• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.17-26
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• 2002

Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

• Korean Journal of Head & Neck Oncology
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• v.8 no.2
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• pp.112-118
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• 1992

Neck mass as a primary presenting sign is a common problem that physicians and surgeons alike have to face but conclusive diagnosis cna be made only by histopathological examination. During the period of four years from January 1988 to December 1991, three hundred sixteen diagnostic incisional or excisional biopsies of the neck masses were performed at the outpatient department of Surgery, Seoul National University Hospital and tissue diagnoses were confirmed by histopatholotical examination. On which a clinical analysis was performed and its results were compared with the results of one hundred fifteen Fine Needle Aspiration Cytologic examinations on neck masses during the same period. The results were as follows: In the histologic types of neck masses. inflammatory disease was the most common (58.2%), metastatic malignant tumor(22.5%), benign tumor(15.2%). primary malignant tumor(0.4%) in decreasing order. Among the individual lesions. tuberculous lymphadenitis was the most common(29.4%) and nonspecific lymphadenitis was the next. Of overall sexual distribution, female preponderated by a ratio of 1.15:1, but in the primary and metastatic malignancies, male did by a ratio of 1.60:1 and 1.53:1, respectively. The most common age group was third decade(26.8%), and fourth decade was the next(20.9%) but in malignant tumors. sixth decade was the most commom. The duration of symptom between one and three months(33.8%), was the most common and between three and six month was the next but the difference between the individual diseases was not significant. Of the metastatic tumor of seventy one cases, primary site was found in fifty cases(84.2%) and stomach cancer was the most comon primary site. In the result of the Fine Needle Aspiration Cytologic(FNAC) examinations, positive for mlignant cells was the most common(33.1%), following the frequencies with tuberculosis(22.6%), and nonspecific lymphadenitis(16.5%) in decreasing order. Eleven cases of FNAC underwent diagnostic biopsies and the diagnostic accuracy of FNAC was 83.3%. Conclusively, in our study, tuberculous lymphadenitis was the most common histologic type, female was predominant third decade was the most common age group. the duration of symptom between one and three month was the most common and in the metastatic tumors, stomach cancer was the most common primary site.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.1
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• pp.91-97
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• 2022

Backgrounds/Aims: Metastatic lesions of the pancreas (PMET) account for 1%-5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET. Methods: Patients who underwent EUS-FNA at a community referral center between 2011-2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET). Results: A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET. Conclusions: PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.

• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.505-513
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• 2004

Background : In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. Methods and Materials : From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (${\geq}5mm$ in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. Results : Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. Conclusions : USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.3
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• pp.247-253
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• 2006

Pleomorphic adenoma of the parotid gland typically presents as painless, mobile mass of long duration, and originate in the superficial lobe but, more rarely these tumors may involve the deep lobe of the parotid gland. The average size of a parotid neoplasm is 2 to 4 cm. The effective treatment of parotid pleomorphic adenoma is surgical excision. The simple excision or enucleation resulted in recurrence rate of 45% in benign tumor. Therefore, the superficial parotidectomy with identification and preservation of the facial nerve is now the most widely accepted surgery. We report a case of the huge pleomorphic adenoma of the left parotid gland in a 67-year-old man who complained the large mass, measured about $10\times7\times5$cm-sized, in front of the left ear and on the mandibular ascending ramus. The diagnosis was confirmed by the clinical examination, computed tomographic scan, fine needle aspiration, and incisional biopsy. Superficial parotidectomy including the tumor and preservation of the facial nerve using the modified Blair approach was performed. And satisfactory results have been obtained cosmetically and functionally.

• Korean Journal of Head & Neck Oncology
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• v.18 no.2
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• pp.216-218
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• 2002

A 38-year-old man, who was diagnosed nasopharyngeal carcinoma (stage T4N2Mx) had rapidly growing lower neck mass (at level IV area) with local inflammation sign during concurrent chemoradiotherapy. After we performed Color Doppler sonography and fine needle aspiration biopsy of the neck mass, we differentiated neck soft tissue infection from tumor extension. Size of the mass decreased after antibiotics therapy. It was difficult to differentiate neck infection from tumor progression during treatment in naspharyngeal carcinoma.

• The Journal of the Korean bone and joint tumor society
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• v.6 no.1
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• pp.35-40
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• 2000

We report the radio-frequency ablation technique applied on an osteoid osteoma under CT guide and review other new methods of treatment for the osteoid osteoma. An 18-year-old boy with an osteoid osteoma at the left proximal tibia, which was visible at plain film and MRI. He was treated by the percutaneous radio-frequency ablation technique under CT guide after a needle biopsy. He is free from any symptom and able to do daily activities. So, we proposed that the percutaneous radio-frequency ablation technique under CT guide is the effective and safe treatment method for an osteoid osteoma.

• Journal of the Korean Society of Radiology
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• v.12 no.5
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• pp.677-682
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• 2018

This study evaluated the usefulness of the elasticity score and elasticity ratio in the differential diagnosis of benign and malignant lesion in breast elastography. We performed a retrospective analysis based on the results of core needle biopsy histology. The Mann-Whitney U test was used to confirm the difference between the 5-degree elasticity score and the Fisher's Exact test. ROC curve analysis was used to determine the elasticity score and the best cut-off value of the elasticity ratio for the prediction of malignant lesions. There was a statistically significant difference (p= .000) between the homogeneity of the elasticity score and the difference of the elasticity ratio between the benign and malignant lesion groups. On the ROC curve analysis, the elasticity score and the elasticity ratio for predicting benign and malignant lesion were determined as AUC 0.806, 0.824, cut-off value 3, 4.4 (p= .001). Therefore, the elasticity score and elasticity ratio may be useful in the differential diagnosis of breast mass.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.991-994
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• 2003

Primary leiomyosarcomas are rare tumors of the lungs. No typical roentgenographic findings of unusual complex of symptoms distinguish this tumor. The most common therapy is surgical resection. Prognosis and significant survivorship are related to the size, grade, metastasis of the lesion. A 25-year-old female patient with chest pain and cough was admitted. In chest X-ray and CT scan, there was a pulmonary nodule in left upper lung field, She was taken a percutaneous needle aspiration biopsy. The result was a spindle cell tumor. Left upper lobe lobectomy was done, and pathologic diagnosis was a low grade leiomyosarcoma arising from left bronchus. During 5 years of follow-up period, she has not shown any metastasis or local recurrence.

• Journal of Korean Neurosurgical Society
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• v.56 no.5
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• pp.431-435
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• 2014

A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.