It is well established that small clinically undetected thyroid carcinomas can produce extensive lymphatic metastases. However, occult papillary carcinoma of the thyroid presenting as a large blood‐borne metastasis and occult papillary carcinoma of the thyroid leading to death are both uncommon. The authors report two unusual cases of clinically occult carcinoma of the thyroid. The first case is a 2.4 mm microscopic carcinoma presenting as a large solitary pulmonary metastasis, and is one of the smallest reported primary papillary thyroid carcinomas presenting as a distant hematogenous metastasis. The second case represents a lethal carcinoma with extensive metastases not diagnosed until autopsy. These two cases effectively illustrate that the absence of a clinically detectable thyroid abnormality does not exclude the possibility of extensive hematogenous and lymphatic metastases from a minute or undetected carcinoma of the thyroid.
The differential diagnosis of the acutely enlarged testis includes numerous benign and malignant disease processes. Most are treated with radical orchiectomy due to difficulty in differentiating between these disorders preoperatively. Saving the involved testis, prevention of recurrent infectious disease in the opposite testis and prevention of systemic manifestations of testicular disease are but a few of the reasons for accurate diagnosis of the acute scrotum. We report a rare case of brucellosis presenting as an acute scrotal mass and stress the importance of accurately identifying the specific etiology of testicular pathology to prevent long-term morbidity.
The authors describe the selection process implemented by a counselor education department for screening doctoral applicants. This 2‐day selection process is designed to assess each applicant in four areas: counseling skills, interpersonal effectiveness, level of professional knowledge, and credentials.
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