• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.71-74
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• 2013

Neck mass is a common manifestation from head and neck malignancy, most of which come from mucosal squamous cell carcinomas in the upper aero-digestive tract. However, once aspiration cytology suggests atypical malignant cells in the neck mass rather than metastatic squamous cell carcinomas, it is confusing to decide the adequate diagnostic work-ups and treatment planning. Here, we report a 29-year-old woman presenting with a growing neck mass mimicking malignancy of unknown origin, which was finally diagnosed as primary lymphoepithelial carcinoma in the parotid gland with multiple metastases to the lymph nodes. The patient underwent comprehensive neck dissection and total parotidectomy and the adjuvant radiation treatment was given. Our report highlight that the primary salivary gland cancer should be considered as the potential tumor origin in case of malignancy of unknown origin in the head and neck region and neck mass suggestive of atypical carcinomas.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.162-165
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• 2008

Diagnosis of primary origin site in the management of malignancy of unknown origin (MUO) is the most important issue. According to the histopathologic subtype of primary lesion, specialized treatment can be given and survival gain is expected. F-18 FOG PET (PET/CT) has been estimated as useful in detection of primary lesion with high sensitivity and moderate specificity. F-18 FDG PET (PET/CT) study before conventional studies is also recommended because it has high diagnostic performance compared to conventional studies. Although there has few data, F-18 FDG PET (PET/CT) is expected to be useful in diagnosis of recurrence, restaging, evaluation of treatment effect, considering that PET (PET/CT) has been reported as useful in other malignancies.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.127-131
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• 2007

Fever of unknown origin (FUO) has been a convenient term used to classify patients who warrant a particular systemic approach to diagnostic evaluation and management. The greatest clinical concern in evaluating FUO is identifying patients whose fever has a serious or life-threatening cause when a delay in diagnosis could jeopardize successful intervention. Thorough history and complete physical examination are critical to uncover the etiologic diagnosis. Most cases of FUO in children are caused by atypical presentations of common diseases rather than by typical manifestations of rare disorders. Selection of diagnostic tests and speed of investigation should be guided by a knowledge of the disease severity, patient age, epidemiologic and geographic information, and any positive findings from a detailed history and physical examination. The three most common causes of FUO in children are infectious diseases, connective tissue diseases, and malignancy. In general, the prognosis of FUO in children is better than that of adults. Although the outcome is dependent on the primary disease process, fever abates spontaneously in most cases in whom the cause of fever remains unclear.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.79-80
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• 2008

Including malignancy, various disease can show abnormal uptake in bone marrow. We report a case of non-specific inflammatory FDG uptake in bone marrow mimicking malignancy. A 35-year old woman with fever of unknown origin (FUO) underwent $^{18}F$-FDG PET/CT to find out fever $^{18}F$-FDG and unknown malignancy. $^{18}F$-FDG was injected and imaged 1hr after injection with Discovery ST (GE, USA), $^{18}F$-FDG PET/CT whole body image showed abnormal uptake in lower extremities (Fig. 1). MRI and biopsy was also done in the sites of abnormal uptake. PET and MRI suspect malignancy (Fig. 2, 3), but biopsy result was non-specific inflammatory process (Fig. 4). The patient was improved her clinical condition after antibiotics therapy.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.185-189
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• 2001

Background: Cervical metastasis of unknown origin is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. Patients and Methods: A retrospective review of 20 cervical metastasis of unknown origin diagnosed and managed between january 1989 and December 1999 at the Korea University was undertaken to determine outcome. Patient age ranged 46 to 78 years (mean 60). There were 17 men and 3 women. The aim of this study is to ananlyze the diagnostic approach and the result of treatment of the cervical metastasis of unknown origin. Result: Histopathologically, squamous cell carcinoma (15 case, 75%) were the most common, followed by adenocarcinoma (4 case, 20%), undifferentiated carcinoma (1 case, 5%) According to the criteria of the AJCC on staging, N1 was 2 cases, N2a 2 cases, N2b 5 cases, N2c 1 cases, N3 10 cases. Overall survival rate for all patients at 2 years was 45% and 5 years 25%, and in the combination therapy(surgery and radiotherapy group (12 cases)) it was 67% and 34% respectively, high compared with other treatment modality such as surgery or radiotherapy alone. In extracapsular spread positive group, 5 year survival rate was 12%, but was 33% in the extracapsular spread negative group. Conclusion: With no stastatical significance, extracapsular spread group was poor outcome in our study. Combination of radiotherapy and surgery was more effective treatment result than surgery alone or radiotherapy alone in our study. But, overall prognosis of cervical metastasis of unknown origin was very poor despite aggressive treatment (5 year survival rate: 25%).

