Introduction. We report this large neck mass, located behind the sternocleidomastoid (SCM) within the posterior cervical space and anterior to the prevertebral fascia. The mass is displacing the carotid sheath and its neurovascular contents medially. It extends almost the whole length of the SCM muscle all the way down to the lung apex. Case Presentation. A 30-year-old female patient presented to our clinic with a left anterior neck mass for a few months with dysphagia. The lipoma was excised completely along with level II to IV lymphadenectomy. A very small volume chyle leak was noted intraoperatively. The drain was removed 2 weeks later only to recur in one month. A new drain was placed by interventional radiology, and the drainage resolved completely. Discussion. The patient with mild dysphagia had a lipoma large enough to push vital structures away from their normal anatomical position. Due to the difficult location and the size of the lipoma, a meticulous formal lateral neck dissection was required. A 3D imaging like CT or MRI would be helpful to preoperatively plan the dissection. Substernocleidomastoid neck lipoma in our case is a rare benign tumor that was challenging to excise.

Highlights Primary retroperitoneal mucinous cystic neoplasms are rare. Due to potential seeding intra-operatively, laparoscopic removal was avoided. Our case showed efficient and safe use of a laparoscopic approach. Surgeons must plan for every cyst to be malignant when planning for removal. With a laparoscopic approach, care is required when aspirating the cyst in vivo.

RESUMEN REPERCUSIONES PSICOLÓGICAS DE LA DISFUNCIÓN ERÉCTIL SOBRE LA AUTOESTIMAY AUTOCONFIANZA Introducción: La disfunción eréctil (DE) está causada por una amplia gama de factores orgánicos, psicológicos, psiquiátricos, interpersonales y farmacológicos. En numerosas publicaciones se menciona la pér-dida de autoestima como un efecto colateral de la DE siendo muy probable también una afectación de la autoconfianza del sujeto. El objetivo del siguiente estudio fue evaluar la autoestima y autoconfianza de sujetos con DE y compararla con un grupo de sujetos sin DE.Material y Métodos: Estudio epidemiológico, transversal, observacional, comparativo y multicéntrico. Se seleccionaron 405 sujetos varones mayores de 18 años en los que el médico de Atención Primaria sospechara que pudieran padecer DE. Todos los participantes debían cumplimentar de forma autoaplicada la versión española del cuestionario de autoestima de Rosenberg y la adaptación cultural al español del Cuestionario de autoconfianza de Johnson y McCoy. Después fueron remitidos a un urólogo que confirmaba el diagnóstico de DE ("gold Standard").Resultados: El análisis estadístico mostró que los sujetos afectados de DE obtenían puntuaciones significativamente inferiores en las escalas de autoconfianza y autoestima que los sujetos sin DE (p< 0.01).Discusión: Los resultados ponen de manifiesto la pérdida de autoconfianza y autoestima que sufren los pacientes afectados de DE.Palabras Clave: Disfunción Eréctil. Autoestima. Autoconfianza. Rosenberg. Cuestionarios. ABSTRACT PSYCHOLOGICAL IMPACT OF ERECTILE DYSFUNCTION ON SELF-ESTEEM AND SELF-CONFIDENCEBackground and objective: Erectile dysfunction (ED) is caused by a large range of organic, psychological, psychiatric, interpersonal and pharmacological factors. Numerous scientific publications mention the loss of self-esteem as a collateral effect of ED, with a very probable affectation of the subject´s self-confidence. The objective of this study was to evaluate the self-esteem and self-confidence of subjects with ED and to compare them with a group of non-ED subjects.Subjects and Method: An epidemiological, cross-sectional, observational, comparative and multicentric study was conducted. General Practitioners selected 405 men older than 18 years in which they suspected ED. All the participants had to complete the self administered form of the Spanish version of the Rosenberg self-esteem scale and the Spanish culturally adapted version of the Johnson and McCoy self-confidence scale. After that, patients were referred to the urologist in order to confirm the ED diagnosis.Results: The statistical analysis of the data showed that the subjects with ED obtained significantly lower scores in the self-confidence and self-esteem scales than the non-ED subjects (p< 0.01).Discussion: The results of this study show the loss of self-confidence and self-esteem that suffer patients with ED.

Introduction An ectopic anomalous accessory thyroid is extremely rare. We present two related case reports. Case A 43-year-old morbidly obese female presented with a palpable left thyroid mass. Initial impression after preoperative workup was a diffuse bilateral multinodular goiter with a left nodule suspicious for malignancy. She underwent a total thyroidectomy. On further palpation after initial excision, two masses on the left neck area were noted, dissected, and excised. In the second case, a 65-year-old female presented with a substernal exophytic mass displacing the trachea to the right after a left thyroid lobectomy 4 years ago. Cytology revealed a retained substernal thyroid. She is scheduled for a substernal thyroidectomy through a median sternotomy. Discussion In all partial or complete thyroidectomy cases, care should be taken to palpate or to use intraoperative ultrasound (IOUS) for any extra thyroid mass. An intuitive surgical approach is needed to evaluate for possible embryologic anomalies of the thyroid. There are two thyroid anlagen that can explain ectopic aberrant anomalies: the median anlage-thyroid rest and the lateral anlage from the ultimobranchial body of the fourth pharyngeal pouch. Surgeons should keep in mind that multiple ectopic thyroid glands could be present in any thyroidectomy procedure.