Abstract Developing region-specific clinical practice guidelines (CPGs) for ear, nose, and throat (ENT) diseases is crucial in Pakistan's primary care, given their significant contribution to clinical cases, aiming to enhance healthcare standards through evidence-based practices with local adaptations. To ensure the standardization of primary healthcare and reduce unnecessary specialist referrals by creating CPGs that are appropriate to our region. We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Ménière's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology–Head and Neck Surgery Foundation as the source guidelines, and employed the Grading of Recommendations, Assessment, Development, and Evaluation–Adoption, Adaptation, and De Novo Development (GRADE-ADOLOPMENT) approach to contextualize guidelines by adopting, adapting, or excluding recommendations from them. Clinical-referral algorithms were created using recommendations from the CPGs created, with additional recommendations sought through a best-evidence review process. We developed local CPGs for eight ENT conditions using the GRADE-ADOLOPMENT approach. While most recommendations were adopted in the local CPGs, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes. Six recommendations were excluded due to service limitations in Pakistan. Additionally, we created 8 clinical-referral algorithms, incorporating 17 additional recommendations to address gaps in practice, distributed across various conditions. The newly-established CPGs are instrumental in delivering standardized, high-quality care at the primary care level. Simultaneously, the development of clinical referral pathways empowers general physicians to manage patients effectively and make timely, appropriate referrals to ENT specialists.

Parathyroid carcinoma (PC) is a rare malignancy often misdiagnosed as parathyroid adenoma due to overlapping biochemical features, including hypercalcemia and elevated parathyroid hormone (PTH) levels. However, PC typically presents with more severe hypercalcemia (> 14 mg/dL), markedly elevated PTH, and a palpable neck mass. Definitive diagnosis requires histopathological evidence of malignancy, such as vascular invasion, perineural invasion, or capsular infiltration. We report a 46-year-old male who presented with an enlarging neck mass initially suspected to be a parathyroid adenoma. Biochemical workup revealed severe hypercalcemia and significantly elevated PTH levels. Imaging and intraoperative findings raised suspicion for malignancy. Histopathological examination confirmed parathyroid carcinoma with involved surgical margins. Due to persistent disease, the patient underwent re-excision and remains under close surveillance. Distinguishing PC from benign parathyroid lesions remains challenging but is critical for appropriate management. The primary treatment is en bloc surgical resection to achieve negative margins and reduce recurrence risk. Adjuvant radiation therapy and chemotherapy have limited roles and are generally reserved for unresectable or recurrent disease.This case underscores the importance of early recognition of PC through comprehensive biochemical, radiological, and pathological assessment. Accurate diagnosis and aggressive initial surgery are essential for optimizing outcomes in this rare but aggressive endocrine malignancy.

Introduction and importance:Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, often presenting with nodal or extranodal masses. However, involvement of the chin region is extremely rare and underreported in literature. This case highlights an unusual extranodal manifestation of germinal center B-cell-like (GCB) DLBCL. Case presentation:A 56-year-old man with a history of hypertension and type II diabetes presented with an 8-month history of a painless, progressively enlarging chin mass. Prior antibiotic therapy failed to resolve the lesion. Examination revealed a firm, 4 × 3 cm subcutaneous swelling involving skin and mucosa. Computed tomography (CT) and positron emission tomography/CT imaging revealed hypermetabolic soft tissue lesions in the chin and right buccogingival region. Histopathology and immunohistochemistry confirmed GCB-type DLBCL. The patient received six cycles of rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone chemotherapy, resulting in a significant reduction in lesion size and metabolic activity. Follow-up showed no recurrence. Clinical discussion:This case highlights the diagnostic challenges posed by extranodal DLBCL in atypical locations. Misdiagnosis as an infection led to a delayed diagnosis. Immunophenotyping revealed expression of both B- and T-cell markers, which complicated the classification of the lymphoma. A prior history of spontaneously resolving axillary masses suggested an indolent precursor phase that later transformed into aggressive DLBCL. Conclusion:DLBCL may present in rare extranodal sites such as the chin, mimicking benign conditions. Persistent lesions unresponsive to antibiotics should prompt a malignancy workup. Comprehensive evaluation, including imaging and immunohistochemistry, is critical for timely diagnosis and effective treatment. Further research is needed to understand unusual immunophenotypes and progression pathways in DLBCL.

