detect distant ENB metastases or other neoplastic localisations.

Correlation of thyroid papillary carcinoma CEUS characteristics with cancer cell proliferation and invasion

Objective:To study the correlation of thyroid papillary carcinoma CEUS characteristics with cancer cell proliferation and invasion.Methods:A total of 128 patients with thyroid papillary carcinoma who received surgical treatment in the hospital between May 2013 and May 2016 were collected, CEUS was used to make clear the peak intensity (PI) and area under the curve (AUC) of tumor tissue and surrounding normal tissue, and the median of PI and AUC was referred to further divide the patients into high PI group and low PI group as well as high AUC group and low AUC group, 64 cases in each group. Fluorescent quantitative PCR was used to determine proliferation and invasion gene mRNA expression in tumor tissues.Results: PI and AUC levels in tumor tissue were lower than those in surrounding normal tissue;proliferation genes EZH2, Livin, hTERT, HMGA1 and Wip1 mRNA expression of low PI group were higher than those of high PI group, and invasion gene Ki-67 mRNA expression was higher than that of high PI group while P53 and MRP-1 mRNA expression were lower than those of high PI group;proliferation genes EZH2, Livin, hTERT, HMGA1 and Wip1 mRNA expression of low AUC group were higher than those of high AUC group, and invasion gene Ki-67 mRNA expression was higher than that of high AUC group while P53 and MRP-1 mRNA expression were lower than those of high AUC group.Conclusion: Thyroid papillary carcinoma CEUS parameters PI and AUC levels can quantifiably reflect the cancer cell proliferation and invasion activity.

Papillary Carcinoma Derived from Ovarian Mature Cystic Teratoma: A New Case Report and Literature Review

Introduction: Papillary carcinoma arising from thyroid tissue in mature cysticteratoma (MCT) of the ovary is extremely rare, and it is not easy to diagnose preoperatively. No clinical, no radiological, no biological signs are specific to malignant transformation. Case presentation: A 51-year-old woman had a left ovarian tumor measuring approximately 18 cm diameter with malignant transformation of a mature cysticteratoma, who was diagnosed postoperatively with follicular variant of papillary thyroid carcinoma. A laparoscopic hysterectomy and left salpingo-oophorectomy were performed. During surgery, there were no signs of invasion or metastasis. Conclusion: Consideration should be given to thyroidectomy followed by total-body scanning and serum studies for foci of thyroid carcinoma and adjuvant therapy with thyroidectomy and radio ablation if residual disease is identified.

Progress in the Study of Gene Mutations Associated with Papillary Thyroid Carcinoma

In recent years, there has been a global rise in cases of papillary thyroid carcinoma (PTC), the predominant form of thyroid cancer. Advances in molecular biology have intensified the focus on the genetic mutations associated with this malignancy. Researchers have conducted extensive investigations into these mutations to elucidate their roles in the initiation, progression, treatment, and prognosis of PTC. This review synthesizes studies on the genetic mutations implicated in PTC, examining specific mutated genes, mechanisms of mutation, correlations with clinicopathological features, and their influence on treatment outcomes and prognosis. The objective is to provide a theoretical framework for enhancing the diagnosis, treatment, and prognostic assessment of PTC in the future.

Childhood Papillary Thyroid Carcinoma: A Case Report

Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.

Low-Risk Papillary Thyroid Carcinoma Recurring as a Single Brain Metastasis: A Case Report and Literature Review

Background: Brain metastases from papillary thyroid carcinoma are infrequent occurring in 0.15% to 1.3% of patients, and they are generally accompanied by synchronous metastases in other sites and in isolation are even less frequent;the information about their management is limited and it has been based mainly on retrospective studies, experiences, case reports, and management guidelines of brain metastasis of other cancers. Aim: We report this case with the objective of describing how unpredictable the behavior of thyroid cancer can be despite being classified as low risk of recurrence. Case Presentation: A female patient with a diagnosis of papillary thyroid carcinoma classified as low risk who after more than a year of surveillance and without alterations in laboratory and imaging studies, developed a single brain metastasis susceptible to treatment with radioactive iodine (RAI) therapy. Conclusion: This case emphasizes the importance of a close follow-up of patients and not to minimize any symptom, no matter how simple it may seem, since cancer has no rules in its evolution.

