• Korean Journal of Head & Neck Oncology
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• v.38 no.1
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• pp.25-29
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• 2022

Parathyroid carcinoma is very rare malignant neoplasm, accounting for less than 0.005% of all cancers. Most parathyroid carcinoma is a functioning tumor that causes hyperparathyroidism, leading to hypercalcemia. We report a parathyroid carcinoma case that was suspicious for spontaneous infarction of cancer, leading to resolution of hypercalcemia. A 29-year-old male visited our hospital presenting with right neck swelling and pain. He has been experiencing frequent urolithiasis for four years but laboratory tests showed normal serum calcium level. Right vocal cord paresis was identified with laryngoscopy. Ultrasonography revealed a 3.7 × 3.5 cm mass in the right thyroid containing a focal cystic portion. Computed tomography confirmed the presence of a low-density right thyroid mass. Right thyroid lobectomy was performed and pathological evaluation revealed parathyroid carcinoma with central necrosis. We report this very rare case with a literature review.

• Korean Journal of Head & Neck Oncology
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• v.39 no.1
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• pp.37-40
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• 2023

Schwannoma is a slow growing benign tumor that can occur anywhere in our body. About 25~45% cases of schwannomas occur in the head and neck, but intra-thyroidal schwannomas are very rare, and mostly are diagnosed by post-thyroidectomy pathologic study. In this article, we present a case of intra-thyroidal schwannoma diagnosed preoperatively with core needle biopsy. The patient underwent enucleation of the thyroid tumor, and the pathology of the tumor was confirmed as schwannoma. Few cases of intra-thyroidal schwannomas have been reported in the literature, but none of them have been diagnosed through core needle biopsy preoperatively. Preoperative diagnosis of intra-thyroidal schwannoma can be helpful when determining appropriate surgical extent and avoid unnecessary thyroidectomy.

• Journal of Breast Disease
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• v.6 no.2
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• pp.79-83
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• 2018

Cowden syndrome (CS), also known as multiple hamartomas syndrome, is a rare hereditary autosomal dominant disorder caused by a germline mutation in the phosphatase and tensin homolog (PTEN) gene mapped on chromosome 10. The clinical features of CS are variable, primarily presenting as mucocutaneous lesions (99%). A mucocutaneous lesion, such as trichilemmoma of the face or keratosis of the extremities, is an important diagnostic marker for CS. CS has been reported to increase the incidence of benign and malignant neoplasms in the breast, thyroid, and gastrointestinal tract. The risk of developing malignancy in individuals with CS is up to 10 times higher than general population throughout an entire life time.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.161-166
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• 2000

Objective: The nm23 gene has been identified as a potential metastasis suppressor gene in various human neoplasms. Both Bcl-2, which promotes cell survival, and Bax, which promotes cell death, have been considered as major factors in controlling the apoptotic pathway. This study was carried out to determine whether these markers are useful in distinguishing potential intrinsic differences in tumor virulence of papillary thyroid cancers. Material and Method: The expressions of nm23, Bcl-2 and Bax have been evaluated using immunohistochemical techniques in 100 pure papillary thyroid cancers and 20 metastatic lymphnodes. The intensity of immnunoreactivity was graded on arbitrary four point scale(grade 0 or 1 : negative reactivity, grade 2 or 3 positive reactivity). The immunoreactivities were analyzed in relation to TNM atage, AMES score, local recurrence and distant metastasis, and that of metastatic LNs was compared with the tumors. Results: The expression of Bcl-2 and bax did not show any statistical differences by TNM stage, AMES score, recurrence, distant metastasis and also between the tumor and metastatic LN. However, the nm23 showed higher expression of Ki67 in distant metastasis than in control group and in metastatic LNs than in the tumors(p<0.05). Conclusion: Although the expression of Bcl-2 and Bax protein showed no correlation with clinical parameters representing tumor virulence, the nm23 expression could be an useful prognostic factor, especially in predicting nodal or distant metastasis in papillary thyroid cancer.

