• Asian Pacific Journal of Cancer Prevention
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• v.13 no.4
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• pp.1267-1272
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• 2012

Background and Objective: The optimal resection extent for clinically unilateral papillary thyroid microcarcinoma (PTMC) remains controversial. The objective was to investigate risk factors associated with occult contralateral carcinoma, and put emphasis on the predictive value of preoperative BRAF mutation. Materials and Methods: 100 clinically unilateral PTMC patients all newly diagnosed, previously untreated were analyzed in a prospective cohort study. We assessed the T1799A BRAF mutation status in FNAB specimens obtained from all PTMC patients before undergoing total thyroidectomy (TT) and central lymph node dissection (CLND) for PTMC. Univariate and multivariate analyses were used to reveal the incidence of contralateral occult cancer, difference of risk factors and predictive value, with respect to the following variables: preoperative BRAF mutation status, age, gender, tumor size, multifocality of primary tumor, capsular invasion, presence of Hashimoto thyroiditis and central lymph node metastasis. Results: 20 of 100 patients (20%) had occult contralateral lobe carcinoma. On multi-variate analysis, preoperative BRAF mutation (p = 0.030, OR = 3.439) and multifocality of the primary tumor (p = 0.004, OR = 9.570) were independent predictive factors for occult contralateral PTMC presence. However, there were no significant differences between the presence of occult contralateral carcinomas and age, gender, tumor size, capsular invasion, Hashimoto thyroiditis and central lymph node metastasis. Conclusions: Total thyroidectomy, including the contralateral lobe, should be considered for the treatment of unilateral PTMC if preoperative BRAF mutation is positive and/or if the observed lesion presents as a multifocal tumor in the unilateral lobe.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3361-3363
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• 2015

Background: Despite the majority of papillary thyroid microcarcinoma (PTMC) patients having an excellent prognosis, cervical lymph node metastases are common. The purpose of this study was to investigate the incidence and the predictive risk factors for occult central compartment lymph node metastasis (CLNM) in PTMC patients. Materials and Methods: 178 patients with clinically node-negative (cN0) PTMC undergoing prophylactic central compartment neck dissection in our hospital from January 2008 to Jun 2010 were enrolled. The relationship between CLNM and the clinical and pathological factors such as gender, age, tumor size, tumor number, tumor location, extracapsular spread (ECS), and coexistance of chronic lymphocytic thyroiditis was analyzed. Results: Occult CLNM was observed in 41% (73/178) of PTMC patients. Multivariate analysis showed that male gender, tumor size (${\geq}6mm$) and ECS were independent variables predictive of CLNM in PTMC patients. Conclusions: Male gender, tumor size (${\geq}6mm$) and ECS were risk factors of CLNM. We recommend a prophylactic central lymph node dissection (CLND) should be considered in PTMC patients with such risk factors.

• The Korean Journal of Cytopathology
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• v.17 no.1
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• pp.46-50
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• 2006

A micropapillary variant of urothelial carcinoma (MPC) is a distinct entity with an aggressive clinical course. It has a micropapillary configuration resembling that of ovarian papillary serous carcinoma. Its cytologic features have rarely been reported. We report a case of MPC detected by urine cytology. A woman aged 93 years presented with a chief complaint of macroscopic hematuria. Cytology of her voided urine showed clusters of malignant cells in a micropapillary configuration. Each tumor cell had a vacuolated cytoplasm, a high nuclear:cytoplasmic ratio, and irregular hyperchromatic nuclei. An ureteroscopic examination revealed exophytic sessile papillary masses extending from the left lateral wall to the anterolateral wall of the urinary bladder. A transurethral resection of the tumor was carried out. The tumor was characterized by delicate papillae with a thin, well-developed fibrovascular stromal core and numerous secondary micropapillae lined with small cuboidal cells containing uniform low- to intermediate-grade nuclei and occasional intracytoplasmic mucinous inclusions. These tumor cells infiltrated the muscle layers of the bladder, and lymphatic tumor emboli were frequently seen. Recognizing that the presence of MPC components in urinary cytology is important for distinguishing this lesion from low-grade papillary lesions and high-grade urothelial carcinomas can result in early detection and earlier treatment for an improved treatment outcome.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.156-161
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• 1999

