Thymic tumours are rare thoracic malignancies with thymic carcinoma accounting for approximately 12% of all thymic tumours compared to thymomas which account for approximately 86%. Unlike thymomas, it is very rare for thymic carcinomas to be associated with autoimmune disorders or paraneoplastic syndromes. When these phenomena do occur, the vast majority are myasthenia gravis, pure red cell aplasia, or systemic lupus erythematous. Paraneoplastic Sjogren’s syndrome is a rare complication of thymic carcinoma, with only two cases previously reported. Here we present 2 cases of patients with metastatic thymic carcinoma who developed autoimmune phenomena consistent with Sjogren’s syndrome without classical symptoms prior to treatment. One patient opted for surveillance of their malignancy, while the other underwent chemoimmunotherapy with favourable results. These case reports describe two distinctive clinical presentations of a rare paraneoplastic phenomenon.

Metastatic spread of prostate cancer to the skeleton may result in debilitating bone pain. In this review, we address mechanisms underpinning the pathobiology of metastatic prostate cancer induced bone pain (PCIBP) that include sensitization and sprouting of primary afferent sensory nerve fibres in bone. We also review current treatments and pain responses evoked by various treatment modalities in clinical trials in this patient population. We reviewed the literature using PubMed to identify research on the pathobiology of PCIBP. Additionally, we reviewed clinical trials of various treatment modalities in patients with PCIBP with pain response outcomes published in the past 7 years. Recent clinical trials show that radionuclides, given either alone or in combination with chemotherapy, evoked favourable pain responses in many patients and a single fraction of local external beam radiation therapy was as effective as multiple fractions. However, treatment with chemotherapy, small molecule inhibitors and/or immunotherapy agents, produced variable pain responses but pain response was the primary endpoint in only one of these trials. Additionally, there were no published trials of potentially novel analgesic agents in patients with PCIBP. There is a knowledge gap for clinical trials of chemotherapy, small molecule inhibitors and/or immunotherapy in patients with PCIBP where pain response is the primary endpoint. Also, there are no novel analgesic agents on the horizon for the relief of PCIBP and this is an area of large unmet medical need that warrants concerted research attention.

AimOur aim was to use epidemiological data to determine the incidence of soccer‐related head injuries in children aged 5–14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia.MethodsED presentation and hospital admission de‐identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer‐related head injury data to determine the incidence of this injury among these children.ResultsThe incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011–2012 to 2015–2016). The 10–14‐years age group presented with more head injuries than the 5–9‐years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with ‘sport as a whole’.ConclusionsThe low incidence of soccer‐related head injuries presenting to an ED or admission to hospital is consistent with international findings.

Introduction: Adenocarcinoma of the gastroesophageal junction (GEJ) is an increasingly common malignancy worldwide with a particularly aggressive pattern and poor prognosis. Extra-nodal metastasis is present in approximately 20% of patients however intrabiliary metastasis is a rare occurrence, and is usually associated with colorectal cancer (CRC). We report the case of a 50-year old male who presented with obstructive jaundice secondary to intrabiliary metastasis from GEJ adenocarcinoma. Case Description/Methods: A 50-year old male presented to the emergency department with a two-day history of jaundice. He reported steatosis, pruritis and epigastric pain. This was on a background of a diagnosis of metastatic GEJ adenocarcinoma. He had a past medical history of hypertension, gout and a previous sub-total thyroidectomy. Examination was unremarkable aside from jaundice. Blood tests demonstrated hyperbilirubinaemia (228 umol/L). Liver function tests (LFTs) were deranged in a cholestatic pattern. His CA19-9 was elevated to 7365 kU/L. Computed tomography abdomen revealed a soft tissue mass in the posterior mediastinum and dilatation of the intrahepatic and common hepatic ducts. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) were performed. EUS identified echogenic material from the ampulla to the mid duct, above which the biliary tree was dilated. ERCP revealed a tight and irregular stricture involving the distal half of the common bile duct (CBD) (figure 1). A guidewire was advanced proximally into the intrahepatic ducts. A sphincterotomy was performed and a 4 French x 9cm pancreatic stent was placed into the pancreatic duct for post-ERCP pancreatitis. A 6cm x 10xm fully covered Wallflex metal biliary stent was deployed across the stricture, along with a second 4cm x 10 cm Wallflex metal biliary stent to ensure trans-papillary stenting. Expansion of the metal stent localised to the stricture was suboptimal and therefore a balloon dilation of the stent was performed to 8mm with a Hurricane dilating balloon. Biliary stricture cytology analysis showed atypical cells consistent with intrabiliary metastasis from GOJ adenocarcinoma. Discussion: Intrabiliary metastasis resulting in obstructive jaundice is an uncommon entity, with CRC usually being implicated. The presented case highlights an uncommon metastatic site in the case of metastatic GEJ adenocarcinoma and highlights the need to consider atypical sites of metastatic disease in the evaluation of obstructive jaundice.Figure 1.: Distal common bile duct stricture with subsequent metal stent insertion and balloon dilatation on ERCP.