재발, 추시 중 소실, 다른 원발성 암의 병발 등으로 복잡해질 수 있는 두경부암 환자 등록에 있어서, '단일등록양식다중항목체제'라는 새로운 체제로, 서울대학교 병원에서 진단한 486명의 두경부암 환자를 대상으로 하여, 데이터베이스를 구성하고, 이의 운용을 '다중등록양식체제'라는 기존의 체제와 비교하였다. 새로운 방법의 구조와 흐름이 보다 간단하고 자료의 검색이 더 효율적이었다. 두경부암 환자 등록의 전용 프로그램 개발에도 이 체제의 도입이 필요할 것으로 사료된다.

Objectives: It is expected that the combined cisplatin and radiation therapy for nasopharyngeal carcinoma produces more sensory neural hearing losses compared to radiation therapy alone. The purpose of this study was to evaluate the incidence of sensory neural hearing losses after concurrent cisplatin and radiation therapy for nasopharyngeal carcinoma. Materials and Methods: From Jun. 1994 to Mar. 1997, 10 patients were available for this study with the following eligibility criteria: 1) The patients received concurrent cisplatin and radiation therapy for nasopharyngeal carcinoma. 2) There was no pre-existing auditory disease except serous otitis media due to nasopharyngeal carcinoma. 3) They had normal sensorineural hearing function on the pretreatment pure tone audiogram. 4) Pure tone audiograms were performed at least one time after treatment between 6months to 1 year follow-up without local recurrence. Results: At 1 year follow-up, 3 patients complained of decreased hearing capacity. Sensorineural hearing losses were developed in 15 ears out of 20(75%) and were more frequent and severe in high frequency area on pure tone audiogram. Conclusion: The concurrent cisplatin and radiation therapy for nasopharyngeal carcinoma may produce sensorineural hearing losses more frequently compared to historical data of radiation therapy alone and close evaluations with regular audiograms are necessary even in patients without symptoms and signs of hearing impairment.

Objectives: Deletion in the short arm of chromosome 3 is common in many human cancers, including sporadic and hereditary renal carcinomas, small cell lung carcinomas, non-small cell lung carcinomas, and carcinomas of the ovary, breast, and cervix. A high frequency of chromosomal aberrations in head and neck cancers involving chromosome 3p has also been reported. These findings suggest that multiple tumor suppressor genes may be present on the short arm of chromosome 3. Materials and Methods: To investigate the possibility of chromosome 3p deletions in the Korean head and neck cancer patients, we applied a polymerase chain reaction(PCR)-based Restriction Fragment Length Polymorphism analysis to the DNA samples of matched normal mucosa and head and neck squamous cell carcinomas from 19 patients. Results: In the 19 normal samples heterozygosity at the polymorphic loci varied: 6 at the D3F15S2 locus(on telomeric 3p21), 2 at the D3S32 locus(on centromeric 3p21), and 4 at the THRB locus(on centromeric 3p24). In 12 matched carcinoma specimens, LOH(loss of heterozygosity) was observed at D3F15S2 in 1 of 6(17%), D3S32 in 1 of 2(50%), and at THRB in 2 of 4 cases(50%). Conclusion: The frequency of chromosome 3p deletion in the Korean head and neck carcinomas appear as other country did.

Objectives, Materials & Methods: To prevent deterioration of postoperative voice due to iatrogenic transection of the recurrent laryngeal nerve during the thyroid surgery, intraoperative medialization of the membranous vocal cord by type I thyroplasty together with direct epineurial neurorraphy was done on 2 cases of benign thyroid lesion. To improve the quality of voice together with complete removal of advanced thyroid carcinoma, intraoperative vocal cord medialization on the lesion side together with total thyroidectomy was done by type I thyroplasty in 2 cases and combined procedure by arytenoid adduction and type I thyroplasty in another 2 cases. Results: The resultant voice of the iatrogenic injury cases was relatively tolerable. The voice of the combined procedure was better than that of type I thyroplasty cases for the intraoperative rehabilitation cases. Not only for the preoperative evaluation of the severity of the nerve lesion but also the prognosis will be expected by use of laryngeal EMG in the cases of thyroid cacer with vocal cord palsy. Conclusion: Intraoperative simultaneous rehabilitation for the vocal cord palsy during thyroid surgery is beneficial for the patients.

