• Clinical and Experimental Pediatrics
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• v.61 no.2
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• pp.49-52
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• 2018

Purpose: Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods: A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results: Before diagnosis, the duration of symptoms in patients was $32.15{\pm}17.8days$. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion: The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

• Journal of Yeungnam Medical Science
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• v.30 no.2
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• pp.152-155
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• 2013

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2361-2368
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• 2015

Objective: To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. Materials and Methods: Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct $2{\times}2$ contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. Results: The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. Conclusions: CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10307-10311
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• 2015

Background: The Bethesda System for Reporting Thyroid Cytopathology is one of the main classification systems for thyroid nodules. It expects that 7% of all fine needle aspiration biopsies will be reported as atypia or follicular lesions of undetermined significance, and 5-15% of these undetermined nodules are malignant. Our study is a retrospective analysis of variables that may be associated with outcome in patients with indeterminate thyroid nodules. Materials and Methods: Patients who underwent thyroidectomy in our institution between 2010 and 2014 were retrieved from the institutional records database. Patient demographics and medical histories were recorded. All ultrasonography reports were examined for nodule features and biochemical blood levels, hormone levels and complete blood counts were recorded. Results: A total of 103 patient cytopathology reports were regarded as belonging to the undetermined category. Some 35% of patients had malignant nodules. Median preoperative red cell distribution width (RDW) level was 13.6 inthe benign group, while it was 14.3 in patients with malignancy, demonstrating a significant correlation (p=0.003). Only calcification presence was significantly different between benign and malignant groups on ultrasonography (p=0.034). Conclusions: Ultrasonography is one of the primary tools for this matter. RDW levels may become another promising tool to predict malignancy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.2
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• pp.165-169
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• 2004

Pleomorphic adenoma is the most common neoplasm of the parotid gland, generally presenting as a slowly growing, firm, well-circumscribed, painless nodule. It is often difficult to separate into benign and malignant categories because its bland histomorphologic and cytologic features. This tumor can be rarely associated with cystic change, hemorrhagic necrosis, or spontaneous infarction. Necrosis of lesional tissue may be associated with malignant transformation, particularly in a pleomorphic adenoma. We report a case of 50-year-old woman presented with a enlarging right parotid mass. Computed tomographic scan demonstrated a right superficial lobe mass with ill-defined border. The preoperative fine needle aspiration yielded necrotic debris and atypical squamous elements that were thought to be compatible with high degree of mucoepidermoid carcinoma. A total parotidectomy with intraoperative frozen section revealed extensive necrosis and diagnosed as malignant tumor. This tumor was finally diagnosed as a pleomorphic adenoma with necrosis on permanent sections. Caution should be exercised in evaluation of the parotid neoplasms with central necrosis to avoid misdiagnosis of such lesions as malignancy.

• Investigative Magnetic Resonance Imaging
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• v.20 no.3
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• pp.185-190
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• 2016

Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3621-3625
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• 2012

Lymphadenopathy is one of the commonest and significant manifestations of local as well as systemic ailments, especially malignancies. Fine needle aspiration cytology (FNAC) helps in diagnosing the disease itself, in general, but more importantly ruling out malignancy, in particular. Hence it saves much of the cost and use of resources incurred with excision biopsy of such lymph nodes. This prompted us to study the cytologic patterns of lymphadenopathy in our setting and the diagnostic utility of FNAC in the evaluation of lymphadenopathy. In this retrospective observational study, 1,579 patients (953 males and 626 females) with lymphadenopathy who were subjected to FNAC over a period of three years (January 2009 to December 2011) were studied. The cervical region was involved in most of the cases (76%) followed by the axillary region (17.5%). Metastatic malignancy (38.2%) was the commonest cause of lymphadenopathy followed by reactive lymphoid hyperplasia (36.9%), tuberculosis (9.1%) and lymphomas (8.6%). Squamous cell carcinoma (32.2%) followed by adenocarcinoma (21.9%) were the most frequent metastatic tumors. FNAC is a useful diagnostic tool in the management of patients presenting with lymphadenopathy and should be considered before more invasive and costly procedures are performed, particularly in developing countries.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.234-243
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• 1993

