Diffuse sclerosing variant of papillary thyroid carcinoma – a rare cause of goitre in a young patient

to occur. Bile also provides a good medium for bacterial growth and so infective sequelae often occur in the setting of a cholethorax. Biliary pleural fistulas and the formation of bilious pleural effusions are known complications of hepatic trauma 1,2 , parasitic liver disease 3 and development of a subphrenic abscess in the setting of biliary obstruction. Iatrogenic causes include biliary stent migration 4 , radio-frequency ablation 5 and following cholecystectomy 6 and liver biopsy 7 However, it is the increasing use of percutaneous biliary drainage which has lead to the greatest number of cases. For a Cholethorax to arise disruption of the pleural space needs to have occurred and this may not necessarily be obvious during the procedure. Rapid thoracentesis, correction of the cause of the fistula, adequate analgesia and the treatment of infective sequelae are essential in the management of this group of patients. 1. Franklin DC, Mathai J. Biliary pleural fistula: a complication of hepatic trauma. fistula presenting as a massive pleural effusion after thoracoabdominal penetrating trauma. Thoracobilia: a surgical complication of hepatic echinococcosis and amebiasis. al. Biliary pleural fistula as a complication of radiofrequency ablation for liver metastasis. [ " Cholethorax " revealing injury to the common bile duct after celioscopic cholecystectomy]. fistula as a complication of percutaneous biliary drainage: experimental evidence for pleural inflammation. Diffuse sclerosing variant of papillary thyroid carcinoma – a rare cause of goitre in a young patient Editor, Papillary thyroid carcinoma is the most common thyroid malignancy. We report a case of a rare variant-diffuse sclerosing papillary thyroid carcinoma (DSPC). Case History: An 18 year old girl presented with a smooth symmetrical goitre. She was clinically euthyroid and had no palpable cervical lymph nodes. Thyroid function tests and anti-thyroid peroxidase level were normal. Ultrasound scan of thyroid showed marked nodular enlargement of the entire gland in keeping with a multinodular goitre. A hypoechoic 1cm nodule was identified at the right lobe which was found to be 'cold' on radio-isotope scanning. A fine needle aspiration of this 'cold' nodule was reported as papillary carcinoma. She was booked for total thyroidectomy. At surgery she had an enlarged thyroid, with a gross appearance in keeping with a thyroidititis or lymphoma. Frozen section confirmed papillary carcinoma. The gland was hard and gritty. Several local lymph nodes were also excised. Post-operative recovery was uneventful. Sectioning revealed a diffusely firm, white, gritty gland (fig 1). Histopathology showed …