• Korean Journal of Radiology
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• v.23 no.11
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• pp.1102-1111
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• 2022

Objective: To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. Materials and Methods: From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. Results: Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." Conclusion: Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2010.03a
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• pp.48-49
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• 2010

• Tuberculosis and Respiratory Diseases
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• v.38 no.3
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• pp.297-303
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• 1991

Subacute necrotizing lymphadenitis is characterized by cervical lymphadenpathy in young patients and mistaken for malignant disease both clinically and histologically. Microscopically, there is a varying degree of effacement of the lymph node architecture and necrosis with an infiltrate of histiocytic cells and absence of polymorphs. We have experienced 4 cases of cervical lymphadenopathy accompanied by fever. All cases had complete recovery to conservative treatment only. The excised lymph nodes were moderately enlarged and typically showed varying degree of necrotizing lesions, and abundant karyorrhectic debris, scattered fibrin deposits, aggregates of large mononuclear cells, and a paucity of plasma cell and neutrophils. For investigating the etiology and pathogenesis of this lesion, further clinical study and stepwise pathologic and immunologic planning would be valuable.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.92-95
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• 2016

Neuroblastomas are sometimes associated with abnormal constitutional karyotypes, but the XYY karyotype has been rarely described in neuroblastomas. Here, we report a case of an esthesioneuroblastoma in a boy with a 47, XYY karyotype. A 6-year-old boy was admitted to our hospital because of nasal obstruction and palpable cervical lymph node, which he first noticed several days previously. A polypoid mass in the right nasal cavity was detected through sinuscopy. Biopsy of the right nasal polyp was performed. Based on the result, the patient was diagnosed with a high-grade esthesioneuroblastoma. Nuclear imaging revealed increased uptake in both the right posterior nasal cavity and the right cervical IB-II space, suggesting metastatic lymph nodes. Cytogenetic analysis revealed a 47, XYY karyotype. Twelve courses of concurrent chemotherapy were administered. Three years after the completion of chemotherapy, the patient had had no disease recurrence. He manifested behavioral violence and temper tantrums, so we started methylphenidate for correction of the behavior.

• Korean Journal of Head & Neck Oncology
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• v.4 no.1
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• pp.5-11
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• 1988

CT examination has been used in the preoperative examination of patients with head and neck cancer. The accuracy of CT in detecting nodal metastases has not been well established. We studied 35 patients (41 neck specimens) with head and neck cancer who underwent neck dissection. Surgical pathologic findings were compared with preoperative CT scan to establish the diagnostic accuracy for cervical lymph node metastases. The results of physical examination, CT scans of neck and histologic examinations were compared each other. The overall diagnostic accuracy of CT was 83.3%. Comparison with clinical accuracy shows the CT scan to be superior to the clinical examination in spite of careful physical examination, particularly in detecting occult metastases.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.3
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• pp.134-139
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• 2024

We systematically reviewed the literature on the co-occurrence of squamous cell carcinoma (SCC) and Warthin's tumor (WT), thought to be quite rare, to help reduce misdiagnosis and improve treatment planning. For this systematic review, we searched for articles in the Web of Science and PubMed databases, analyzed relevant studies for forward and backward citations, and identified only articles reporting on the "co-occurrence" of WT and SCC. Of the 237 studies identified, 12 comprising 18 patients met the inclusion criteria, to which we added one study from our institution. Most WTs were associated with SCC in the parotid gland or cervical lymph nodes. Most patients (89.5%) underwent selective or radical neck dissection due to identification of lesions separate from the primary SCC. Despite its frequent co-occurrence with other neoplasms, WT in the parotid or cervical lymph nodes tends to be misdiagnosed as a metastatic node when SCC is observed as the primary tumor. Factors to consider in diagnosis and neck management include identification of an association other than growth or development by lymphangiogenesis and whether the patient is a smoker, a strong risk factor.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.519-522
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• 2015

Background: We aimed to investigate whether the tumor free distance (the distance between the uterine serosa and the tumor at its deepest point) is useful in surgical staging and in predicting prognosis. Materials and Methods: Data from patients who underwent complete surgical staging for endometrial cancer between January 2006 and June 2011 were reviewed retrospectively. All demographic findings, surgical stages, histological type and grade, myometrial invasion, lymphovascular space invasion as well as abdominal cytology, cervical, adnexal, and omental involvement, and lymph node metastasis were recorded. The relations between myometrial invasion and tumor free distance from uterine serosa with prognostic factors were investigated. Results: Seventy patients were included in the study. Sixty-four (91.5%) had endometrioid type cancers and forty-four (62.9%) were grade 1. The deepest myometrial invasion was less than 1/2 in 42 patients (60%). In 18 patients (25.8%) lymphovascular invasion was noted. Eight (11.4%) were found to have cervical involvement, five (7.1%) had adnexal involvement and in 4 cases (5.7%) the peritoneal washings included malignant cells. Four patients had pelvic and one para-aortic node metastasis. We recognized that an invasion of more than 1/2 was correlated significantly with lymphovascular space involvement, histological grade, positive abdominal washing cytology, nodal and cervical involvement, but not with adnexal involvement. Tumor-free myometrial thickness was negative and statistically significant correlated with surgical stage, histological grade, lymphovascular space involvement, positive abdominal washing cytology, cervical and adnexal involvement. The importance of tumor-free myometrial thickness in determinating the lymphovascular space invasion was found to be highest in terms of sensitivity and specificity when crossing the ROC curve at 11 millimeters. Conclusions: Depth of myometrial invasion is more valuable for predicting lymph node metastasis than tumor-free myometrial thickness. The tumor-free myometrial thickness provides a better prediction for adnexal involvement.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.4
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• pp.442-446
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• 1995

