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Thyroid cancer surgery has evolved dramatically with advances in our understanding of the biological behaviour of WDTC. Molecular profiling is shedding light on the subset that may behave aggressively. In an era when thyroid cancer management is becoming increasingly conservative, decision making regarding the extent of surgery must be objectively guided by molecular markers. The aim of the present article is to summarise the current published literature and provide possible practice recommendations. An online search for relevant published articles was performed using several databases. Title, abstract, and full-text screening, along with data extraction, was performed by two independent reviewers after the inclusion and exclusion criteria were defined. A total of 1241 articles were identified, and 82 relevant articles were extracted and scrutinised. BRAF V600E and TERT promoter mutations were found to be associated with an increased risk of disease recurrence and distant metastases. Several other mutations have been identified that enhance disease aggressiveness (such as RET/PTC, PTEN, and TP53). One of the most important determinants of the outcome in WDTC is the extent of surgical resection. The evolution of molecular testing has reached a stage of personalised incorporation into surgical practice. Guidelines for molecular testing and surgery in WDTC will need to be clearly defined, arguably representing the next chapter in the management of the disease.

A man in his 70s was referred to the endocrine surgery department after incidental finding of hypercalcaemia during preoperative work-up for abdominal aortic aneurysm repair. The patient reported severe fatigue and malaise with no previous history of nephrolithiasis or osteoporosis. After biochemical confirmation of primary hyperparathyroidism, localisation studies suggested multiple gland disease. Intraoperatively, three enlarged parathyroid adenomas were found and excised. Histopathological and immunohistochemical examination revealed triple water clear cell (WCC) parathyroid adenomas. Adenomas being entirely composed of WCCs are rare. In addition, triple adenomas are so rare that their existence is disputed by some authors. The present paper reports on an extremely rare case of a patient suffering from triple parathyroid adenomas composed entirely of WCCs. To our knowledge, this is the first such reported case in the English language literature., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Occlusion of the larynx of neoplastic origin was treated by CO2 laser in seven patients between Marc 1982 and April 1983. Temporary tracheotomy was avoided in all 7 cases but treatment had to be repeated in two patients. Specific anesthetic techniques necessary when using the laser in hypercapneic patients are described, and the advantages, limitations and complications of this therapy are discussed.

The authors analyse the results of treatment of 84 squamous cell carcinomas of the mobile portion of the tongue treated between 1961 and 1982. 64% of the patients treated were Stage I or II. The local recurrence rate was 13% at 5 years (6/43) for T1, T2. Recurrences were more frequent after interstitial radium therapy (17% at 5 years: 5/28) than after partial glossectomy performed at the outset (6.6% : 1.15). The treatment of stage NO remains controversial. The frequency of lymph node recurrences remains proportional to lymph node involvement by histology (NO, N-: no recurrences; NO, N+: 18.1%: 6/33) but seemed to be independent of the initial treatment of the regional nodes: no treatment, neck dissection with or without subsequent external radiotherapy. It is important to emphasize that lymph node recurrences contralateral to the tumour always occurred in the presence of initial homolateral lymphadenopathy with capsular rupture. Other oncological failures were frequent (35% : 20/56) at 5 years, grouping together visceral metastases (14.3% : 8/56) and second primary cancers in the upper respiratory/digestive tract (21.4% : 12/56).