Objectives: The tall cell variant is an uncommon variant and has been known as more aggressive form of papillary thyroid carcinoma (PTC). Owing to the rarity of these thyroid cancers, their clinical behavior remains incompletely understood. To elucidate the clinicopathologic characteristics of tall cell variant, we retrospectively reviewed our surgical experience of patients with tall cell variant. Methods: Between August 1993 and July 2004, a total of 11 consecutive patients who were pathologically diagnosed with tall cell variant of papillary thyroid carcinoma were enrolled in this study. All patients underwent total (8 cases) or subtotal thyroidectomy (3 cases) with central compartment node dissections. The lateral neck dissection was added in 6 patients. After the operation, neck ultrasound and serum thyroglobulin were checked regularly during the follow-up period. Results: The mean age of the patients was 56.6years (range, 30-74years) at the time of diagnosis. 3 patients were men, and 8 were women. The mean diameter of tumor was 3.7cm(range, 1.5-6.0cm), and 6 patients had lateral neck node metastasis. Extrathyroidal extension was seen in 5 patients (45%). Loco-regional recurrence was found in 2 patients (18%), and distant metastasis in 1 patient (9%). The 5-year disease free survival rate was 68%. Conclusion: The tall cell variant of papillary thyroid carcinoma is an uncommon disease. Clinicopathologic feature and prognosis of this disease show more aggressive behaviors than ordinary papillary thyroid carcinoma. More aggressive treatment and close follow-up should be undertaken in the tall cell variant of papillary thyroid carcinoma.

Background and Objectives: Angiogenesis is the process of new blood vessel development from preexisting vessel. Angiogenenesis has been considered to be essential for the growth and expansion of a solid tumor. Vascular endothelial growth factor (VEGF), known as one of the most important vascular permeability factors, induces proliferation of endothelial cells, stiumulates angiogenesis, and increases vascular permeability. Several recents reports have documented that VEGF overexpression is associated with poor clinical outcomes in many maligmancies. The aims of this study were to determine whether microvessel density and VEGF expression are related to clinicopathologic factors such as age, sex, tumor size, tumor stage, and prognostic factors and to evaluate the relationship between VEGF expression and angiogenesis in benign and malignant thyroid tumors. Materials and Methods: The subjects were 65 patients (27 with papillary carcinoma, 27 with adenomatous hyperplasia, 11 with follicular adenoma) who underwent thyroidectomy from 1995 to 2001. Imuunohistochemistry was used to detect VEGF expression and microvessel density (MVD) in paraffin-embedded thryoid tumor specimens. Results: The intensity of the VEGF expression did not show stastically difference between benign and malignant thyroid tumors. There was no apparent correlation between VEGF expression and age, tumor size, T stage or scores of the AGES, AMES and MACIS systems. The neo-microvessel density was higher in the maligant tumor than the benign tumors. Also, higher neo-microvessel density was associated with metastases of the lymph nodes and scores of the AMES and AGES systems. Conclusion: Our results suggest that neo-microvessel vessel density may be a significant prognostic factor in the thyroid papillary carcinoma. But the VEGF expression does not appear to be an significant independent prognostic factor for thyroid papillary carcinoma.

Objectives: The purpose of this study was to evaluate for prognostic significance of VEGF expression and tumor angiogenesis in papillary carcinomas of the thyroid. Materials and Methods: The materials were 79 cases of papillary thyroid carcinomas, and age, sex, tumor size, multiplicity of tumor, capsular invasion, lymph node metastasis, recurrence, TNM stage, DeGroot stage and AMES scale were evaluated. An immunohistochemical stains for CD 34 to estimate microvessel density (MVD), and VEGF were done. MVD was defined as an average count of vessels per ${\times}400$ power field in the most vascularized area. VEGF expression was interpreted as 1+ and 2+ according to staining intensity and percentages of positive cells. Results: Mean score of MVD was $39.7{\pm}16.9.$ MVD were significantly higher in cases with capsular invasion (p=0.0001), lymph node metastasis (p=0.0001), TNM stage III (p=0.0022), DeGroot stage III (p=0.0163) and high risk group by AMES scale (p=0.0001). VEGF 2+ expression rate was significantly increased in cases with capsular invasion and lymph node metastasis (p=0.0006, p=0.0013), and in cases with TNM stage III, DeGroot stage III and high risk group by AMES scale (p=0.0236, p=0.0003, p=0.0293). In VEGF 2 + expression group, MVD was significantly higher than in VEGF 1 + group (p=0.0008), and MVD showed positive relation to VEGF 2 + expression (r=0.4616). Conclusion: VEGF expression and high MVD were significantly correlated to capsular invasion, lymph node metastasis, TNM stage III, DeGroot stage III and high risk group by AMES scale. The expression of VEGF and high MVD could be considered to be one of prognostic factor in papillary thyroid carcinomas.

