Abdul Ahad Riaz

Introduction: Phyllodes tumors are rare fibroepithelial breast neoplasms, typically affecting middle-aged women. Malignant phyllodes tumors (MPTs) account for a minority of these cases and are extremely uncommon in adolescents. The synchronous presentation of MPT with contralateral invasive ductal carcinoma (IDC) is exceptionally rare and presents unique diagnostic and therapeutic challenges. Case presentation: We report the case of a 19-year-old female who presented with a rapidly enlarging mass in the left breast, initially misdiagnosed as an abscess. On physical examination, a distinct right breast mass and bilateral axillary lymphadenopathy were also noted. Imaging and biopsy revealed an MPT in the left breast. Histopathology confirmed IDC in the right breast and metastatic adenocarcinoma in both axillae. Immunohistochemistry revealed high proliferative activity in the IDC. The patient underwent left mastectomy and was started on systemic chemotherapy, with a favorable initial response. Clinical discussion: This case underscores the importance of considering rare malignancies in adolescents with atypical breast presentations and highlights the diagnostic limitations of imaging alone. The concurrent diagnosis of two distinct breast cancers in a young patient raises concern for a possible underlying genetic predisposition and supports the need for a multidisciplinary approach to management. Conclusion: The simultaneous occurrence of MPT and IDC in adolescents is extraordinarily rare. Early histopathological assessment, comprehensive bilateral evaluation, and coordinated oncologic care are essential for optimal management in such complex cases.

Background: Follicular dendritic cell sarcoma (FDCS) is an extremely rare malignancy originating from antigen-presenting dendritic cells of the B-cell follicles. While typically affecting adults and occurring in lymphoid tissues such as tonsils and the Waldeyer’s ring, FDCS in the parotid gland is exceptionally rare, with only five adult cases reported to date. To our knowledge, this is the first documented pediatric case of FDCS of the parotid gland. Materials and methods: We present the case of a 13-year-old male with a progressively enlarging mass in the right parotid region. Diagnostic workup included imaging (MRI and CT), biopsy, and immunohistochemical staining positive for CD21 and CD23. The patient underwent systemic chemotherapy with a CCABE regimen (cisplatin, cyclophosphamide, bleomycin, etoposide, and doxorubicin), followed by external beam radiotherapy using LINAC at 40 Gy/20 fractions. Response to treatment was monitored through serial MRI and CT imaging. Results: The patient showed significant regression of both the primary tumor and pulmonary metastases following combined chemoradiotherapy. His quality of life markedly improved, and follow-up imaging confirmed resolution of the primary lesion. However, metastatic recurrence in the lungs was later observed, though the primary site remained disease-free. The patient was restarted on the same chemotherapy regimen. Conclusion: This case represents the first known pediatric FDCS of the parotid gland and demonstrates that a combination of systemic chemotherapy and targeted radiotherapy can achieve promising results, even in metastatic disease. Long-term follow-up is required to evaluate sustained response and monitor for recurrence or late treatment complications.

Introduction and Importance: Kienböck’s disease, or avascular necrosis of the lunate bone, is a rare condition with an estimated prevalence of 7 per 100 000 individuals. It typically affects males aged 20–40 years and often presents with wrist pain, decreased grip strength, and reduced mobility. Early diagnosis and appropriate management are crucial to prevent long-term joint destruction. Case presentation: We present a case of a 32-year-old female with chronic right wrist pain and reduced grip strength for 2 years. Examination revealed tenderness over the lunate and decreased wrist motion. Imaging confirmed sclerosis and avascular necrosis of the lunate (Stage II Lichtman classification). Conservative management with NSAIDs and physical therapy was initiated, followed by radial shortening osteotomy. Clinical discussion: Kienböck’s disease diagnosis relies on radiography, MRI, and occasionally bone scintigraphy. Early stages benefit from conservative management, while surgical intervention is recommended for more advanced cases. Radial shortening osteotomy has shown excellent outcomes in pain relief and functional recovery. Our patient showed significant improvement in pain and wrist mobility after surgery and rehabilitation. Conclusion: This case highlights the importance of early diagnosis and stage-specific management of Kienböck’s disease. Combining non-surgical and surgical approaches can achieve favourable outcomes. Longer follow-up is necessary to monitor for potential late complications.

Introduction and importance: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are distinct thyroid malignancies with different cellular origins and management strategies. The coexistence of these two cancers within the same thyroid gland, particularly in separate lobes, is rare and presents unique diagnostic and therapeutic challenges. This case highlights the importance of distinguishing between these malignancies to ensure accurate diagnosis and appropriate treatment. Case presentation: A 60-year-old male presented with a progressively enlarging neck mass over 6 months, accompanied by mild discomfort and intermittent dysphagia. Physical examination revealed a firm, fixed mass in the right thyroid lobe. Laboratory tests showed normal thyroid-stimulating hormone, elevated calcitonin (330 pg/mL), and carcinoembryonic antigen (12 ng/mL). Thyroid ultrasound identified a 4.5 cm hypoechoic nodule in the right lobe and a 1.2 cm nodule in the left. Fine needle aspiration cytology confirmed PTC in the right lobe and MTC in the left. Clinical discussion: Total thyroidectomy with central neck dissection was chosen as treatment. Histopathology confirmed classical PTC in the right lobe and MTC in the left, with characteristic amyloid deposition and positive staining for calcitonin and other markers in MTC. RET proto-oncogene mutation testing was negative. The patient received postoperative radioactive iodine therapy and levothyroxine. At six months, there was no evidence of recurrence. Conclusion: The coexistence of PTC and MTC in separate thyroid lobes is a rare occurrence. Accurate cytological, histopathological, and immunohistochemical evaluations are essential for proper diagnosis and management.

Introduction and importance: Laryngeal squamous cell carcinoma (LSCC) commonly metastasizes to regional lymph nodes, lungs, liver, and bones. Intracranial metastasis from LSCC is exceedingly rare, reported in only 0.4% of cases. The atypical presentation can delay diagnosis and negatively impact prognosis. We report a rare case of solitary brain metastasis from LSCC, highlighting the diagnostic challenges and clinical considerations. Case presentation: A 68-year-old Pakistani male with a prior diagnosis of LSCC presented with new-onset generalized tonic-clonic seizures. He had previously undergone total laryngectomy, radiotherapy, and chemotherapy. Brain MRI revealed a right frontal lobe lesion with surrounding edema, consistent with a solitary metastasis. Histopathology following craniotomy confirmed metastatic squamous cell carcinoma. The patient was managed with antiepileptics and referred for palliative whole-brain radiotherapy. He and his family opted for palliative care, declining further aggressive treatment. Clinical discussion: Distant brain metastasis in LSCC is rare and may occur without prior systemic spread. The mechanism may involve perineural invasion, although the exact pathophysiology remains unclear. Current diagnostic approaches include MRI and FDG-PET/CT. Due to limited cases, standardized treatment protocols are lacking. Management options include surgery, radiotherapy, chemotherapy, and palliative care, depending on disease progression and patient preference. Seizures as a presenting symptom are uncommon but may indicate intracranial involvement. Conclusion: This case emphasizes the need for high clinical suspicion and comprehensive neurological assessment in patients with advanced LSCC. Early diagnosis and multidisciplinary management are essential for improving outcomes in this rare but serious manifestation.