• Journal of Endocrine Surgery
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• v.18 no.4
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• pp.228-235
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• 2018

Purpose: The epidermal growth factor receptor (EGFR) family plays a crucial role in the growth of malignant tumors. EGFR and human EGFR 2 (HER2) protein overexpression are associated with an unfavorable prognosis and are important therapeutic targets in breast cancer. The aim of this study was to evaluate the relationship between EGFR and HER2 expression and clinicopathological factors in papillary thyroid carcinoma (PTC) at a single institution. Methods: A total of 129 consecutive patients with PTC were enrolled in this study and underwent thyroid surgery between October 2013 and February 2015. EGFR and HER2 protein expression was evaluated in the 129 primary tumors by immunohistochemistry, and the results were compared with the clinicopathological features. Results: Of the 129 PTC tumors, 20 (15.5%) were HER2 positive, and 109 (84.5%) were HER2 negative. Moreover, EGFR positivity were observed in 111 (86%) tumors. The mean age of the patients was $46.3{\pm}11.9years$ (range, 20-74 years), and the mean tumor size was $1.08{\pm}0.75cm$ (range, 0.2-3.5 cm). Tumor size, extrathyroidal extension, histological subtype, and TNM stage were not significantly associated with EGFR or HER2 expression. Meanwhile, high Ki-67 labeling index was significantly associated with EGFR expression (P=0.002), HER2 expression was significantly associated with younger age (${\leq}45years$) and cervical lymph node metastasis. Conclusion: Based on our data, it is not clear whether EGFR and HER2 expression is associated with tumor aggressiveness in PTC.

• Korean Journal of Head & Neck Oncology
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• v.29 no.1
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• pp.33-35
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• 2013

Thyroglossal duct cyst(TGDC) is the most common midline congenital neck mass in children. However, carcinoma arising from TGDC is very rare and most of them are found in adults. In this report, we describe a 9-year-old child presenting with TGDC, which finally turned out to be papillary thyroid carcinoma. He underwent Sistrunk operation only. We review the literature and highlight the important points of the treatment.

• Korean Journal of Head & Neck Oncology
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• v.33 no.1
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• pp.85-89
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• 2017

A 62-year-old female patient had goiter for twenty years. She visited out-patient clinic with a hoarse voice and intermittent breathing difficulties. About protruding 15cm sized mass located the anterior neck and right vocal cord paralysis was observed. Preoperative CT scan was strongly suspected of thyroid gland cancer and cervical lymph node metastasis. Therefore, fine needle aspiration test was performed and surgical treatment was planned with the histopathologic results (papillary thyroid carcinoma). Surgery was performed with total thyroidectomy, bilateral cervical lymph node dissection, and right selective nodal lymph node dissection (level II-V). During operation right thyroid seemed to be adherent to surrounding tissue and the blood vessels were extremely engorged. There was hypotensive crisis because of intraoperative excessive bleeding. However it was managed by repetitive transfusion. The operation was completed without abnormalities. She underwent 4 times of bleeding control operation due to postoperative bleeding. After complications were improved, we are currently undergoing out-patient follow up without morbidity.

• Korean Journal of Head & Neck Oncology
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• v.4 no.1
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• pp.53-58
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• 1988

We have experienced 3 cases of papillary carcinoma of the thyroid gland seen as lateral neck cyst, Usually cystic lesions of the neck have been considered as benign lesions from clinical viewpoint. The usual differential diagnosis includes branchial cleft cyst, cystic hygroma, dermoid cyst, cold abscess(tuberculous lymphadenitis) and cavitating squamous cell carcinoma. A lateral neck cyst as the sole presenting complaint of the papillary thyroid carcinoma is very rare. Preoperative diagnosis of lateral neck cyst is often diagnostic dilemma. Fine-needle aspiration cytology can be helpful in detecting the cancer cells and in demonstrating the nature of the fluid component of the lateral neck cyst. Presence of brown murky fluid from the aspirated fluid is highly suggestive of thyroid carcinoma. The thyroid scans and B-mode ultrasonography mayor may not be helpful to detect the primary focus of the thyroid gland. We suggest that a patient with a lateral neck cyst in adult age group should be considered to be a possibility of underlying thyroid carcinoma presanting as lateral neck cyst.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.1-7
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• 2018