Objectives: Minimal improvement in the long-term survival of head and neck cancer(HNC) patients has occurred despite a multitude of advances in the control of loco regional disease and a second primary malignancy(SPM) contribute to the continued poor prognosis for the HNC patients. This study was performed in order to identify the clinical characteristics of SPM in the HNC patients. Materials and Methods: The medical records of 354 patients of head and neck squamous cell carcinoma that were followed up after initial treatment during the period of 1987 through 1994 were reviewed. This study examines the medical records of 354 patients with squamous cell carcinoma of the head and neck, of whom 26 subsequently developed a second neoplasm. Results: The actuarial SPM rate was 7.3%, and median time to presentation for the SPM was 26.8 months. The SPM were more likely to occur in male patients who had oral cavity index tumors. Patient whose index tumor was small at diagnosis had a greater chance of developing a second tumor as did those with no cervical lymph node metastases to the neck. Initial treatment modality was not associated with an increased risk of developing a second tumor. The commonest sites for the SPM were the lung and other head and neck area. The 3-year survival for patients who developed a secondary tumor from the time of its diagnosis was 27.8%. Conclusion: The SPM in the head and neck cancer patients are not uncommon and early detection of the SPM will contribute to increase the long-term survival of HNC patients.

Backgroud and Objectives: Major salivary gland tumor is a rare disease with a largely unknown origin. And also corresponding to the diversity of histopathologic characteristics is an equally wide distribution of clinical behavior that makes treatment decisions difficult. The aim of this study is to analysis the clinical experience of our major salivary gland tumor and to suggest a guidline of management. Materials and Methods : We studied clinical manifestations and treatment results of 104 patients who were diagnosed as major salivary gland tumors. Tumor site, patient age and sex of the patients were analysed. Histopathologic diagnosis, treatment modality, lymph nodes metastasis, recurrence rate and 5-year survival rate were studied on malignant tumors. Results: 1) 48 patients were male and 56 patients were female. 2) Benign tumors were 79 cases. They consisted of 57 cases(72%) of parotid tumor, 22 cases(27%) of submandibular tumor. And pleomorphic adenoma was the most common benign tumor. 3) Malignant tumors were 25 cases and were consisted of 19 cases(76%) of parotid tumor, 4 cases(l6%) of submandibular tumor and 2 cases(8%) of sublingual gland tumor with high-grade mucoepidermoid carcinoma as the most common cause. 4) In the malignant tumors, the number of stage I, II tumors was 14 and that of stage III, IV tumors was 11. Neck node metastasis was noted in 8 cases. 5) 8 cases of malignant tumor were died and all of them had high-grade malignancy. And they were dead before 17 months from the time of diagnosis. 6) Mean survival duration in the malignant salivary gland tumor was 56 months. 7) High-grade malignancy had a 5-year survival rate of 57.9%. A 5-year survival rate of TI, T2 patients was 92.9% and that of T3, T4 patients was 36.4%. That of patients who had neck node metastasis was 37.5% and that of those who had tree neck was 82.4%. Conclusion: The results of this study suggest that the survival rate is dependent on the tumor size, lymph node matastasis and histologic grade. And also the early diagnosis and radical surgery result in the increased survival rate and are effective for prevention of the tumor recurrance.

Background: Hypopharyngeal cancer represents about one-third the incidence of laryngeal cancer which is the most common cancer in head and neck area. Although there have been numerous reports regarding its clinical and statistical characteristics, more precise and ample data should be collected and analyzed in this country. Objectives: This study was designed to evaluate the pattern and patient's profile of the hypopharyngeal cancer, and we reviewed the treatment outcomes to search for an index of treatment modalities. Materials and Methods: The authors retrospectively analyzed 73 cases of hypopharyngeal cancer treated at Yonsei Medical Center during the 10-year period from 1985 to 1994. Five-year survival rate was calculated according to the primary site, clinical stage and treatment modality. Results: The incidence was predominated in male by 9 to 1 and peak incidence was 6th and 7th decades. Pyriform sinus was the main primary site(80.8%) followed by posterior hypopharyngeal wall(13.7%) and postcricoid area(5.5%). Advanced stage cancers(87.7%) were more common than early stage cancers. Radiotherapy(60.3%) was the most commonly used as primary treatment modality. Neck node metastasis was early occurred even in early stage cancers(61.5%), and overall rate of neck node metastasis was 69.9%. All surgical cases received procedures more than total laryngectomy and partial pharyngectomy. The most common cause of death was primary failure(81.5%) and it was highest in radiotherapy group. Five-year survival rate was significantly high in surgery group(90.9%). The overall 5-year survival rate of hypopharyngeal cancer was 30.3%. Conclusion: High index of suspicion should be required for early diagnosis. Also, surgery may be recommended for the primary treatment modality in advanced stage cancers.

