Abstract:We report the immunohistochemical diagnosis, including TTF-1 (thyroid transcription factor 1) and Ki-67, of a rare mixed thyroid neoplasm composed of minimally invasive well differentiated follicular areas and highly aggressive undifferentiated anaplastic areas. A 75 old female presented to our clinic with a rapidly growing neck mass. Considering the dynamics of the disease and the multiple challenges presented by the patient: advanced age, tumor size, history of a longstanding goiter we decided to transfer her to the department of surgery. The intraoperative findings were an enlarged right lobe with tracheal and surrounding tissues infiltration. Total thyroidectomy, radical neck lymph nodes dissection and tracheostomy were performed. The histopathological and immunohistochemical examination revealed a coexistent anaplastic and follicular thyroid carcinoma. The proliferation index Ki-67, a cell proliferation marker, was found to be significantly higher in the anaplastic areas (30 ± 5%) in the comparison with the follicular areas (2 ± 1%). The evaluation of the thyroid transcription factor 1 (TTF-1) expression revealed a correlation with the tumor cells aggressiveness accordingly to the cancer areas. After a radical surgery an external adjuvant radiation was applied. The patient is alive and more than five years after diagnosis she presented an increase of the serum thyroglobulin level suggesting, probably, a recurrence of the follicular form of the cancer. According to our survey we suggest that in thyroid cancers TTF-1 and Ki-67 could provides useful information on the differentiation activities of thyroid tumor cells and may be helpful to distinguish well differentiated and undifferentiated areas in a mixed thyroid cancer.

Merkel cell carcinoma is a rare and highly agressive primary cutaneous cancer with epithelial and neuroendocrine features. Currently, for stage IV disease, up-front immunotherapy with check-point inhibitors, anti PD-L1 and anti PD-1, is recommanded. We report the case of a patient who was treated with Avelumab for a metastatic Merkel cell carcinoma. He presented a treatment induced grade II immune colitis, treated successfully with oral Budesonid, a synthetic steroid with high topical anti-inflammatory activity, minimal systemic absorption, and fewer side effects.

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Isolated hypercalcaemia, leukocytosis or thrombocytosis is common in cancer patients, but the association of the first two is rarely described and the triple paraneoplastic syndrome is even more exceptional. Their concomitance portends a poor prognosis in solid tumor patients. We report the case of a 53-year old man with hypercalcaemia-leukocytosis-thrombocytosis paraneoplastic syndrome associated with a urothelial carcinoma which was fatal 4 months after diagnosis. Pathophysiology remains unclear but secretion of parathyroid hormone related protein (PTHrp) and cytokines such as granulocyte colony stimulating factor (G-CSF) as well as activation of thrombopoietin (TPO) receptor might be implicated. Although very rare, this paraneoplastic syndrome should be considered in solid tumor patients presenting with concomitant hypercalcaemia, leukocytosis and thrombocytosis, as it presages a poor prognosis with a rapid disease progression, and should be looked for and when present taken into account in the management of urothelial carcinoma, where no biological prognostic marker is available in clinical practice.