BACKGROUND:Diseases of the ear, nose, and throat (ENT) account for a significant portion of a primary care physician's practice in Pakistan, a South Asian lower-middle income country. This increasing burden demands comprehensive clinical practice guidelines and primary care clinical referral algorithms to be devised so that general physicians can adequately provide standardized primary health care and prevent needless specialist ENT referrals. METHODS:We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Meniere's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology-Head and Neck Surgery Foundation as the source guidelines and employed the GRADE-ADOLOPMENT approach to contextualize guidelines by adopting, adapting, or excluding recommendations from these guidelines. Clinical referral algorithms were created using recommendations from the created clinical practice guidelines, with additional recommendations being sought via a best evidence review process. RESULTS:We successfully created local clinical practice guidelines for the eight ENT conditions using the GRADE-ADOLOPMENT process. While most recommendations were adopted in the local clinical practice guidelines, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes to provide supporting information. Six recommendations were excluded mostly due to the unavailability of services in Pakistan. Eight clinical referral algorithms were also created which incorporated 17 additional recommendations to fill gaps in clinical practice including four additional recommendations to the epistaxis algorithm, three for neck lumps/mass, rhinosinusitis, and allergic rhinitis, two for acute otitis externa, and one for Meniere's disease and dysphonia algorithms. CONCLUSION:The newly created clinical practice guidelines will help in the provision of standardized, high-quality care at the primary care level. Concomitantly, the clinical referral pathways can assist the general physicians in the management of patients as well as guide appropriate timely referrals to ENT specialists.

Paragangliomas (PGLs) are extremely rare endocrine tumors that arise from the autonomic nervous system. Their rarity contributes to their frequent misdiagnosis. Ultrasound and immunohistochemical findings are heavily relied on for correct diagnosis. We present a case of thyroid PGL in a 40-year-old female patient who presented with a 1-year history of anterior neck mass and a 4-month history of hemoptysis. Ultrasound findings showed a solitary, lobulated, hypoechoic, and vascular lesion in the right thyroid lobe. She underwent total thyroidectomy and tracheal end-to-end anastomosis. Histopathology showed cells organized in distinct nests (zellballen) pattern enclosed by a delicate fibrovascular stroma. On immunohistochemical analysis, the tumor was positive for synaptophysin, CD56, GATA-3, and S100. The patient is stable postoperatively and disease-free. The role of ultrasound is vital in forming a correct diagnosis of thyroid PGL preoperatively. We review the current literature regarding diagnostic findings and treatment of thyroid PGLs with the aim of supplementing the findings of the thyroid PGLs that have been previously reported. The creation of a robust imaging and immunohistochemical profile for this entity is needed to combat the frequent misdiagnoses that occur with thyroid PGLs.

