Solid variant is a rare and poorly characterized variant of papillary thyroid carcinoma (PTC) and comprises approximately 3% of PTCs. It is more common in children and has high propensity for extrathyroidal metastasis. It is seen in higher proportion in post-radiation PTCs and has been seen in more than one-third of post Chernobyl radiation induced PTCs in some studies. It usually presents with differential diagnosis of poorly differentiated carcinoma versus anaplastic versus medullary thyroid carcinoma versus metastasis from extrathyroidal malignancy on fine needle aspiration cytology. This report describes a case of solid variant of PTC in a child who had no history of radiation exposure and shows the importance to be given to histopathology when the pre-operative diagnosis is not clear.

BACKGROUND Persons suffering from medical illness suffer from a great deal of stress due to various factors such as the distress caused by the symptoms, restriction of movement and functioning, financial costs of treatment, worries about the prognosis and the future, and frequent hospitalizations with a loss of a sense of security and individuality leading to impaired QoL. This study aimed to examine the levels of, and the relationship between, perceived stress levels, and quality of life in patients hospitalized with medical illnesses. The study also attempted to understand the association of perceived stress, quality of life, various sociodemographic and clinical variables. METHODS This is a cross-sectional study conducted among 200 consenting patients in the age group 18-80 years, admitted in the General Medicine ward with various ailments. Sociodemographic profile and clinical profile were assessed using appropriate tools. Stress was measured using PSS and the QoL was assessed using the WHOQOL-BREF. Data collected was tabulated and statistical analysis was carried out using SPSS-21. RESULTS The mean age of the participants in the study was 45 years. Majority of the participants in the study were male, married, employed, belonging to Hindu nuclear family of lower middle and lower socioeconomic status and hailing from rural areas. Mean total Perceived Stress Scale (PSS-10) score was found to be 16.34 (S.D.= 5.89), with more than two-thirds of the patients reporting moderate to high levels of perceived stress. High levels of QoL was noted in 58.5-87% of the participants in the four domains of WHOQOL-BREF, with less than 10% of the participants reporting low quality of life in each of the domains. Lower socioeconomic status was found to be associated with higher perceived stress (t=2.670, p<0.01) and lower QoL. Lower age, fewer hospitalizations in the past year, and employment status was associated with better physical health quality of life. Perceived stress score was negatively correlated with all domains of quality of life (p<0.001). CONCLUSIONS Medical illness and hospitalization are associated with increased perceived stress levels. Perceived stress is significantly associated with a lower quality of life in all domains. This study emphasises the need for better integration of medical and psychiatric services to improve the overall health of the patient and further research in the field to understand the association between stress and quality of life better.