Papillary thyroid carcinoma has a good prognosis, but the frequency of locoregional lymph node metastasis is high and is known to occur stepwise fashion. Prophylactic central node dissection in papillary thyroid carcinoma is widely performed from the past. But, the pros and cons of the prophylactic central node dissection has been ongoing for a long time. In the American Thyroid Association management guideline for thyroid nodules and differentiated thyroid cancer, which is the most widely used, recommendations about prophylactic central node dissection has been changed in past ten years. In recent systematic review and meta-analysis, prophylactic central node dissection increases the rate of transient hypocalcemia and recurrent laryngeal nerve injury, but there is no difference in the frequency of permanent hypocalcemia or recurrent laryngeal nerve injury. Prophylactic central node dissection has not been shown to improve patient survival, but recurrence has been reported to decrease. According to a questionnaire survey of the members of Korean Scociety of Thyroid-Head and Neck Surgery, Korean doctors tend to perform the prophylactic central node dissection more aggressively than other countries. The reason for this is that Korea has a large number of thyroid surgeries and therefore surgeons are more experienced than other countries.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.311-315
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• 2018

Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer. In contrast, thyroid lymphoma is a very rare disease. Concurrent onset of both is very rare in the thyroid gland. Ultrasound (US)-guided Fine needle aspiration (FNA) is a useful diagnostic tool, but occasionally pathology results may change after the surgery. A 56 years old woman visited with Hashimoto's thyroiditis and nodule on the thyroid gland isthmus on US exam. US-guided FNA was performed at thyroid nodule and diagnosed as PTC. The patient underwent total thyroidectomy. The pathological findings revealed a mucosa associated lymphoid tissue (MALT) lymphoma accompanied with PTC. Authors report this unusual case with a review of literature.

• Korean Journal of Head & Neck Oncology
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• v.40 no.1
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• pp.7-13
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• 2024

The current standard of treatment for differentiated thyroid cancer is surgical resection followed by radioactive iodine therapy according to the recurrence risk. However, external beam radiotherapy may be recommended in limited cases where surgical resection is impossible or residual gross lesion remains or the aforementioned standard therapy is deemed insufficient in achieving local control. We report a case of 59 year old patient who presented with advanced papillary thyroid carcinoma of right neck but was unable to receive surgical resection due to underlying Eisenmenger syndrome. He received radiation therapy of 67.5 Gy in 30 fractions with palliative aim with no further treatment and has been maintaining long-term stable disease state for 38 months. Herein, we report a rare case of palliative aim radiation therapy alone for advanced papillary thyroid carcinoma with literature review.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.9-13
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• 2018

Background/Objectives: Brain metastasis (BM) is a rare form of distant metastasis with papillary thyroid cancer (PTC). Patients with BM of PTC carry a poor prognosis. The aim of this study was to contribute to the understanding of this disease by analyzing patients with BM of PTC. Materials & Methods: Between March 2003 and December 2013, the patient database was conducted to identify thyroid cancer patients treated. Among the 22,758 thyroid cancer patients, 14 (0.06 %) were identified to have metastasis to the brain during follow-up. The medical records of 14 patients with BM were retrospectively reviewed, focusing on the following: patient characteristics, synchronous or previous distant metastasis, treatments including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgery, and characteristics on radiologic findings, time interval between first diagnosis of primary thyroid cancer and BM and survival after BM. Results: The mean age at initial diagnosis and BM were $50.9{\pm}15.8years$ and $61.3{\pm}12.7years$. The mean duration between initial diagnosis and BM was $10.4{\pm}7.9years$. Patients were treated with varied combinations of surgery, SRS and WBRT except 4 patients who had refused treatment. The median overall survival (OS) time after BM diagnosis was 10 months (range 1 - 19). Patients receiving treatment (WBRT and/or surgery, SRS) had a significant longer median OS of 16.5 months in comparison to 3.5 months for those treated without treatment. (p = 0.005) Conclusion: Patients who received aggressive treatment had a longer OS than those with only supportive care. Treatment such as surgery, SRS and WBRT should be considered in patients with BM.