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N – 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46–28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Background: Lipomas are the most frequent neoplasm of mesenchymal origin in the head-and-neck region. Around 15% of lipomas are found in the head-and-neck region. The usual site where lipomas can be found in the head-and-neck region is in the posterior triangle of the neck but they can also be found in the anterior neck, infratemporal fossa, submandibular space, larynx, pharynx, and parotid gland. The incidence of parotid lipoma ranges from 0.6% to 4.4% of all parotid neoplasms. There are two histological variants, focal lipoma and diffuse infiltrating variant. We describe two cases of rare focal lipoma of the parotid gland, therefore, must be reported. As rare as it may appear, existing relevant literature suggest management to includes definitive radiological investigations such as magnetic resonance imaging (MRI) and complete removal of lipoma with or without a cuff of parotid tissue. Case Report: Two cases were identified with a parotid lipoma on final histology. Case 1 is a 57-year-old male with a history of painless left parotid swelling for 2 years, reported to be 5 cm × 4 cm size on ultrasound, therefore, underwent superficial parotidectomy. Case 2 is a 67-year-old male who presented with right parotid swelling for 15 years, reported on ultrasound to be 5 cm × 5 cm, and underwent excision of intraparotid tumor. He later went on to develop breast carcinoma. The facial nerve was intact of both patients. Conclusion: Parotid lipomas are rare entities that should be a differential for clinically soft parotid swellings. Management includes definitive radiological investigations such as MRI and complete removal of lipoma with or without a cuff of parotid tissue instead of regular ultrasound followed by fine-needle aspiration cytology. Although our cases were managed on the same regular outlines, but reporting these cases would suffice the potential role of MRI and computed tomography scan for parotid swelling as per existing literature.

Minimally invasive surgery (MIS) and robotics have revolutionized the field of Otolaryngology. MIS and robotics have reshaped traditional otolaryngological practices, offering patients a multitude of benefits. Reduced incision sizes and tissue manipulation minimize postoperative pain and discomfort, while also improving cosmetic outcomes. MIS has facilitated enhanced visualization and access to intricate anatomical structures, enabling the treatment of previously inaccessible lesions. MIS procedures also offer shorter hospital stays, reduced blood loss, and faster healing times whilst enhancing patient satisfaction and overall quality of life The ongoing progress in minimally invasive approaches solidifies their role as a cornerstone in modern Otolaryngology, and surgeons navigating this transformative landscape must embrace the learning curve associated with these advanced techniques, recognizing the potential for improved patient outcomes. This article explores the transformative impact of MIS and robotics on the diverse branches of Otolaryngology, highlighting the technological advancements that have enabled these techniques to flourish. Continue...

Thyroid hemiagenesis is defined as a failure of one thyroid lobe development. This condition predominantly manifests as an incidental finding during radiological investigation. This paper reports the case of a 53-year-old female, a known case of hypertension, who visited the ENT clinic at AKU, a tertiary care centre in Karachi, Pakistan. The patient presented with hemiagenesis of the right thyroid lobe with enlargement of the contralateral lobe resulting in airway compression. She was subjected to excision of the thyroid gland without any intra-operative or postoperative complications. There were no complaints of dyspnoea, stridor or hoarseness during the hospital stay. The patient was discharged and was found to be well on subsequent follow-ups. Keywords: Unilateral Thyroid Agenesis, Thyroidectomy, Case Report.

Colorectal cancer ideally spreads via the haematogenous or lymphatic route with the most common metastasis to the liver or lungs. Metastasis of this cancer to the parotid gland has not been previously reported. This paper presents a case of rectal adenocarcinoma in a 34-year-old Pakistani male, who presented with histopathological evidence of metastasis in the parotid gland within one year of treatment. He had previously undergone neoadjuvant chemo-radiotherapy with surgical resection of rectal adenocarcinoma. Metastasis to the parotid gland is an uncommon occurrence in our setting and to our knowledge, this is the first instance of its kind. Careful surveillance of colorectal cancer patients after primary treatment may result in the early recognition of metastases, possibly providing patients with better treatment options and prognosis. This case undoubtedly provides a valuable contribution to the existing literature on colorectal cancer metastasis and points towards the need for additional assessment of these patients posttreatment.

