Purpose In the last edition of the American Joint Committee on Cancer (AJCC) staging system, differentiated thyroid cancers (DTC) showing microscopic extrathyroidal extension (mETE) are considered comparable to intrathyroidal cancers for their clinical behavior and prognosis. The aim of the study is to evaluate the impact of this updated assessment of T, when applied to the postoperative recurrence risk stratification, according to the American Thyroid Association Guidelines (ATA-RR). Methods One-hundred DTC patients who underwent total thyroidectomy were retrospectively evaluated. The downstaging of mETE was introduced in the definition of T, and the updated classification defined as modified ATA-RR (ATAm-RR). For each patient, post-surgical basal and stimulated thyroglobulin (Tg) levels, neck ultrasound (US) and post-ablative 131-I whole body scan (WBS) reports were considered. The predictive performance (PP) of disease recurrence was calculated both for each single parameter, as well as for all of them. Results According to ATAm-RR classification, 19/100 patients (19%) were downstaged. ATA-RR proved a significant PP for disease recurrence (DR) (sensitivity 75.0%, specificity 63.0%, p = 0.023). However, ATAm-RR performed slightly better due to an increased specificity (sensitivity 75.0%, specificity 83.7%, p < 0.001). For both classifications, the PP was optimal when all the above-mentioned predictive parameters were considered. Conclusion Our results suggest that the new assessment of T considering mETE resulted in a downgrading of ATA-RR class in a significant number of patients. This provides a better PP for disease recurrence, and the best PP was obtained when considering the whole predictive variables together.

Purpose: This study aimed to describe a rare case of bilateral choroidal effusion following a XEN45 implantation. Case Report: An 84-year-old man with primary open-angle glaucoma underwent uneventful ab interno XEN45 device implantation in the right eye. The immediate postoperative period was complicated by hypotony and serous choroidal detachment, which were treated and resolved using steroids and cycloplegic drops. Eight months later, the fellow eye underwent the same surgery, which was followed by choroidal detachment that required transscleral surgical drainage. Conclusions: This case highlights the importance of a careful postoperative follow-up and a timely intervention in the context of XEN45 implantation, and suggests that choroidal effusion in one eye may be a risk factor for choroidal effusion in the other eye when undergoing the same type of surgery.

Choroidal osteoma is a rare clinical entity of unknown etiology. It is a benign ossifying tumor characterized by mature bone replacing choroid. It typically affects young females, unilaterally. Vision loss occurs mainly due to photoreceptor degeneration secondary to decalcification and/or development of choroidal neovascularization, especially if located near the macular area. We present a case of an old woman with bilateral choroidal osteomas identified incidentally. An 84-year-old Caucasian woman who was asymptomatic, without clinical features suggestive of choroidal osteoma, was referred to our hospital for a follow-up visit. On the fundus examination, both eyes showed a suspected lesion. B-scan ultrasound demonstrated bilateral highly reflective calcified lesions within the choroid, with an evident cone of shadow, suggestive of choroidal osteoma. Further investigations have performed to confirm the diagnosis. Although the literature reports a more common one-sidedness and typical manifestation of choroidal osteoma in the teenage years, our case report refers to bilateral choroidal osteomas in an elderly woman.