Objectives: The epidermal growth factor receptor(EGFR) family has been increasingly recognized as an important component in the control of normal cell proliferation and the pathogenesis of cancer. To confirm the usefulness of epidermal growth factor receptor as a tumor marker, we initiated this study. Materials and Methods: EGFR was measured by immunohistochemical staining using EGFR antibody. It was performed on section from paraffin blocks of 65 thyroid tissue including 33 paillary carcinoma, 11 follicular carcinoma, 11 nodular hyperplasia, 5 follicular adenoma and 5 normal thyroid tissue. We evaluated morphologic characteristic of various thyroid neoplasms, and the relationship between EGFR and other prognostic factors in papillary thyroid carcinomas. Results: The expression of EGFR was commonly found in neoplasms of thyroid, with trend for stronger staining in the more malignant tumor(p=0.000). Also the expression of EGFR in papillary thyroid cancer related to tumor characters including tumor size(p=0.042), extent(p=0.024) and prognostic features including AMES scores(p=0.019). The strong EGFR staining in papillary carcinoma was significantly associated with tumor recurrence(p=0.003). Conclusions: EGFR may have a role in the regulation of normal and neoplastic thyroid cell growth. EGFR status may help predict the clinical course of patients with malignant thyroid neoplasms. However, the study of more cases will be needed for significance of the information about the EGFR as an independent prognostic factor.

• International journal of thyroidology
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• v.11 no.2
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• pp.123-129
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• 2018

Background and Objectives: Hypermethylation of the tumor suppressor gene RASSF1A and activating mutation of BRAF gene have been recently reported in thyroid cancers. To investigate the role of these two epigenetic and genetic alterations in thyroid tumor progression, methylation of RASSF1A and BRAF mutation were examined in thyroid tumors. Materials and Methods: During 2007 to 2017, 69 papillary carcinomas, 18 nodular hyperplasia, 3 follicular carcinomas, and 13 follicular adenomas were selected. The methylation-specific polymerase chain reaction (MSP) technique was used in detecting RASSF1A methylation and polymerase chain reaction (PCR)-single-stranded conformation polymorphism and sequencing were used for BRAF gene mutation study. Results: The hypermethylation of the RASSF1A gene was found in 84.6%, 100% and 57.9% of follicular adenomas, follicular carcinomas, and papillary carcinomas, respectively. Nodular hyperplasia showed a hypermethylation in 33.3%. The BRAF mutation at V600E was found in 60.7% of papillary carcinoma and 27.0% of nodular hyperplasia, but none of follicular neoplasms. The BRAF mutation was correlated with the lymph node metastasis and MACIS clinical stage. There is an inverse correlation between RASSF1A methylation and BRAF mutation in thyroid lesions. Conclusion: Epigenetic inactivation of RASSF1A through aberrant methylation is considered to be an early step in thyroid tumorigenesis, and the BRAF mutation plays an important role in the carcinogenesis of papillary carcinoma, providing a genetic marker.

• Korean Journal of Head & Neck Oncology
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• v.16 no.1
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• pp.83-86
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• 2000

Thyroglossal duct cyst is common midline mass, which is related to hyoid bone and may show signs of inflammation. Carcinoma arising in the thyroglossal duct cyst is rare, occuring in less than 1% of thyroglossal duct cyst. Papillary adenocarcinoma is the most common histologic type(75-85%). The initial treatement of choice is wide excision of the tumor bearing tissue(Sistrunk procedure), resection of associated lymph node alone is enough when they are small and isolated, but a modified neck dissection must be done if regional involvement is more extensive. Its prognosis is excellent(the incidence of regional lymph node metastasis is 7% compare to 89% for papillary cancer of thyroid gland proper).