Introduction The disease course of head and neck (H&N) cancer can severely impair patients’ quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. Methods An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. Results A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). Conclusion The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Abstract Background Patients after completing their treatment for HNC, are often functionally challenged by the acute and chronic complications in the oral cavity such as oral pain, limited mouth opening, xerostomia etc. These complications are known to reduce their OHRQoL, because of restricted food intake, limited social activity and economic growth, therefore impacting their overall well-being and survival. This study aims to assess the OHRQoL and its associated sociodemographic factors, oral hygiene related factors and oral clinical parameters such as OH status and OM grade in HNC survivors within one-year post cancer treatment.Methodology This was a cross-sectional study performed among HNC survivors at the ENT and dental clinics of Aga Khan University Hospital, Karachi. OHRQoL was assessed using EORTC QLQ H&N – 35, patients were examined for oral hygiene status using OHI- simplified and oral mucositis grade using WHO oral mucositis scale at one point in time. One sample t- test and multiple linear regression was used to test OHRQoL and its associations with the sociodemographic and clinical factors.Results The results of the study showed an overall higher mean score for OHRQoL of 25.02 ± 15.86 (95% CI 21.46–28.57), with difficulty in mouth opening and dry mouth because of salivary dysfunction among the most affected domains with higher symptoms scores in the study population. Significant association of OHRQoL were found with BMI, OH status, marital status, monthly income, gender and fluoride toothpaste use in HNC patients within one-year post cancer treatment (p < 0.05).Conclusion: High mean score for OHRQoL in HNC patients suggests their QoL is negatively impacted by their poor oral health post cancer treatment, therefore it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Cutaneous leishmaniasis can occur on any exposed area of the body; however, the pinna is an exceptionally rare site for the disease. Caused by the parasiteLeishmania, cutaneous leishmaniasis has a wide range of presentations and thus is very easy to misdiagnose or mistake for a neoplastic lesion. Here, we report the case of a middle-aged male patient presenting with a painful, ulcerated lesion on the left auricle initially suspected to be a malignancy with histopathology eventually revealing a diagnosis of auricular leishmaniasis. The patient received appropriate therapy and was found to be disease free at follow-up. These isolated lesions of the pinna often resemble neoplastic lesions and thus may escape diagnosis for months at a time, increasing patient stress as well as expenditure. In addition, prompt recognition may also help mitigate recurrence of the disease, making it worthwhile to include cutaneous leishmaniasis as part of the differential, especially in endemic areas.

Abstract Background We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire’s Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience. Methods We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability (using Cronbach’s alpha) of the EORTC QLQ-H&N35 were assessed. Results Our sample comprised 250 patients with H&N cancer, most commonly oral (82%). The Urdu translations were comprehensible for all patients. The Cronbach alpha for QLQ-H&N35 multi-item domains ranged from 0.75 to 0.98 (acceptable to excellent), barring “Senses Problems”, which was less than the generally acceptable level (0.50). The patient-reported content validity index (CVI) scores for relevance and clarity of the Urdu version of the QLQ-H&N35 were 0.93 and 0.92, respectively (both excellent). Our results revealed weak bidirectional correlations of the QLQ-H&N35 with resilience, depression, and anxiety, showing good discriminant validity. A weak-to-moderate but significant negative correlation (r: − 0.185 to − 0.613; p < 0.01) was seen between the QLQ-H&N35 and the global QoL measure of the QLQ-30. Conclusion Our Urdu translation of the EORTC QLQ-H&N35 demonstrated validity comparable to previous studies, with good discriminant construct validity when measured against resilience, depression, and anxiety. An issue of concern is the poor internal consistency of the “Senses Problems” domain. Nevertheless, the Urdu translation produced in this study serves as a valid and reliable measure to measure QoL in H&N cancer in clinical or research settings in Pakistan.

Introduction The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan. Methods An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young’s Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI). Results The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (− 17[− 20.98,-12.93]) or borderline depression (− 4[− 8.41,-0.39]), severe anxiety (− 11 [− 17.88,-4.18]), low social support (− 6[− 9.62,-1.71]), having family members of > 6 in the household (− 2[− 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (− 4[− 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker). Conclusion In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.