Background and Object: The role of fine needle aspiration cytology (FNAC) and frozen section (FS) in management of thyroid neoplasms continues to generate considerable controversy. We reviewed our current experience to determine the clinical utility of FNAC and FS in our surgical management and investigated reliability of FNAC and FS in planning the extent of thyroid resection. Material and Method: 212 patients who had operations for thyroid disease from May 1996 to November 2003 were included our retrospective study. FNAC was undertaken in 175 patients and FS was done in 148 patients. Result: The sensitivity and specificity of FNAC were 72.1% and 100%, respectively, and those of FS were 67.2% and 100%. The results of FNAC were benign (n=72) , malignancy (n=31), indeterminate (n=9), and nondiagnostic (n=63). The results of FS were benign (n=95), and malignancy (n=53). The 9 indeterminate cases on FNAC were benign (n=6) and malignancy (n=3) on final pathology, and benign (n=7) and malignancy (n=2) on FS. The false negative of FNAC were micro papillary carcinoma (n=6) and follicular carcinoma (n=6). The false negative of FS were micropapillary carcinoma (n=10) and follicular carcinoma (n=2). Conclusion: When results of FNAC are interpreted as indeterminate, FS is a valuable tool. FS is helpful in determining the extent of thyroidectomy when results of FNAC were follicular neoplasm. However we always concerned about micropapillary carcinoma and follicular carcinoma although FNAC and FS were benign.

Objectives: Head and neck squamous cell carcinoma (HNSCC) is the most common head and neck malignant tumor. The molecular genetic changes involving both oncogenes and tumor suppressor genes are known to be involved in head and neck squamous cell carcinogenesis, but the roles of the known tumor suppressor genes in carcinogenesis are not fully elucidated. The objectives of this study are to demonstrate the genetic alterations including the loss of heterozygosity (LOH) , amplification, and microsatellite instability of known tumor suppressor genes in HNSCC and to evaluate the relationship between genetic alterations of tumor suppressor genes and clinicopathologic features. Materials and Methods: Genetic alterations of 10 micro satellite markers of the 6 known tumor suppressor genes (APC, EXT1, DPC4, p16, FHIT, and PTEN) were analysed by DNA-PCR in paraffin-embedded histologically confirmed HNSCC specimens. Results: The genetic alterations of tumor suppressor genes were found frequently. Among the genetic alterations, LOH was most frequently found one. LOH was found frequently in APC (45.4%), EXT1 (36.4%), DPC4 (54.5%), and p16 (50%), but not found in FHIT. Also, the author found that abnormalities of APC gene was related to cervical lymph node metastasis and recurrence and that abnormalities of EXT1 gene were coexisted with those of APC gene or DPC4 gene. But these coexistences had no correlation with clinical features. Conclusion: These results suggested that APC, EXT1, p16, and DPC4 genes might play important roles and multiple tumor suppressor genes may participate dependently or independently in the carcinogenesis of HNSCC. These results also suggested that APC gene might relate to prognosis.

