• Archives of Plastic Surgery
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• 제47권1호
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• pp.42-48
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• 2020

Background Methods for identifying local lymph node metastasis in malignant melanoma include sentinel lymph node biopsy (SLNB) and lymph node dissection (LND). In particular, SLNB has been widely used in recent years. This study aimed to retrospectively confirm the adequacy of the current indication criteria for SLNB by applying those criteria to a mixed group of patients who previously received SLNB and LND. Methods This study included 77 patients with malignant melanoma of the extremities and trunk who were monitored for >24 months. The patients were classified according to whether the current indication criteria for SLNB were applicable. The sentinel lymph nodes were evaluated for each group. Patients for whom the indication criteria for SLNB and LND were applicable were analyzed according to whether SLNB or LND was performed. Finally, the outpatient records of these patients were reviewed to evaluate recurrence, metastasis, and prognosis. Results Of the 77 patients, SLNB was indicated according to the current criteria in 60 cases. Among the 60 patients for whom SLNB was indicated, 35 survived the follow-up period disease-free, 21 died during the follow-up period, and four experienced metastasis. The 17 patients for whom SLNB was not indicated had no recurrence or metastasis. Conclusions Patients for whom SLNB was not indicated had no recurrence or metastasis. In cases where SLNB is indicated, the possibility of metastasis and recurrence may be high even if SLNB is negative or LND is performed, so more aggressive treatment and careful follow-up are crucial.

• Clinical and Experimental Pediatrics
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• 제64권11호
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• pp.559-572
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• 2021

The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5%-10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dosage of 2-3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, may be used for small superficial type IHs at a dosage of 1-2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.

• 대한두경부종양학회지
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• 제39권1호
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• pp.45-48
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• 2023

Angiosarcoma is a very rare subtype of sarcoma. It mainly occurs in the head and neck, and cutaneous angiosarcoma in this region seems to be a distinctive neoplasm with characteristic clinicopathologic features that differ from those of angiosarcoma in other anatomical locations. The prognosis of angiosarcoma in the head and neck region is poor, and the risk of local recurrence and metastasis is high. We reconstructed an atypical angiosarcoma that presented as a solitary nodule with a shape suggestive of hemangioma on the cheek using a modified bilobed local flap. At a 12-month follow-up visit, the patient in this case showed successful recovery after radiation therapy.

• 대한두경부종양학회지
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• 제39권2호
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• pp.31-34
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• 2023

Pilomatricoma is characterized by a semi-transparent epidermis, especially pigmented pilomatricoma, containing melanocytes in basaloid cells, which are dark and purple, resembling vessel-derived skin masses. If the vascularity at doppler ultrasound is high before surgery, it may be misdiagnosed. A 10-year-old female patient visited our clinic because of a mass in the right ear triangular fossa. Ultrasonography was performed, and a vascular-origin tumor was suspected because of the high vascularity. The excised mass was diagnosed as pigmented pilomatricoma by a pathologist. Pilomatricoma is mistaken for other masses owing to its various phenotypes. A misdiagnosis can lead to misdirected strategies which can cause delayed treatment and can result in an increase in the size of the pilomatricoma, making the sequalae of surgery more complicated. For proper treatment, careful examination and evaluation are required before surgery.

• Korean Journal of Radiology
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• 제21권5호
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• pp.550-560
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• 2020

Objective: To evaluate the interobserver agreement, diagnostic value, and associated clinical factors of automated breast ultrasound (ABUS) coronal features in differentiating breast lesions. Materials and Methods: This study enrolled 457 pathologically confirmed lesions in 387 female (age, 46.4 ± 10.3 years), including 377 masses and 80 non-mass lesions (NMLs). The unique coronal features, including retraction phenomenon, hyper- or hypoechoic rim (continuous or discontinuous), skipping sign, and white wall sign, were defined and recorded. The interobserver agreement on image type and coronal features was evaluated. Furthermore, clinical factors, including the lesion size, distance to the nipple or skin, palpability, and the histological grade were analyzed. Results: Among the 457 lesions, 296 were malignant and 161 were benign. The overall interobserver agreement for image type and all coronal features was moderate to good. For masses, the retraction phenomenon was significantly associated with malignancies (p < 0.001) and more frequently presented in small and superficial invasive carcinomas with a low histological grade (p = 0.027, 0.002, and < 0.001, respectively). Furthermore, continuous hyper- or hypoechoic rims were predictive of benign masses (p < 0.001), whereas discontinuous rims were predictive of malignancies (p < 0.001). A hyperechoic rim was more commonly detected in masses more distant from the nipple (p = 0.027), and a hypoechoic rim was more frequently found in large superficial masses (p < 0.001 for both). For NMLs, the skipping sign was a predictor of malignancies (p = 0.040). Conclusion: The coronal plane of ABUS may provide useful diagnostic value for breast lesions.

• Radiation Oncology Journal
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• 제37권4호
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• pp.271-278
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• 2019

Purpose: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group. Results: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080). Conclusion: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients.

• Journal of Chest Surgery
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• 제38권12호
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• pp.866-869
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• 2005

랑게르한스 세포 조직구증(Langerhans Cell Histiocytosis)은 병적인 랑게르한스 세포의 과도한 증식과 침윤으로 생기는 병으로 병태 생리가 확실하게 밝혀져 있지 않다. 소아에서 백만명 당 3$\∼$4명의 발생률을 보이나 성인의 경우 그 발생빈도가 확실치 않다. 피부, 귀, 골수, 간, 비장, 폐, 뇌하수체-시상하부, 위장관 등 거의 모든 장기가 침범되며 뇌하수체-시상하부 축이 침범되면 요붕증이 발생한다. 원발성 폐 랑게르한스 세포 조직구증이 타장기의 침범과 동반되는 경우는 드물며, 요붕증을 동반한 경우는 더욱 드물다. 국내에서 랑게르한스 세포 조직구증 중 요붕증을 동반한 예는 다수의 보고가 있었으나 중추신경계 등 폐 이외의 장기침범이었으며 원발성 폐 랑게르한스 세포 조직구증과 동반된 중추성 요붕증은 1예가 보고되었다. 저자는 중추성 요붕증을 동반한 폐 랑게르한스 세포 조직구증을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• The Korean Journal of Pain
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• 제33권4호
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

• Radiation Oncology Journal
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• 제35권3호
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• pp.208-216
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• 2017

Purpose: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). Materials and Methods: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. Results: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. Conclusion: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.764-768
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• 2006

Purpose: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. Methods: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. Results: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. Conclusions: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.