• Korean Journal of Bronchoesophagology
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• v.3 no.2
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• pp.338-342
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• 1997

Thyroglossal duct cysts are the most common anomaly in thyroid development. Generally, duct cysts are benign, but 1 per cent of cases may be malignant. Tumors of the thyroglossal duct are very rare and are usually papillary thyroid carcinomas. In most cases the diagnosis is only established after excison of a clinically benign thyroglossal duct cysts. The etiology of such tumors is unclear, but do novo origin and spread from a primary thyroid gland tumor has been suggested. We reported a case of papillary carcinoma arising in a thyroglossal duct cyst treated successfully with surgical excision in 37-year-old-female.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.988-993
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• 2021

Cardiac papillary fibroelastoma (CPF) is the second or third most common primary cardiac tumor. Although histologically benign, it can cause serious symptoms depending on its location of occurrence, size, and motility. Herein, we report CPF in the left ventricular trabeculation as a potential cause of cerebral infarction.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.62-68
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• 1997

The papillary carcinoma is the most common malignant neoplasm of thyroid gland and the prognosis is better than anyother type of thyroid carcinoma. However, the thyroid is closed to the important organs such as esophagus, trachea and larynx, there are some possibilities to invade these organs. In case of advanced disease, not only surrounding structures but also mediastinum and cervical lymphatic chain can be involved or distant metastasis develops frequently. Therefore in these cases the prognosis is worse and the rate of inoperable case is more than those of non-metastatic group. Generally, the treatment modality for papillary thyroid carcinoma consists of surgery, postoperative thyroid hormone and radioiodine therapy. If the tumor invades surrounding structures, cervical lymph node or mediastinum, total thyroidectomy and wide excision of tumor invaded area including mediastinal dissection and neck dissection is necessary. Recently, the authors have experienced a case of locally invasive and recurred papillary thyroid carcinoma without treatment for 7 years. The patient was performed previously thyroid lobectomy and isthmusectomy 13 years ago. We had determinded surgical therapy for this patient and performed mass excision with overlying skin, completion total thyroidectomy, right type I modified radical neck dissection, left lateral neck dissection, thoracotomy with supramediastinal dissection, shaving of diffusely involved trachea and skin defect reconstruction with pectoralis major myocutaneous flap. After operation 2 cycles of radioiodine therapy were taken. Now the patient is following up at the outpatient base and no evidence of disease state for postoperative 16 months. So we report on this case with a brief review of literature.

• Korean Journal of Head & Neck Oncology
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• v.24 no.1
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• pp.47-52
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• 2008

Purpose：The incidence of papillary thyroid microcarcinoma(PTMC) has increased due to the widespread use of high resolution ultrasonography and fine-needle aspiration biopsy. However, the clinical and biologic behaviors of PTMC is debatable. The aim of this study was to describe clinicopathologic features of PTMC and to suggest whether tumor size(5mm) might prove the useful parameter for determining the surgical strategy in PTMC. Material and Methods：From Jan. 2000 to Dec. 2005, 1355 of 2678 patients with papillary thyroid carcinoma were identified as having PTMC, based on tumor size${\leq}$10mm(50.6%). Among patients with PTMC, we further separated tumors<5mm(minute group：group M) from those 5 to 10mm(tiny group：group T). We compared the clinicopathological characteristics and the TNM stagings between two groups. Results：There were 114(8.4%) men and 1241(91.6%) women with a median age of 47 years(range；13-79). During a mean follow-up of 47.3(range；22-93), 13 patients(1.0%) developed locoregional recurrences and 3 patients(0.2%) showed distant metastases at initial presentation. Statistical analysis revealed that the presence of extracapsular invasion(p<0.0001), invasion to adjacent structure(p<0.0001), multifocality(p<0.0001), central lymph node metastasis(p<0.0001), and lateral lymph node metastasis(p<0.0001) were all significantly higher in tiny group(tumor${\geq}$5mm). Furthermore, minute group demonstrated a significantly lower tumor stage(AJCC TNM classification) compared with tiny group(p<0.0001). Conclusion：Patients with PTMC have a favorable treatment outcomes, although the distinction needs to be made with reference to the clinicopathologic behaviors. It would be reasonable to consider that tumor size(5mm) would be useful parameter for the treatment strategy of PTMC.