Objectives: We'd like to give help in diagnosis and treatment of children's thyoid tumor through our clinical experiences and reference consideration. Materials and Methods: The authors report their experiences with 33 cases of thyroid tumor in patients younger than 16 years of age who were treated at Presbyterian Medical Center from 1979 to 1995. Results: 1) Girls were more predominant than boys by a ratio of 5.6:1. The peak incidence was in the 15 years old of age. 2) The final diagnosis in the 33 patients were thyroid carcinoma in 12 cases, nodular goiter in 6 cases, adenoma in 6 cases, Graves disease in 4 cases, Hasimoto's disease in 4 cases and cyst in 1 case. 3) All of 12 patients with thyroid cancer had nodular tumor. 4) In 5 of 6 patients with palpable cervical lymphadenopathy, the final diagnosis was thyroid carcinoma. 5) Delayed diagnosis arose in 6 of 12 thyroid carcinomas which were treated for long periods as benign disease. 6) The surgical procedures were total thyroidectomy in 3 cases, subtotal thyroidectomy in 13 cases and thyroid lobectomy in 17 cases. 7) 11 of 12 patients with thyroid carcinoma had subtotal or total thyroidectomy with lymphnode dissection and only one had lobectomy. 8) The overall rate of postoperative complication was 3%(1 of 33 patient). 9) Postoperative $^{131}I$ therapy was done in 7 case because of recurrence and distant metastasis in six and severe local invasion in one. 10) In thyroid cancer, the metastatic rate of lymph node at initial surgery was 81%(9/11) and rate of recurrence was 50%(6/12). 11) Patients with thyroid carcinoma were followed up for a mean of 12 years but only one died as a result of thyroid carcinoma 3.5 years later. Conclusion: The authors suggest that thyroid tumors in childhood should receive the benifit of joint management by endocrine pediatrician and experianced surgeons with an agreed protocol of diagnosis and management. We, also, recommend aggressive surgical and $^{131}I$ treatment as the most effective regimen for children with thyroid carcinoma.

Objectives: The response rate of the radioactive iodine(RI) therapy with low dose was variable. Only a few studies reported the response and complication rate with high dose. The goal of this study was to access the ablation and complication rate after high dose of RI therapy (more than 100mCi) and to evaluate the factors affect the results. Material and Methods: During a period of 12 years, 225 patients received high dose of RI from 100 to 200mCi depending on the RI uptake in the whole body after total thyroidectomy. 100mCi of RI was given to 123 patients for ablation who showed the uptake only in the thyroid bed. 150mCi was given to another 84 patients for ablation who had uptake confined to the neck. The other 21 patients took more than 200mCi of RI because the whole body scan showed distant metastasis. Among these patients, the ablation and the complication rate was investigated. Results: Elevated level of the serum thyroglobulin(Tg) decreased less than 5ng/ml after RI therapy in all patients except two in the first group. The second group showed reduction of the serum Tg in 93%. Eighteen of the 21 patients in the third group are still alive after RI therapy. There were no fatal complications after high dose RI therapy and most of the complications were minimal and transient. The complication rate was not related with the dose of RI, age, sex, DNA flowcytometry, serum thyroglobulin level and the extent of node dissection. Conclusion: We concluded that RI therapy with high dose was very effective for thyroid ablation after operation and it also showed excellent results with minimal complications for treatment of metastatic lesions.