Technological progress has changed the landscape of surgical practice. Minimally invasive surgery (MIS) and percutaneous interventions (PC) are constantly replacing open procedures. This reduces hospital stay and allows quicker recovery. The application of MIS should follow the good medical practice dictum by Hippocrates i.e. "First do no harm". To remain abreast with new procedures, the medical personnel are required to update and enhance their knowledge and skill. To ensure safety, the innovations are rigorously tested and tried. The learning curve of MIS is shortened by simulator training and proctorship. Credentialing processes are in place to enhance safe delivery of care. Despite of all these measures MIS and PCI are associated with adverse effects. The purpose of this article is to overview the iatrogenic trauma associated with MIS and PCI in major surgical subspecialties.

Introduction The larynx is a part of the upper respiratory tract that performs many essential functions including breathing, speaking, and swallowing. For this reason, the quality of life is significantly affected by laryngeal cancer and its treatment. Therefore, the focus of management for the last few decades has been on preserving the function of a larynx without compromising survival. This study was done with the purpose of reviewing our experience of organ preservation approach with concurrent chemoradiation therapy (CCRT) for locally advanced cancers of larynx. Methods A retrospective chart review was carried out for the data of pathology reports and clinical notes of the patients who were diagnosed with laryngeal squamous cell carcinoma and primarily treated with CCRT at our tertiary care institute from November 2010 to June 2015. Results Of 25 patients included in the study, there were 19 males and six females. The mean age was 56 years. On comparison of post-treatment CT scan following eight weeks of completion of therapy, 21 patients showed complete resolution of the disease and four patients had persistent disease who were later treated with salvage laryngectomy. The speech was understandable in 18 patients and poor or not understandable in seven patients. Three patients had chronic aspiration and breathing difficulties necessitating permanent tracheostomy. Three patients required permanent gastrostomy due to chronic dysphagia, one of them belonged to those who were also tracheostomized. Conclusions Our experience with CCRT as an organ preservation approach for advanced laryngeal cancers was promising. When considering the functional organ preservation, the proportion of success is remarkably less; however, the overall impression is worthy enough to uphold the sentiment in favor of non-surgical organ preservation. The debate is ongoing in the quest of finding a balanced approach with acceptable toxicity and decent functional outcome with adequate speech, breathing, and swallowing.

INTRODUCTION:Synovial sarcoma makes up 8-10% of all soft tissue sarcomas, and constitutes 3-10% of all sarcomas occurring in the head and neck region. It shows male predominance (3:2), and the mean age of presentation is 30 years.CASE REPORT:A 51-year-old gentleman presented with right-sided neck swelling which had been progressively increasing in size for the past 2 years. A computed tomography (CT) scan revealed a large heterogeneously enhancing mass on the right side of the neck measuring 7.5 × 6.2 cm. Biopsy of an enlarged node revealed papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with right neck dissection. Final histopathology revealed a papillary carcinoma of the thyroid, and the right-sided mass was shown to be monophasic synovial sarcoma.CONCLUSION:We present a case of a concurrent pathology of neck papillary thyroid carcinoma with monophasic synovial sarcoma. We experienced difficulty in diagnosis and misdirection due to raised C-reactive protein (CRP) levels, until final histopathology of the neck mass.

Cervical thymus cyst is a rare entity and resembles lymphangioma or branchial cleft cyst therefore, presents as a diagnostic challenge. It has a slight male predominance and presents on the left side of the neck in up to 70% of cases. It is a painless mass that progressively increases. We present a case of a seven year old child with a right sided neck swelling that would increase on phonation therefore, adding to the complexity of the case. Surgical excision was performed and final histopathology revealed an ectopic thymic cyst.

In patients with well-differentiated thyroid carcinoma (WDTC), the extent of thyroid surgery is controversial. There are proponents of both total thyroidectomy (TT) and thyroid lobectomy (TL). A review of literature was performed. We included studies investigating the extent of thyroid surgery, TT versus TL, for WDTC. Multiple studies have failed to show any significant difference in posttreatment recurrence between TT and lobectomy. In properly selected low-to-intermediate risk patients, the extent of initial thyroid surgery probably has little impact on disease-specific survival.