Background and Objectives: Neck metastasis is one of the most important prognostic factors in treating tonsillar cancer. Incidence and pattern of lymph node metastasis of tonsillar squamous cell carcinoma are the basic knowledge of treatment decision. Occult metastasis rate of tonsillar cancer and pattern of metastasis, failure pattern, survival were retrospectively analyzed. Patients and Methods: Seventy six patients who underwent surgery for tonsillar squamous cell carcinoma as an initial treatment from 1992 to 2004 were evaluated. Charts, imaging studies and pathologic reports were reviewed. Results: At the time of surgery, 78% of patients with tonsillar cancer had neck metastasis and 66% had multiple node metastasis. Occult neck metastasis was in 26%. There was high incidence of neck metastasis even in early stage of primary lesion. Conclusion: High incidence of lymph node metastasis was confirmed histopathologically in tonsillar cancer. All tonsillar cancer patients may need elective treatment of the neck. Tonsillar cancer had relatively good prognosis even though its neck metastasis rate is very high.

Objective: The aim of this study is to evaluate shoulder function and preoperative and postoperative electrophysiological changes related to the spinal accessory nerve with reference to neck dissection technique. Materials and Methods: We evaluated shoulder function by pain, strength and range of motion in a total of 35 neck dissection cases of 29 patients with head and neck cancer or thyroid papillary cancer. Electrophysiologic studies were performed before surgery, after third postoperative weeks and 6 months respectively. The results of each test according to the types of neck dissection were compared. Results: Clinical parameters of shoulder function and electrophysiologic study showed deterioration in early postoperative periods and improvements in late postoperative periods when the spinal accessory nerve was spared and permanent nerve damage was observed in radical neck dissection. There were correlations between the clinical parameters and electrophysiologic studies. Conclusion: The shoulder function after spinal accessory nerve sparing procedure is better than the function after nerve sacrificing procedure.

Background and Objectives: Squamous cell carcinoma of retromolar tringone (RMT) is an uncommon head and neck tumor. RMT cancer has unique clinical feature and specific considerations for surgical treatment are needed but, reports on the treatment of RMT cancer are still lacking. Patients and Methods: From May 1997 to July 2004, 8 patients with histologically proven squamous cell carcinoma of the RMT were treated in Severance Hospital. Surgical excision of the primary lesion and neck dissection were performed in all patients. Reconstruction was accomplishing using several methods. Charts and other medical records were reviewed. Results: In early cases, lower cheek flap was appropriate but, mandibular swing or madibulectomy approach was appropriate in advanced cases. Reconstruction was needed in all patients and excision of mandible was needed in majority of patients. 6 patients were disease free status and one died from recurrence and one was lost to follow up. Conclusion: In treatment of RMT cancer, several surgical approach methods and reconstruction should be considered before treatment. Surgical treatment of RMT cancer may be one of a useful primary treatment modality.

Background and Objectives: Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we designed induction chemotherapy followed by definitive radiation in patients with potentially respectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival. Materials and Methods: The twenty-six patients diagnosed advanced head and neck squamous cell carcinoma, Stage III or IV (AJCC 2002) and performed organ preservation protocols in Ajou university hospital from 1994 to 2001 were included in this study. Results: Neoadjuvant chemotherapy showed an overall response rate of 84.6% and a complete remission (CR) rate was 59.1% following neoadjuvant chemotherapy and radiation. Seven of thirteen patients were able to preserve their larynges for more than two years by chemotherapy and radiation. There were no treatment related mortality after 2 cycles of induction chemotherapy. Conclusion: Although Organ preservation protocol through neoadjuvant chemotherapy and radiation need more controlled randomized study, it was considered alternative treatment modality in advanced head and neck cancer.