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.143-146
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• 2004

Background and Object: The role of fine needle aspiration cytology (FNAC) and frozen section (FS) in management of thyroid neoplasms continues to generate considerable controversy. We reviewed our current experience to determine the clinical utility of FNAC and FS in our surgical management and investigated reliability of FNAC and FS in planning the extent of thyroid resection. Material and Method: 212 patients who had operations for thyroid disease from May 1996 to November 2003 were included our retrospective study. FNAC was undertaken in 175 patients and FS was done in 148 patients. Result: The sensitivity and specificity of FNAC were 72.1% and 100%, respectively, and those of FS were 67.2% and 100%. The results of FNAC were benign (n=72) , malignancy (n=31), indeterminate (n=9), and nondiagnostic (n=63). The results of FS were benign (n=95), and malignancy (n=53). The 9 indeterminate cases on FNAC were benign (n=6) and malignancy (n=3) on final pathology, and benign (n=7) and malignancy (n=2) on FS. The false negative of FNAC were micro papillary carcinoma (n=6) and follicular carcinoma (n=6). The false negative of FS were micropapillary carcinoma (n=10) and follicular carcinoma (n=2). Conclusion: When results of FNAC are interpreted as indeterminate, FS is a valuable tool. FS is helpful in determining the extent of thyroidectomy when results of FNAC were follicular neoplasm. However we always concerned about micropapillary carcinoma and follicular carcinoma although FNAC and FS were benign.

• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.138-142
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• 2015

L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the $7^{th}$ RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.71-75
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• 2012

Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time ($19.5{\pm}0.3$ sec) was longer than a previously-reported value in conventional reconstruction patients ($18.8{\pm}6.6$ sec). The present phonation efficiency index ($7.88{\pm}0.78$) was higher than that previously calculated in conventional reconstruction ($7.59{\pm}2.82$). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.37-40
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• 2013

Background and Objectives : To assess the usefulness of computed tomography image before papillary thyroid cancer surgery, focus on confirmation of lateral cervical lymph node metastasis not detected by ultrasonography. Material and Methods : From January 2008 to May 2009, total 150 patients who had undergone thyroid surgery and been confirmed papillary thyroid cancer pathologically were enrolled. They had taken neck computed tomography following the ultrasonography. Results : Computed tomography had found suspicious metastatic lateral neck lesion in 13 patients. After the image study, lateral neck lymph node dissection had been included in their surgical plan. Of these, only 7 cases were confirmed pathologically lateral neck lymph node metastasis(positive predictive value=0.54). Taken as whole 150 patients, additionally 4.7% of patients confirmed lateral neck lymph node metastasis by preoperative computed tomography. Conclusion : If preoperative ultrasonography was performed precisely, additional benefits that could be achieved by computed tomography were not much.

• Annals of Surgical Treatment and Research
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• v.95 no.6
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• pp.297-302
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• 2018

Purpose: Increased robotic surgery is attended by increased reports of complications, largely due to limited operative view and lack of tactile sense. These kinds of obstacles, which seldom occur in open surgery, are challenging for beginner surgeons. To enhance robotic surgery safety, we created an augmented reality (AR) model of the organs around the thyroid glands, and tested the AR model applicability in robotic thyroidectomy. Methods: We created AR images of the thyroid gland, common carotid arteries, trachea, and esophagus using preoperative CT images of a thyroid carcinoma patient. For a preliminary test, we overlaid the AR images on a 3-dimensional printed model at five different angles and evaluated its accuracy using Dice similarity coefficient. We then overlaid the AR images on the real-time operative images during robotic thyroidectomy. Results: The Dice similarity coefficients ranged from 0.984 to 0.9908, and the mean of the five different angles was 0.987. During the entire process of robotic thyroidectomy, the AR images were successfully overlaid on the real-time operative images using manual registration. Conclusion: We successfully demonstrated the use of AR on the operative field during robotic thyroidectomy. Although there are currently limitations, the use of AR in robotic surgery will become more practical as the technology advances and may contribute to the enhancement of surgical safety.

• Korean Journal of Radiology
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• v.25 no.10
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• pp.924-933
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• 2024

Objective: This study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration. Materials and Methods: This retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared. Results: The intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs (P ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone (P < 0.048). Malignancy was not found in the very low risk category of USC RSS. Conclusion: The diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.