Studies on surgical methods for sporadic micromedullary thyroid carcinoma

Background:To observe the changes in serum calcitonin levels after application of different surgical methods for primary medullary thyroid microcarcinoma(MTMC)and explore a more reasonable surgical method.Methods:A retrospective analysis of 36 patients with MTMC,16 in group A and 20 in group B,was performed.In group A,tumors were single and confined to the thyroid lobe,and thyroid lobectomy with isthmusectomy was performed.In group B,tumors were in the isthmus or invaded the thyroid gland,or there were multiple foci in bilateral lobes,and patients with primary foci underwent total thyroidectomy.The median follow-up time was 3.6 years.Clinical and pathological characteristics and changes in serum calcitonin(CTn)and carcinoembryonic antigen levels after the surgery were compared between the 2 groups.Results:The difference in the biochemical cure rate after surgery was statistically significant between patients with preoperative serum calcitonin levels<150 pg/mL and≥150 pg/mL(P<0.01).No significant differences in the biochemical cure rates and serum calcitonin levels were noted at different time points after surgery between group A and group B(P>0.05).One recurrence and metastasis were observed in each group after surgery.Conclusions:After performing different surgical methods for the primary foci of MTMC,the changes in serum calcitonin and carcinoembryonic antigen levels are similar.Especially for patients with single foci confined to the thyroid lobe without lateral cervical lymph node metastasis and with serum calcitonin levels<150 pg/mL,the unilateral thyroid lobectomy with isthmectomy can achieve the same therapeutic effect and biochemical cure rate as total thyroidectomy.

Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma:A case report and review of literature

BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,Hürthle cell carcinoma,poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature,but there have been no reports about PTMC.CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination.She had no symptoms,and the physical examination showed no positive signs.Subsequent ultrasonographyguided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance,with some actively growing cells(TBSRTCⅢ)and the BRAFV600E mutation not present.This patient underwent left thyroidectomy,isthmus lobectomy,prophylactic central lymph node dissection and thromboembolectomy.Postoperative pathology showed papillary microcarcinoma of the left thyroid,and the thrombus in the middle thyroid vein was a tumor thrombus.CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC,but it does exist.Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid,and we strongly suggest close follow-up of these patients.

Predictive value of enhanced CT Hounsfield unit value for central lymph node metastasis in Hashimoto’s thyroiditis with papillary carcinoma

Objective To investigate the diagnostic and predictive value of enhanced CT Hounsfield unit value for central lymph node metastasis(CLNM)in patients with Hashimoto’s thyroiditis(HT)complicated with papillary thyroid carcinoma(PTC).Methods The CT images of HTs with PTC confirmed by operation and pathology from 88 patients were analyzed retrospectively.Among them,50 cases of CLNM were all negative and 38 cases of CLNM were all positive.One lymph node was selected as the study subject in each case.The average HU values(AHUVs)and maximum HU values(MHUVs)were measured on the enhanced CT.The diagnostic efficacy of the two parameters for diagnosing CLNM was analyzed by the receiver operating specificity curve(ROC),and the best cut-off values were obtained,which were used to predict 103 HT with PTC CLNM in the validation group.Results The AHUVs of negative group and positive group were(63.79±15.34)HU and(90.92±18.04)HU(t=8.828,P<0.001).The MHUVs of negative group and positive group were(77.08±15.30)HU and(108.79±18.37)HU,respectively(t=7.615,P<0.001).The AUCs for AHUVs and MHUVs for the diagnosis of CLNM-positive was 0.870 and 0.906,and the cut-off values were 84.0 HU and 96.5 HU,respectively.The sensitivity,specificity,and accuracy of predicting CLNM positivity in the validation group using AHUVs≥84.0 HU were 35.7%,95.1%,and 70.9%,respectively,and MHUVs≥96.5 HU were 38.1%,93.4%,and 70.9%,respectively.Conclusion AHUVs≥84.0 HU and MHUVs≥96.5 HU have high specificity for the diagnosis of HT with PTC CLNM,which can provide an important basis for clinical treatment decision.

A Case of Papillary Thyroid Carcinoma Arising from Struma Ovarii and Extending into the Bladder

Ovarian goiter is a form of single tissue teratoma of the ovary, accounting for 2% - 3% of mature ovarian teratomas. Malignant transformation may occur in rare cases. Papillary thyroid-type carcinoma represents the most common type of malignant struma ovarii, followed by follicular carcinoma. Malignant struma ovarii is commonly seen in women in the fifth decade. The diagnosis is often made post-operatively after histological examination. Histology also helps assess tumor aggressiveness (mitoses, necrosis, poorly differentiated subtype, etc.). Given the rarity of these lesions, no therapeutic consensus or prognostic value had yet been formally established. We report herein, the case of a 76-year-old woman with a cystic tumor of the right ovary and a nodular lesion of the bladder. The clinical symptomatology is nonspecific, associating abdomino-pelvic pain and a right latero-uterine mass on abdominal palpation. After total hysterectomy with bilateral adnexectomy, the diagnosis of papillary carcinoma arising from struma ovarii and extending into the bladder was made. Through this observation, we suggest to discuss the anatomoclinical particularities of this rare pathological entity.