Patient: Female, 27Final Diagnosis: Invasive thyroglossal duct cyst papillary carcinomaSymptoms: Painless cervical enlargementMedication: —Clinical Procedure: Sistrunk’s procedureSpecialty: SurgeryObjective:Rare diseaseBackground:Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature.Case Report:A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk’s procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal.Conclusions:Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.

The Erector Spinae Plane Block (ESP) is a novel regional technique for anesthesia or analgesia. Originally the ESP block was described in 2016 in a case report regarding analgesia intervention for a case of thoracic neuropathic pain. Since then, there has been growing interest and research adding experience about the ESP block as regional anesthetic and analgesic technique. Reviewing the literature about this novel technique in databases like PubMed using the key words “erector spinae plane block” returns approximately 56 publications. So far there is no available big series of cases or reviews regarding the ESP block. The literature is limited to case reports or case series. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic cholecystectomy. We describe the case of a 76-year-old female patient scheduled for laparoscopic cholecystectomy. Written informed consent was granted (for procedure and publication of photos). We applied a bilateral ultrasound-guided ESP block at T6 level while the patient was awake before general anesthesia induction. The anesthetic solution we used consisted of 12 mL Ropivacaine 0.375% plus 2 mg dexamethasone (on each side). After the successful administration of the block (observation of the solution spread between transverse process and the erector spinae muscles), general anesthesia was induced and the procedure was started. Procedure and recovery was uneventful with the patient experiencing very good analgesia (NRS pain score 0 up to 6 hours after block placement). The patient presented mild pain (NRS score of 2–3) after 6 hours and requested the “on demand” pain medication (1 g paracetamol IV) only 10 hours after the ESP block (NRS pain score of 4–5). The patient experienced no nausea or vomiting, was mobilized easily about 6 hours after the block and was discharged the next day. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use.

Patient: Male, 40Final Diagnosis: Mesenteric desmoid tumorSymptoms: Abdominal massMedication: —Clinical Procedure: Laparotomy exploratorySpecialty: SurgeryObjective:Rare diseaseBackground:Desmoid-type fibromatosis (DF) is a rare entity that predominantly involves the extremities, the trunk, and the abdominal cavity. It is a non-metastasizing, sporadic mesenchymal tumor with high tendency to recurrence and often is categorized as low-grade sarcoma.Case Report:We present here an extremely rare case of a mesenteric desmoid tumor (DT). A 40-year-old man presented to our clinic with a mass in the right-lower quadrant of the abdomen, which he incidentally palpated. A computerized tomography (CT) scan of the abdomen showed a mass between the loops of small intestine. The patient was treated successfully with wide excision of involved mesentery and adjacent small intestine. Histopathology of the mass revealed DT of the mesentery. No adjuvant treatment was applied and the patient was free of disease after a 6-month follow-up.Conclusions:Intra-abdominal DF is a rare pathology which should be differentiated while exploring abdominal tumors. Surgery, when dealing with operable masses, is the appropriate treatment.