Objective: Papillary thyroid microcarcinoma (PTMC) often presents with multifocality and bilaterality, but the clinical significance of these features and their association with cervical lymph node metastases (LNMs) remain debated. The aim of this study was to investigate the patterns of multifocality and bilaterality in PTMC and their association with central and lateral neck lymph node metastases. Methods: This retrospective study analyzed 254 patients with histologically confirmed PTMC treated at the Institute for Oncology and Radiology of Serbia between 2004 and 2016. All patients underwent total thyroidectomy with central and, when indicated, lateral neck dissection. Associations between multifocality, bilaterality, and cervical LNM were evaluated using appropriate statistical tests. A p-value < 0.05 was considered statistically significant. Results: Multifocal tumors were present in 40.55% of patients, with bilateral involvement in 27.17%. Cervical LNM occurred in 33.07% of patients, with 26.77% showing central and 20.08% lateral metastases. Patients with multifocal tumors were associated with significantly higher proportions of male patients (p = 0.0283), higher rates of capsular invasion (p = 0.0002), larger tumor size (p = 0.0134), and increased incidence of LNM (p = 0.0152). Bilateral tumors were associated with larger tumor size (p = 0.0004) and more frequent capsular invasion (p = 0.0248), but not with a statistically significant increase in LNM. The number of tumor foci was strongly associated with both central and lateral LNM (p < 0.001). Conclusions: Multifocality, particularly with a higher number of tumor foci, is significantly associated with more aggressive tumor features and higher rates of cervical lymph node metastases in PTMC. While bilaterality also reflects a more aggressive phenotype, it was not independently predictive of LNM. These findings underscore the importance of careful risk stratification in PTMC and suggest that multifocality should inform surgical and follow-up strategies.

Background/Objectives: Multiple primary malignancies (MPMs) are defined as the occurrence of two or more independent primary tumors in the same patient, histologically distinct and not of metastatic origin. Patients treated for Hodgkin’s lymphoma (HL) carry an increased risk of developing secondary malignancies, especially after chemotherapy and radiotherapy. The synchronous occurrence of breast and kidney carcinoma in this population is extremely rare. Methods: We present a 41-year-old female patient with a history of HL treated at the age of 23 with ABVD chemotherapy and supradiaphragmatic radiotherapy. Results: During staging for a newly diagnosed breast tumor (ER+/PR+/HER2+, pT1cN0), an incidental renal mass was identified and histologically confirmed as clear cell renal cell carcinoma (pT1aNxMx, G2). A multidisciplinary team performed simultaneous partial breast resection with sentinel lymph node biopsy and nephrectomy. The postoperative course was uneventful, and adjuvant systemic therapy was initiated according to oncological guidelines. Conclusions: Synchronous malignancies in HL survivors pose a clinical challenge, as they must be distinguished from metastatic disease and require coordinated therapeutic planning. Risk factors include prior radiotherapy, chemotherapy, genetic predisposition, and family history. This case highlights the importance of long-term surveillance of HL survivors, particularly young women, due to their elevated risk of secondary malignancies. Synchronous breast and kidney carcinomas after HL therapy are extremely rare and demand an integrated multidisciplinary approach. Early recognition and coordinated therapy are crucial for optimizing outcomes and contributing to a better understanding of the etiology and pathogenesis of multiple primary malignancies.

Background/Objectives: Distinguishing parathyroid carcinoma from parathyroid adenoma remains a major diagnostic challenge because these tumors frequently share similar clinical, biochemical, radiological, and histopathological features. Accurate diagnosis is essential for appropriate surgical management, highlighting the need for reliable adjunctive biomarkers. This study evaluated the diagnostic value of tumor angiogenesis, quantified by microvessel density (MVD), for differentiating parathyroid carcinoma from parathyroid adenoma and its association with clinicopathological characteristics. Methods: This retrospective study included 50 patients with primary hyperparathyroidism who underwent surgery at a tertiary endocrine surgery center, including 10 parathyroid carcinomas and 40 parathyroid adenomas. Tumor angiogenesis was assessed by immunohistochemical staining, and MVD was quantified in vascular hot spots using standardized methods. Receiver operating characteristic (ROC) analysis evaluated the diagnostic performance of MVD, while correlations with clinicopathological parameters were analyzed. Results: Parathyroid carcinoma demonstrated significantly higher MVD than parathyroid adenoma (median 901.14 vs. 431.24; p < 0.001). ROC analysis showed excellent diagnostic performance, with an area under the curve of 0.917. Higher MVD was positively associated with Ki-67 expression, preoperative parathyroid hormone and calcium levels, and tumor weight, indicating a close relationship between angiogenesis, tumor proliferation, biochemical disease severity, and tumor burden. No significant associations were observed with age or preoperative phosphate levels. Conclusions: Quantitative assessment of MVD is a promising adjunctive immunohistochemical biomarker for distinguishing parathyroid carcinoma from parathyroid adenoma. Incorporating MVD into conventional histopathological evaluation may improve diagnostic confidence, particularly in morphologically challenging cases. Larger multicenter studies are warranted to validate these findings and further establish the clinical utility of MVD.

Background/Aim: Breast angiosarcoma is a rare tumour of vascular endothelium origin, accounting for less than 0.05% of all breast malignancies. The aim of this case report was to point out the importance of early recognition and a multidisciplinary approach in the diagnosis and treatment of this rare entity. Case report: A 44-year-old woman presented for a clinical examination due to a tumour in her right breast. After a mammographic examination, which verified a highly suspicious lobular change at the junction of the upper quadrant of the right breast with a diameter of 86 × 98 mm, a biopsy with a core needle was performed, followed by a radical mastectomy. Pathohistologically, a vascular mesenchymal tumor was verified. Using the immunohistochemical staining method, the tumor showed immunoreactivity to Vimentin, CD31, CD34, and Factor VIII, while AE1/AE3, EMA, estrogen, progesterone, and HER2 were negative, and the diagnosis of poorly differentiated primary angiosarcoma was made. Conclusion: Primary breast angiosarcoma represents a real diagnostic challenge. Due to the tumor's rarity and aggressiveness, a multidisciplinary approach to diagnosis and treatment is essential. Because of the nonspecific clinical and radiographic features of primary angiosarcoma, differential diagnoses encompass both benign and malignant breast conditions. Therefore, histopathological analysis is crucial for accurate diagnosis.