Appendiceal intussusception is rare with an estimated incidence of 0.01%. Although it is infrequently encountered, the few documented cases of this entity have shown it may mimic or indicate an underlying neoplasm when evaluated with colonoscopy. With the abundant use of multi-detector CT and increased utility of CT colonography, awareness of the radiologic findings of this condition has become increasingly important. Appendiceal intussusception, while potentially pathologic in its own right, may mimic or even coexist with other pathologies, both malignant and benign. We present a case of adult appendiceal intussusception without a "lead point" that was successfully diagnosed by CT imaging.

Patient: Female, 32 Final Diagnosis: Papillary thyroid carcinoma Symptoms: Cervical node metastasis Medication: — Clinical Procedure: Radioactive iodine treatment Specialty: Oncology Objective: Rare co-existance of disease or pathology Background: Theranostics is a combined diagnostic and treatment approach to individualized patient care. Kostmann syndrome, or severe congenital neutropenia, is an autosomal recessive disease that affects the production of neutrophils. Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy associated with gene alterations, including in the mitogen-activated protein kinase ( MAPK ) signaling pathway gene. Translocation of the ETS variant 6/neurotrophic receptor tyrosine kinase 3 ( ETV6/NTRK3 ) gene has been implicated in radiation-induced and pediatric forms of thyroid carcinoma but has rarely been described in sporadic PTC. This report is of a case of PTC in a patient with Kostmann syndrome associated with ETV6/NTRK3 gene translocation. Case Report: A 32-year-old woman with a history of Kostmann syndrome, acute myeloid leukemia (AML), and chronic graft versus host disease (GVHD) was diagnosed with PTC with cervical lymph node metastases and soft tissue invasion following total thyroidectomy and bilateral modified radical neck dissection. Her postoperative radioactive iodine (RAI) scan confirmed lymph node metastasis. Gene expression studies identified increased expression of iodine-handling genes and ETV6/NTRK3 gene fusion. Because of the bone marrow compromise due to Kostmann syndrome and AML, a careful genomic and molecular analysis was performed to guide therapy. Conclusions: This is the first reported case of the association between PTC, Kostmann syndrome, and ETV6/NTRK3 gene translocation in which multimodality treatment planning was optimized by genomic profiling.