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Highlights • Occult thyroid cancer may present as nodal metastases mimicking benign disease. • A comprehensive workup of any neck lump is essential to exclude sinister pathology. • Early MDT involvement is vital when there is a lack of widely accepted guidelines., Introduction The approach to the anterior neck lump involves the consideration of numerous benign and malignant differentials. Presentation of case We present a rare case of an occult papillary thyroid cancer with cystic nodal metastases presenting as a thyroglossal duct cyst. Discussion We explore the literature surrounding occult papillary thyroid carcinoma/microcarcinomas and the potential for the disease to present as a cervical lump. There is discussion surrounding the diagnostic and therapeutic difficulties associated with this case, and the importance of lateral thinking and clinical flexibility. Conclusion We recommend that the management approach to any anterior midline neck lump involve a comprehensive work-up including radiological imaging, routine histopathological analysis, and the early involvement of the subspecialty multidisciplinary team.

The traditional management of pancreatic pseudocyst (PP) is surgical drainage; however, there is significant morbidity associated with this approach. An endoscopic ultrasound (EUS)-guided transgastric endoscopic approach is preferred if there is favourable access to the PP. This case report describes a rare complication of an EUS-guided transgastric drainage of a PP secondary to a suboptimally positioned stent. Significant soiling of the peritoneal cavity by pancreatic juices and gastric contents occurred due to leakage around the stent puncture sites. A novel technique using an infant feeding tube is described to inflate the collapsed PP and facilitate definitive surgical cystogastrostomy. A literature review and discussion surrounding the safety of endoscopic decompression and the type of stent utilised is also presented.

Patient: Female, 6-year-old Final Diagnosis: Burkitt’s leukemia Symptoms: Right iliac fossa pain Medication: — Clinical Procedure: Laparoscopic cecectomy Specialty: Surgery Objective: Rare disease Background: Appendicitis is the most common cause of an acute abdomen. Approximately 1% of appendicectomies will have an incidental finding of an appendiceal neoplasm. A primary appendiceal lymphoma is extremely rare, and is found in 0.015% of all appendiceal specimens. Burkitt lymphoma is an aggressive B cell lymphoma characterized by translocation and dysregulation of the c-Myc gene. Burkitt leukemia is considered to be an alternative manifestation of the same pathology, and is defined by the presence of >25% Burkitt blasts within the bone marrow. The treatment approaches for Burkitt leukemia/lymphoma are similar. Case Report: A 6-year old girl presented with a history, examination, and radiological imaging consistent with acute appendicitis. An inflamed, edematous appendix was identified intraoperatively, and a cecectomy was performed. Histopathological investigations demonstrated Burkitt leukemia with isolated extra-nodal involvement of the appendix. The patient was subsequently started on a multi-agent steroid and chemotherapy regimen. A literature review was performed, identifying cases of Burkitt leukemia/lymphoma presenting as appendicitis. Conclusions: This case highlights the importance of clinical vigilance and routine specimen histopathology review, and explores key management considerations associated with the incidental diagnosis of Burkitt leukemia/lymphoma.

A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.

© 2016, Springer Science+Business Media New York. Purpose: The purpose of the present study is to explore the role of the general practitioners, family physicians and primary care physicians (GP) in the provision of follow-up cancer care. Methods: PubMed, MEDLINE and CINAHL were systematically searched for primary research focussing on the role of the GP from the perspective of GPs and patients. Data were extracted using a standardised form and synthesised using a qualitative descriptive approach. Results: The initial search generated 6487 articles: 25 quantitative and 33 qualitative articles were included. Articles focused on patients’ and GPs’ perspectives of the GP role in follow-up cancer care. Some studies reported on the current role of the GP, barriers and enablers to GP involvement from the perspective of the GP and suggestions for future GP roles. Variations in guidelines and practice of follow-up cancer care in the primary health care sector exist. However, GPs and patients across the included studies supported a greater GP role in follow-up cancer care. This included greater support for care coordination, screening, diagnosis and management of physical and psychological effects of cancer and its treatment, symptom and pain relief, health promotion, palliative care and continuing normal general health care provision. Conclusion: While there are variations in guidelines and practice of follow-up cancer care in the primary health care sector, GPs and patients across the reviewed studies supported a greater role by the GP. Implications for Cancer Survivors: Greater GP role in cancer care could improve the quality of patient care for cancer survivors. Better communication between the tertiary sector and GP across the cancer phases would enable clear delineation of roles.