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Thyroglossal duct cyst carcinoma is uncommon and management is controversial. In low-risk patients (single tumor focus, negative margins, normal preoperative neck/thyroid imaging, no extension of TGDC carcinoma beyond the cyst wall), the Sistrunk procedure alone with observation of the thyroid may be sufficient. In this patient population, RAI is unlikely to be of any substantial benefit.

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Rhabdomyoma is a rare benign tumor with skeletal muscle differentiation. Rhabdomyoma is further classified into cardiac, adult, fetal, and genital subtypes. Out of these, fetal type rhabdomyoma (FTR) is the rarest. Only a small number of cases have been recorded in the literature. FTR typically affects male infants and young children and occurs predominantly in the head and neck region. FTR is exceedingly rare in the adult, with less than 30 cases reported. The classic FTR is composed of primitive undifferentiated spindle cells with scant eosinophilic cytoplasm embedded in a myxoid stroma. Immunohistochemically, the tumor cells are positive for desmin, muscle specific actin, and myogenin. Awareness and proper recognition of this rare entity is of considerable importance to avoid misdiagnosis of embryonal rhabdomyosarcoma. In this study, we report one case of FTR in an adult patient and reviewed the literature about the clinical and pathologic presentation of FTR in the adult.

ObjectivesHistorically at a multi‐hospital residency program, there was an unexpected number of non‐urgent consults from the county hospital emergency room (ER) that caused residents to make more trips between hospitals and come closer to violating duty hours. Moreover, there was also a poor follow‐up rate for these patients. An alternate pathway to redirect such consults to the Otorhinolaryngology–Head and Neck Surgery (ORL–HNS) clinic, staffed by an attending physician, was devised. This study illustrates how an undemanding process change can improve access to care, and resident duty hours and satisfaction.Study DesignQuality Improvement StudyMethodsThe average rate of no‐show appointments and overall number of patients referred from the county hospital ER; a survey of impact on resident workload; and an average number of on‐call resident trips to county hospital were compared in the 12 months before and after implementation of an expedited ER referral pathway.ResultsThe overall number of patients referred to clinic from ER increased by 35% (123 to 166 patients). The average number of completed visits for patients referred to the ORL‐HNS clinic from the ER increased by 29% (91 to 117 patients). There was no statistically significant change in the no‐show rate of said patients. The average number of overnight resident trips to the county hospital, frequency of resident unpreparedness for routine clinical duty and need to alter schedule to avoid duty hour violations all decreased, while resident satisfaction increased.ConclusionsAn undemanding process change in a safety‐net, publicly‐funded, county hospital setting can decrease resident workload and improve satisfaction while possibly improving patient access to specialty clinic care and follow‐up rates for patients.Level of Evidenceclinical outcomes, level IV