Objectives: To completely excise a malignant tumor which invades carotid artery walls, the resection and reconstruction of the carotid artery is essentially required. In most of the cases, interposition graft using a saphenous vein has been performed, however the vessel caliber discrepancy between a common carotid artery and the saphenous vein can result in a problem on surgical technique. We have introduced and evaluated a new titanium hemoclip tailing method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection in the treatment of head and neck cancers. Method: After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and an orifice of the common carotid artery was gradually reduced to a little larger than or the same size as the orifice of the vein by using the titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein through anastomosis. The same method was also applied to the distal anastomosis site. There after, the vessels were connected through the anastomosis, and a circulation was restored by releasing a vascular clamp. Then, a titanium hemostatic clip-applied redundant portion on the outside of carotid artery was sutured by the blanket edge suture method, using 6-0 Prolene. Results: We have experienced this method in two patients with recurrent squamous cell carcinoma and neuroblostoma, respectively. The interposition saphenous vein graft of these patients was found to maintain good patency on the follow up angiography after one year, and they had no specific vascular complication, such as atherosclerosis. Conclusion: This method made it possible to simply perform the interposition saphenous vein graft (ISVG) within a short time and, therefore, was very useful for shortening the duration to block circulation.

Background: About 3% of all cancer patients suffer from cancer of unknown primary origin. Generally, carcinoma of unknown primary (CUP) carries a grave prognosis, but primary tumor presented to the neck is exception to this. The aims of study are to determine the role of chemotherapy and to find the prognostic factors in unknown primary tumor presented to the neck. Method and Material: Eighty-four patients were diagnosed with unknown primary tumor presented to the neck between January 1996 and June 2002. Among 84 patients, 43 patients (52%) received chemotherapy, radiation or surgery were performed in 20 patients (23%), 21 patients (25%) had no treatment. Results: The response rates to chemotherapy were 87.5% in CUP only localized to the neck and 44.0% in CUP systemically involved (p=0.012). A median follow-up duration was 6.4 years and overall median survival time was 9 months. The median overall survival time of patients treated with chemotherapy were 17 months and that of patients who received surgery or radiation were 20 months (p=0.3548). The important prognostic factors were performance status and the number of involved organ. Conclusion: The prognosis of patients with CUP presented to the neck is more favorable than that of patients with CUP of other localization. The effectiveness of chemotherapy for CUP only localized to the neck was similar to that of surgery or radiation. The important prognostic factors were performance status and the number of involved organ.

Basaloid squamous carcinoma (BSC) is an uncommon aggressive variant of squamous cell carcinoma with a predilection for hypopharynx, tongue base, and larynx. We present 5 cases of BSC of unusual sites, each from maxillary sinus, external auditory canal, submandibular gland, tonsil, and nasopharynx. Only a few cases arising in these sites have been reported to date. Patients included 3 men and 2 women with the age range of 45-69 years (mean, 56.4 years). Microscopically, the tumors were characterized by solid lobules and nests of ovoid basaloid cells with abundant desmoplastic stroma. Comedonecrosis, peripheral palisading of tumor cells, trabecular pattern, and rosette-like arrangement were commonly observed. Tumor cells had scanty cytoplasm and their nuclei were ovoid, relatively uniform, and hyperchromatic. In two cases, concomitant squamous cell carcinoma in situ was identified. Immunohistochemical stains revealed that tumor cells were strongly positive for pancytokeratin and negative or weakly positive for p63. Being aware of BSC that can arise from unusual sites would help diagnose correctly and treat properly this rare and distinct clinicopathologic entity.

Castleman's disease was first described from Benjamin Castleman in 1956. The disease today is enumerated among lymphoproliferative disorders and has unknown etiology. Although the mediastinum is a their most common location, they also occurs in other areas of the body, usually where lymph nodes are normally found. Castleman's disease of the neck is very rare. We describe a case of Castleman's disease of the neck in a middle aged man, and discuss the clinical presentation, radiological findings, and pathological features.

Neuroendocrine carcinomas are rare neoplasms of the hypopharynx. Neuroendocrine neoplasms are divided into four main types : carcinoid, atypical carcinoid, small cell carcinoma and paraganglioma. The diagnosis is primarily based on light microscopy and should be confirmed by immunohistochemical investigation. Small cell neuroendocrine carcinoma of the hypopharynx is extremely uncommon tumor and surgical results for this tumor have been disappointing. Chemotherapy and radiotherapy currently appear the most effective forms of therapy. We report our case of small cell neuroendocrine carcinoma of the hypopharynx with the brief review of literatures.