• Journal of Chest Surgery
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• v.23 no.3
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• pp.594-599
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• 1990

Congenital or acquired esophagotracheobronchial fistula are rare. The chief causes of the acquired form are malignancy developing on the esophagus or tracheobronchial system and infection, and trauma. The pathognomonic symptom is a paroxysmal cough occurring several seconds after ingestion of liquids. This report reviews a case of bronchoesophageal fistula of unknown origin accompanying bronchiectasis. The patient is 32 years old woman with excellent result by surgical intervention. But the fistula is accidently found in the operation field. The surgical procedures consissts of fistulectomy with Right lower lobectomy.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.683-686
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• 2014

Objective: The purpose of the study was to evaluate clinical value of dual-phase $^{18}F$-FDG SPECT with serum procalcitonin (PCT) in identifying cancers in patients with fever of unknown origin (FUO). Methods: PCT test and dual-phase $^{18}F$-FDG SPECT were sequentially performed on 50 consecutive patients with FUO. Two radiologists evaluated all $^{18}F$-FDG SPECT data independently. A consensus was reached if any difference of opinions existed. Final diagnosis was based on a comprehensive analysis of results for the PCT test, dual-phase $^{18}F$-FDG SPECT and bacterial cultivation, regarded as a gold standard. Results: Among 50 patients, 34 demonstrated PCT ${\geq}0.5{\mu}g/L$. Coincidence imaging showed in 37 patients with inflammatory lesions, and 13 with malignancy. Finally, 36 bacterial, 1 fungal and 1 viral infections, as well as 12 cancerous fevers were confirmed by dual-phase $^{18}F$-FDG SPECT with PCT, combined with bacterial cultivation and clinical follow-up. Conclusion: Our study demonstrated that dual-phase $^{18}F$-FDG SPECT in association with PCT could be a valuable tool for diagnosis in tumor patients with FUO.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.47-50
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• 2006

This 51-year-old man suffered from paraparesis of 1-week history. On preoperative images, spinal cord compression by infiltrative vertebral mass was shown at T3 and T4 level. Several months earlier, he underwent surgical resection of left 2nd to 4th ribs, due to painful growing chest wall mass, which was proved to be hepatocellular carcinoma. All available diagnostic procedure failed to uncover origin of malignancy. Operation was followed by adjuvant irradiation and chemotherapy to the vertebral mass, however he only to die in 3 months after operation. This is an extremely rare case of ectopic hepatocellular carcinoma at thoracic vertebrae which showed very aggressive clinical course. Possible pathogenic process is presented and discussed.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.487-490
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• 1995

We have experienced the 37 patients of pericardial effusion during last 8 years[1986-1993 . They were 17 male and 20 female patients, and their age range was 6months to 80 years.The causes of this pericardial effusion were 10 cases of tuberculosis, 7 cases of malignancy, 2 cases of acute pyogenic infection, 2 cases of postpericardiotomy pericardial effusion, 2 cases of trauma, 1 case of congenital heart disease, 1 case of SLE, and other 12 cases of unknown origin. All patients, except one, were managed by pericardiotomy with subxiphoid tube drainage. One case was managed by pericardiectomy. After operation, their symptoms and sign were dramaticaly improved. However, 3 patients were died postoperatively. Two of them were died of respiratory failure. One of them was died 28 months later with unrelated cause. They have already far advanced lung cancer. We conclude that the pericardiotomy with subxiphoid tube drainage was effective treatment in the patients with pericardial effusion.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1173-1179
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• 2007

The diagnosis of juvenile rheumatoid arthritis (JRA) is based on patient's age at disease onset, symptom duration, gender, and clinical manifestations. JRA is of unknown origin, begins under the age of 16, and persists for a minimum of 6 weeks. JRA is categorized into three principal types, systemic, oligoarticular and polyarticular. Infection, other connective tissue diseases, malignancy, trauma, and immunodeficiency are discussed as differential diagnoses for JRA. Because of joint damage, focusing on early diagnosis and intervention, a vigorous initial therapeutic approach must be taken in patients who have poor prognostic factors. A multidisciplinary team approach is also important for the care of patients with JRA.