Rationale: Venous thrombus embolism (VTE) includes deep-vein thrombosis (DVT) and pulmonary embolism (PE) which may be an initial symptom for patients with cancer. PE has diverse clinical manifestations and is a rare complication of testicular tumor (TT). Patient concerns: Here, we report a 21-year-old man admitted to our hospital due to syncope. Diagnoses: Clinical examinations upon admission demonstrated PE resulting in syncope. Further, a malignant TT, liver metastasis, and inferior vena cava (IVC) thrombosis were diagnosed. Interventions: Low molecular heparin was administered immediately after PE was diagnosed. Outcomes: The patient suffered from cardiac arrest on hospitalization. Lessons: Physicians should consider the possibility of TT when a young male patient presents with syncope and is diagnosed with PE that cannot be explained by a common cause. Treatment for TT and PE should be performed as early as possible to improve the prognosis of patients combine with TT and PE.

Rationale: Hürthle cell adenoma (HCA) of the thyroid is a rare thyroid tumor, and there are limited studies on the contrast-enhanced computed tomography (CT). Patient concerns: We report the case of a 63-year-old woman with gradual enlargement of the thyroid over 10 years. Diagnoses: Preoperative contrast-enhanced CT revealed typical lesion characteristics of HCA, confirmed by postoperative pathology. Interventions: Left thyroidectomy and partial right thyroidectomy were performed on the patient after general anesthesia. Outcomes: At follow-up of 12 months after surgery, the patient was in good health without recurrence. Lessons: The typical imaging features of HCA on contrast-enhanced CT are helpful for the early diagnosis of thyroid eosinophilic adenoma. This will provide an important basis for the preoperative diagnosis and treatment strategy of HCA of the thyroid in future.

Rationale: Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors. Patient concerns: Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission. Diagnoses: Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed. Interventions: Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed. Outcomes: The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed. Lessons: It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.

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