A 67-year-old male patient presented to our surgical oncology outpatient department, with lower abdominal pain and right scrotal swelling, gradually increasing in size for two months duration. He gave a history of reduced appetite and weight loss with regular bowel and bladder habits. He was on steroid inhalers and long acting β agonist for more than five years as treatment for Chronic Obstructive Airway Disease (COPD).

Introduction: Collision tumours (CT) of the thyroid refer to the coexistence of two or more independent, histologically distinct malignant tumours. Though the presence of multifocal differentiated thyroid carcinomas is common, it is extremely rare for the thyroid to harbour more than one type of malignancy simultaneously. Methods: An extensive literature search of PubMed databases identified very few cases indicating the tumour rarity. To the best of our knowledge, this is the first documentation of a case series including various combinations of CT in the thyroid. Our main aim is to explore the phenotypic characteristics of CT in the thyroid with an aim of revealing unique features associated with this rare entity. Results: Of a total of 138 thyroid cancers treated during the eight-year period, five (3.62%) were diagnosed as CT. All were females with a median age of 50 years. Papillary Thyroid Carcinoma (PTC) was the major component (80%) in collision with medullary (MC), follicular, and hurthle cell carcinomas. Both cases with papillary microcarcinoma showed vascular emboli and patients with a combination of MC and PTC had nodal metastasis. 80% of patients had a survival of more than 2.5 years and are alive without disease at present. Our study showed features like female predominance and PTC as the most common component with good overall survival. Metastatic and survival rates were consistent with matched singleton pathology. Conclusion: Insight into the genomic and proteomic pathways of this entity is the need of the hour.

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Small cell Neuroendocrine Carcinoma (SmNEC) is defined as the malignant neoplasm with Neuroendocrine (NE) differentiation. SmNEC of urinary bladder is a rare entity accounting for 0.3 to 0.7% of all malignant bladder tumours. The largest case series to date includes 64 cases from multiple hospitals across the world. In the present series author undertook a retrospective analysis of clinicopathological and survival characteristics of all cases with immunomorphological diagnosis of primary SmNEC of bladder treated at our centre from 2015-2019. Indian literature describing this entity is still sparse, and to the best of our knowledge present study is the first of its kind from Southern India. Of the total 569 cases of bladder carcinomas reported in our institution, during the five year period, six cases (0.8%) were of primary SmNEC. All the cases were at stage III/IV at the time of diagnosis. Along with characteristic histopathological features, Immunohistochemistry (IHC) for p16 and for NE differentiation- IHC-CD56 was positive in all cases leading to a definite diagnosis. Different modalities of treatment were offered owing to the lack of specific treatment guidelines. Median survival time was found to be seven months.