• Radiation Oncology Journal
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• v.31 no.3
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• pp.162-170
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• 2013

Purpose: To analyze the outcome of adjuvant postoperative external beam radiotherapy (EBRT) in well-differentiated thyroid cancer (WDTC). Materials and Methods: We identified 84 patients treated with EBRT for WDTC from February 1981 to December 2010. Among them, we analyzed 39 patients who received EBRT after initial radical surgery. Twenty-four females and 15 males were included. The median age was 49 years (range, 16 to 72 years). There were 34 papillary thyroid carcinomas and 5 follicular thyroid carcinomas. Most patients showed pathologic T3/T4 stage (54%/26%). Ten patients (25.6%) had gross residual tumors. Five patients (12.8%) had tumor cells at the margin. The median EBRT dose and fraction size were 62.6 Gy and 1.8 to 2.0 Gy, respectively. Results: The median follow-up was 73 months (range, 21 to 372 months). The five-year overall survival (OS) and locoregional recurrence free survival (LRFS) were 97.4% and 86.9%, respectively. Locoregional failures occurred in 5 and all failure sites were the neck node area. In univariate analysis, OS was significantly influenced by invasion of the trachea (p = 0.016) or esophagus (p = 0.006). LRFS was significantly decreased by male (p = 0.020), gross residuum after resection (p = 0.002), close or positive tumor at surgical margin involvement (p = 0.044), and tracheal invasion (p = 0.040). No significant prognostic factor was identified in the multivariate analysis. No patient experienced the Radiation Therapy Oncology Group grade 3 or more toxicity. Conclusion: Our locoregional control rate of 87.2% is comparable to historical controls with surgery alone, even though our study had a large proportion of advanced stage. Adjuvant EBRT may an effective and safe treatment option in patients with WDTC.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.22-29
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• 2007

Purpose: Metastatic thyroid cancers with I-131 uptake have been known to show no increase of FDG uptake whereas those without I-131 uptake tend to demonstrate increased uptake on PET. In this study, we evaluated the degree of FDG uptake in primary thyroid cancers of papillary histology before surgery. Material & Methods: Forty FDG PET studies were performed on the patients who had papillary cancer proven by fine needle aspiration. The degree of FDG uptake was visually categorized as positive or negative (positive if the tumor showed discernible FDG; negative if the tumor didn't) and the peak standard uptake value (peak SUV) of the papillary thyroid cancer (PTC) were compared with the size of PTC. Results: The mean size of 26 PTC with positive FDG uptake was $1.9{\pm}1.4\;cm(0.5{\sim}5\;cm)$. In 13 PTC with negative FDG uptake, the mean size of those was $0.5{\pm}0.2\;cm\;(0.2{\sim}0.9\;cm)$. All PTC larger than 1cm ($2.5{\pm}1.4\;cm,\;1{\sim}5\;cm$) have positive FDG uptake (peak $SUV=6.4{\pm}5.7,\;1.7{\sim}22.7$). Among the micropapillary thyroid cancer (microPTC; PTC smaller than 1cm), 8 microPTC show positive FDG uptake(peak $SUV=2.9{\pm}1.3,\;1.7{\sim}5.5$), while 13 microPTC show negative finding(peak $SUV=1.3{\pm}0.2,\;1.1{\sim}1.7$). The size of microPTC with positive FDG uptake is significantly larger than that of microPTC with negative FDG uptake ($0.7{\pm}0.1\;cm$ vs $0.4{\pm}0.2\;cm$, p=0.01). Conclusion: All PTCs larger than 1cm show positive FDG uptake in our study. In other words, thyroid lesions larger than 1cm with negative FDG uptake are unlikely to be PTC. So far, only poorly differentiated thyroid cancers are known to show increased FDG uptake. Our results seem to be contradictory to what is known in the literature. Further study is needed to understand better the significance of increased FDG uptake in PTC in relation to expression of NIS and GLUT.