• Clinical and Experimental Pediatrics
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• 제61권2호
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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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• 제30권2호
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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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• 제16권6호
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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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• 제15권23호
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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 Chest Surgery
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• 제23권5호
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• pp.1003-1008
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• 1990

Primary choriocarcinoma of the lung is extremely rare and have been reported ten and several cases only in the literature. It is very difficult to confirm the "Pure primary pulmonary choriocarcinoma" clinically, so most cases that have been reported in the literature confirmed by autopsy and the prognosis is relatively poor compared with metastases. We experience one case of the primary pulmonary choriocarcinoma. She was 53 year old multiparous woman[4 \ulcorner0 \ulcorner2 \ulcorner0] who complain right chest pain for 4 years. On plain film and computerized tomogram of the thorax at admission, 2.5cmx3.5cmx5 cm sized, well demarcated ovoid mass was founded on the right middle lobe just below the parietal pleura and growing rapidly on plain film to 5cm x 6.5cm x 7cm after 15 days. We confirm the choriocarcinoma in the lung by percutaneous needle aspiration biopsy and strongly suspect primary after various examination for rule out metastases from the ovary or uterus. We perform middle lobe lobectomy because that can not confirm the primary or the metastases because there are not complete histological examination by bilateral ovariectomy and hysterectomy, and under the belief that extragestational or extragonadal primary choriocarcinoma is more resistant to the chemotherapy, and could be reduce the duration of hospitalization and the amount of chemotherapy used to achieve remission On 14th postoperative day, serum p-HCG level was returned to normal limit, and perform chemotherapy two times on 3rd and 5th week for prevention surgical traumatic hematogenous metastases or undetected microfocus, but the patient expire on 68th postoperative day due to intracerebral hemorrhage in the intracranial choriocarcinoma which strongly suspected surgical traumatic hematogenous metastases.etastases.

• Journal of Chest Surgery
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• 제28권6호
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• pp.591-595
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• 1995

Recently, primary lung cancer has increased markedly in incidence and prevalence in Korea. From January 1986 to June 1993, 86 patients were operated and evaluated at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The results are as follows; 1. There were 79 males and 7 females with the peak incidence of 5th and 6th decades of life[75.6% . The age ranged from 13 to 76[mean 56.6$\pm$10.3 years. 2. Symptoms were cough[47.7% , sputum[25.6% , chest pain or dyspnea[18.6% , and hemoptysis or blood tinged sputum[20.9% in order. Symptoms were frequently encountered before hospitalization, but asymtomatic patients were 12.8% in this study. 3. Methods of diagnostic confirmatiom were bronchoscopic biopsy[55.8% , percutaneous needle aspiration[29.1% , suspicious sputum cytology[1.2% , and open biopsy[14.0% . 4. Histopathologically, squamous cell carcinoma[51.2% was the most frequent cell type and adenocarcinoma[26.7% , large cell carcinoma[8.1% , adenosquamous cell carcinoma[3.5% , and the others in order. And TNM stages were Stage I 40.5%, Stage II 15.5%, Stage IIIa 27.4%, and Stage IIIb 3.6%. 5. Methods of operation were pneumonectomy[25.6% , bilobectomy[5.8% , lobectomy[53.4% , segmentectomy[1.2% , and exploration[14.0% . The overall resectability was 86.0% 6. The operative mortality was 2.3% and postoperative complications developed in 7 cases[8.1% . 7. The postoperative follow-up reveals that the overall cumulative survival rates at 1 year, 2 year, 3 year, 4 year, 5 year were 76%, 62%, 43%, 36%, and 27%, respectively.

• Tuberculosis and Respiratory Diseases
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• 제75권2호
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• pp.67-70
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• 2013

A 52-year-old man was referred to our clinic for an 11.3 mm nodule in the left lower lobe that was discovered on a chest computed tomography (CT) scan. Eleven small nodules were subsequently found in both lungs. Initially, we performed a transthoracic needle aspiration using CT scan guidance. The pathologic report showed a few clusters of atypical cells that were suspicious for malignancy. The positron emission tomography images revealed multiple lung nodules scattered throughout both lungs. The largest nodule (11.3 mm) in the left lower lobe did not have any discernible fludeoxyglucose uptake. For pathologic confirmation, we consulted a thoracic surgeon to perform the video-assisted thoracoscopic surgery. The final diagnosis was minute pulmonary meningothelial-like nodules (MPMNs). MPMNs are benign in nature, and only a few cases require treatment. However, when clinicians are suspicious of potential malignancy, a pathological correlation is essential, even if the final diagnosis is MPMNs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권2호
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• pp.165-169
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• 2004

본 증례는 우측 이하선에 종물을 가진 50세 여자 환자에서 술전에 시행한 세침흡인검사와 전산화단층촬영 소견 및 술중에 시행한 동결생검에서 괴사소견으로 인해 점액표피양암종으로 진단되어 우측 이하선 전적출술과 경부청소술 등을 시행하였으나 수술 후 조직병리학적 검사에서 괴사를 동반한 다형성 선종으로 최종 진단되었다. 괴사를 동반한 다형성 선종에서 보이는 편평 상피세포는 점액표피양암종에서 나타나는 편평세포의 특징으로 오진할 수 있으므로 주의해야 한다. 본 증례는 악성종양으로 잘못 진단할 수 있는 다형성 선종의 괴사와 조직병리학적 특징들을 이해함으로써 임상의사들의 오진 가능성을 예방하고 다형성 선종의 진단과 치료에 주의해야 함을 시사한다.

• Investigative Magnetic Resonance Imaging
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• 제20권3호
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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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• 제13권8호
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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.