Thyroid carcinomas are usually classified as papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and anaplastic thyroid carcinoma. Among the thyroid carcinomas, the incidence of medullary and anaplastic thyroid carcinoma is low, but the rate of lymph node & distant metastasis from them are more common compared to other types. Follicular thyroid carcinoma has a low rate of lymph node metastasis as 10% and has a high occurrence of hematogenous metastasis to lung, bone, brain and liver. Papillary thyroid carcinoma accounts for $60{\sim}70%$ of whole thyroid carcinomas and the cervical lymph node metastasis is $21{\sim}81%$ including micrometastasis, but the distant metastasis is rare. In the case of bone metastasis, follicular type reveals most frequent, and the rate is about 5%, and more likely to be found on vertebra, pelvis, ribs, femur, and skull. The clinical symptoms of bone metastasis are pain, swelling, pathological fracture and radiologically osteolytic lesions can be observed. But distant metastasis of papillary thyroid carcinoma is very rare and especially, bone metastasis has hardly been reported. The treatment modalities of metastatic thyroid carcinoma to mandible are known as follows : thyroidectomy to treat primary site, resection of the affected site of mandible, external beam radiotherapy and radioiodine therapy etc.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.347-354
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• 1993

This is a retrospective analysis of 67 patients with histologically proven invasive carcinoma of uterine cervix treated with surgery followed by adjuvant radiotherapy at Inje University Seoul Paik Hospital between october 1983 and september 1991, Postoperative radiotherapy was carried out in patients with high risks of locoregional recurrence such as positive pelvic lymph node (38 pts), large tumor size more than 3 cm (22 pts), cervical stromal invasion more than 2/3 (46 pts), parametrial involvement (9 pts), positive resection margin (14 pts), endo/myometrial extension (10 pts), and angiolymphatic invasion (13 pts). Stage I A, I B, and IIA were 2 $(3\%),$ 39 $(58.2\%),\;and\;26\;(38.8\%),$ respectively. Median follow-up period was 48 months with ranges from 13 to 115 months. All 67 patients were treated externally with standard pelvic field with radiation dose ranging from 4080 to 6120 cGy in 4~6 weeks period of time. Of these, 45 patients received intracavitary radiotherapy. The overall survival rate and disease free survival rate at 5-year were $88.0\%\;and\;82.1\%,$ respectively. The survival rates by stage were $87.1\%$ in IB and $88.4\%$ in IIA. Local control rate was $80.6\%(58\;pts).$ The treatment failure was noted in 12 of 67 patients $(17.9\%):$ locoregional failure in $7(10.4\%),$ distant metastasis in 3 $(4.5\%),$ and locoregional and distant metastasis in $2(3\%),$ The univariate analysis of prognostic factors disclosed endo/myometrial extension as a significant factor of survival and recurrence $(70.0\%\;vs\;91.1\%\;P<0.05\;&\;30.0\%\;vs\;15.8\%,\;respectively).$ The complication of postoperative radiothrapy was not significant and all patient were well tolerated. In conclusion, postoperative radiotherapy in patients with high risks of locoreginal recurrence is relatively well tolerated and it gives significantly improved survival rate especially in patients with positive lymph nodes, bulky tumor size $(\geqq3\;cm),$ parametrial involvement, cervical stromal invasion more than 2/3, positive resection margin and angiolymphatic invasion.

• Journal of Veterinary Clinics
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• v.33 no.1
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• pp.51-57
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• 2016

In this study, the features of canine lymphoma on fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) were evaluated in three small breed dogs. In case 1, ultrasonography and CT indicated neoplastic involvement of the sternal, right axillary, submandibular, lower cervical, tracheobronchial, mesenteric, and sublumbar lymph nodes; spleen; and liver. However, intense FDG uptake on PET/CT images was detected only for the lymph nodes and spleen. No FDG uptake by the liver was detected for case 1 despite the confirmation of lymphoma by cytology. In case 2, ultrasonography and CT indicated neoplastic involvement of the axillary, mesenteric, and sublumbar lymph nodes and the spleen, while intense FDG uptake on PET/CT images was detected for the axillary and a few mesenteric lymph nodes, and the spleen. FDG uptake was additionally observed from popliteal lymph nodes, however there was no uptake by the sublumbar lymph nodes and some mesenteric lymph nodes. In case 3, neoplastic changes in the splenic, mesenteric, and sublumbar lymph nodes and spleen were suspected on ultrasonography, and lower cervical and popliteal lymph node involvements were additionally detected on PET/CT. Compared to ultrasonography, repeated PET/CT showed increased FDG uptake by the lymph nodes at an earlier stage after chemotherapy in case 3. This study illustrated the features of PET/CT in canine lymphomas and compared those to ultrasonography and CT findings. FDG uptakes were not detected from some lesions which were suspected to be neoplastic involvement in case 1 and 2. We could not clearly explain the reason of this result in the present study because cytological or histological examination was not performed for lesions that showed different results on ultrasonography, CT, and PET/CT. Further studies on the subclassification of canine lymphoma and the sensitivity and specificity of PET/CT for the detection of canine lymphoma are required. PET/CT data can provide useful information for predicting the therapeutic response at an early stage after treatment.