The thyroid nodules are the most common endocrine disease requiring surgical management. Up to date, various diagnostic techniques and surgical management have been developed. Authors analysed 2285 cases of thyroid nodules who were treated at Department of Surgery, Pusan National University for the duration of 10 years from January 1980 to December 1989 and the results obtained were summerized as follows: 1) Patients were composed of 1727 cases(75.8%) of benign nodule and 558 cases(24.5%) of malignant nodule. Benign nodule was prevalent in forth and fifth decade comparing with malignant nodule was sixth and fifth decade. The sexual distribution revealed female preponderance with 1:10.8 in benign nodule and 1:9.3 in malignant nodule. 2) The histopathologic classfication of benign nodule in decreasing order of frequency were follicular adenoma 1009 cases(54.8%), adenomatous goiter 573 cases(33.3%), simple cyst 65 cases(3.8%), and Hashimoto's thyroiditis 52 cases(3.0%). The malignant disease were papillary adenocarcinoma 460 cases(82.4%), follicular adenocarcinoma 69 cases(12.4%), undifferentiated carcinoma 13 cases (2.0%), and medullary carcinoma 7 cases(1.0%). 3) Fine needle aspiration cytology was performed in 1758 cases and it showed 80.5% of sensitivity, 96.5% of specificity, 19.5% of false negative and 80% of accuracy. 4) The location of nodule was 87.7%, in unilateral, 12.2% in bilateral. 5) On the radioiodine scanning, the incidence of benign nodule with cold nodule was 83.9% and the incidence of benign nodule with hot nodule was 7.5%. The incidence of thyroid carcinoma with cold nodule was 88.3% and the incidence of thyroid carcinoma with hot nodule was 4.6%. 6) Most cases of benign nodules were treated with lobectomy 82.6%, subtotal thyroidectomy 10.1% and subtotal lobectomy 3.0%. Malignant nodules were treated with lobectomy and/or isthmusectomy 37.6%, total thyroidectomy 17.7%, subtotal thyroidectomy 15.4%, and any thyroidectomy and neck dissection 13.5%. 7) Postoperative complications were developed in 3.8% of benign nodules and 13.8% of malignant nodules.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.177-180
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• 1996

Warthin's tumor is a benign and slow growing tumor found exclusively in the parotid gland or the periparotid lymph nodes. It mostly affects males between the age of forty to seventy years and is closely related with smoking history. Between January 1981 and June 1996, 42 patients underwent surgical excision of Warthin's tumor of the parotid gland; which made up 10.6% of all parotid gland surgeries(398 cases) during the same period. Their ages ranged from 36 to 75 years with a mean age of 56 years. There were 33 male and 9 female patients with a 4.3 : 1 male to female ratio. The majority of the tumors were situated in the parotid tail whereas one was in the deep lobe. Bilateral simultaneous involvements of the parotid gland were found in 4 patients(9.5%) ; therefore total of 46 parotid glands were involved. Four(8.7%) of the 46 parotid glands had multifocal tumors ranginging from two to three lumps. Tumor sizes varied from 1.5 to 6.0cm with mean diameter of 3.lcm. Of the 42 patients, 26(61.9%) were diagnosed preoperatively or peroperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 46 tumors, 30 underwent a superficial(n=29) or total(n=1) parotidectomy and for 16 cases with tumors suspected preoperatively or peroperatively of being single Warthin's tumor, only enucleation was performed. No cases of recurrence were identified during the follow up period regardless of type of operation performed, however the postoperative complication rate was much higher in the parotidectomy group(33.3%) than in the enucleation only group(12.5%). We feel that an enucleation procedure may be appropriate for the patients with single Warthin's tumor.

• Korean Journal of Head & Neck Oncology
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• v.8 no.1
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• pp.31-36
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• 1992

Neck mass is common neoplasms, but it poses a diagnostic dilemma for the physician. The differential diagnosis include neoplastic, inflammatory and developmental causes. The FNAC is one of the most valuable tests in the initial assessment and differential diagnosis of the neck mass. FNAC was performed with 267 cases of the neck mass, during the period from April, 1988 to October, 1990 at the department of General Surgery, Soon Chun Hyang. University Hospital. Thyroid lesions were excluded from this analysis. Final diagnosis was based on resection histology in 58 cases, and surgical specimens were compared with FNAC. The following results were obtoired ; 1) Of 267 cases, there we re 9 cases(3.4%) of congenital lesion, 74 cases(27.7%) of inflammatory lesion, 40 cases(15.0%) of benign tumor, 12 cases(4.5%) of primary malignant tumor, 37 cases(13.8%) of metastatic tumor, 75cases(28.1%) of reactive hyperplasia, 20 cases(7.5%) of unsatisfactory. In the pathologic classification, inflammatory lesion was the most common. 2) In the 58 cases of excisional biopsy, sensitivity 93.8%, specificity 95.2%, false positive 11.8%, false negative 2.4%, positive predictive value 88.2%, negative predictive value 97.6%, accuracy 94.8%. 3) The most common disease was the tuberculous lymphadenitis (53 cases, 19.8%). sensitivity 57.9%, specificity 100.0%, false positive 0.0%, false negative 17.0%, positive predictive value 100.0%, negative predictive value 83.0%, accuracy 86.2%.