Tumor growth and metastasis depends on angiogenesis. Vascular endothelial growth factor (VEGF) is a potent mitogen for vascular endothelial cells in vitro and promotes neoangiogenesis in vivo. Objective: Follicular thyroid cancers(FTC) are a vascular tumor and traditionally metastasize via blood vessels. Likely other cancers, angiogenesis may playa important role in FTC. We, therefore, investigated the expression of VEGF and microvascular density by immunohistochemistry in FTC and follicular adenoma(FA). Materials and Methods: Findings of immunohistochemical stainings for VEGF and CD31 were measured by grading scale from +1 to 4+(strongest) and by counting the stained microvessels in 14 FTCs and 14 FAs. Results: 1) Expression of VEGF. a) FTCs have stronger expression than FAs in areas of tumor adjacent to capsule($mean{\pm}SD\:\;3.2{\pm}0.9\;vs\;2.0{\pm}0.9$, p<0.01) and in central area($2.3{\pm}0.7\;vs\;1.3{\pm}0.6$, p<0.01). b) The VEGF expression of capsular area in FTCs are higher than that of central area(p<0.05). 2) Microvascular density by CD31. a) FTCs have more microvessels than FAs in areas of adjacent to capsule($78.9{\pm}27.3\;vs\;38.7{\pm}15.6$, p<0.01) and in central area($75.5{\pm}23.3\;vs\;27.8{\pm}10.7$, p<0.01). b) In FTCs, the number of microvessels of capsular area are more than that of central tumor area, but not significant statistically(p>0.05). Conclusion: The higher expression of VEGF and microvascular density in FTC suggests angiogenesis plays an important role in progression of FTC.

Generally, the papillary carcinoma generally has a favorable prognosis, and several variants of pathologic heterogeneity are recognized. Variants that are regarded as more aggressive are tall cell, columnar cell, and diffuse sclerosing types. Seventeen cases of papillary thyroid carcinoma showing clinically aggressive behavior, invading extrathyroidal structures, were retrospectively reviewed to evaluate the morphological variants of the tumors. Six of them were found to be pure papillary and nine were mixed types regarded as non-aggressive variants. Four cases were found to be tall cell variants, two cases of non-extrathryoidal invasion and two of extrathyroidal invasion regarded as aggressive variants. Our findings suggest that the prognosis of papillary carcinoma not always be based on its morphological variant and more attention should be given to other clinical parameters.

Fine needle aspiration cytology was used widely to select thyroid nodules for surgery. The result could be highly reliable for most malignancies and for benign nodules. The purpose of this study was to determine the value of frozen biopsy by directly comparing the results of preoperative fine needle aspiration cytology to frozen biopsy examination. In our university hospital, 103 patients with thyroid nodule were operated during the years 1996 through 1997. A comparison of accuracy of the fine needle aspiration cytology with frozen biopsy was made for 85 patients who underwent both procedures. The 85 patients were separated into two groups. The group I included 65 patients, whose preoperative fine needle aspiration cytology results were reported as benign or malignant lesion definitely. The group II included 85 patients, the patients whose reported fine needle aspiration cytologic result was suspicious for malignancy were regarded .as malignant lesion and results for follicular neoplasm were regarded as benign lesion. The accuracy of both procedures was compared on two group also. The sensitivity, specificity, and accuracy of frozen biopsy were 76.7%, 93.5%, and 85.2% in group I and 75.6%, 95.5%, and 85.9% in group II, respectively, compared with 63.3%, 87.1%, and 75.4% in group I and 65.4%, 81.8%, and 72.9% in group II for fine needle aspiration cytology. On benign lesion, the accuracy was 95.5% in frozen biopsy and 68.2% in fine needle aspiration cytology, 75.6% in frozen biopsy and 53.7% in fine needle aspiration cytology on malignant lesion. We conclude that although fine needle aspiration cytology is the reliable diagnostic test in the evaluation of thyroid nodule, frozen biopsy should be performed intraoperatively, because fine needle aspiration cytology is insufficiently sensitive for reliable surgical planning.

In order to review the clinicopathologic characteristics of the thyroid cancer associated with benign thyroid disease, we evaluated 47 patients treated between January, 1993 and September, 1997 at the Chonnam National University Hospital. In those period, we had operated a total of 690 thyroidectomy of which 320 were diagnosed as thyroid cancer. Forty three(91.4%)occurred in women and four(8.5%)occurred in men. The mean age at operation was 46.7years(range, 15 to 76 years). Forty three of the 47 cancers(91.4%) were papillary carcinomas while 4(8.5%)were follicular. Twenty four of the 47 patients (51%) were occult thyroid carcinomas measured less than 1 cm in diameter. The concurrent benign disease were nodular goiter(n=17), Hashimoto's thyroiditis(n=16), follicular adenoma(n=10), Graves' disease(n=2) and diffuse hyperplasia(n=2). Thirty one patients were diagnosed by preoperative FNAC and they underwent total thyroidectomy. Three were diagnosed by frozen section examination at the time of operation. Among them, one underwent total thyroidectomy and two underwent subtotal thyroidectomy. Eight cases revealed lymph node metastases and 2 cases extended to surrounding muscles. In conclusion, concurrent thyroid cancers and benign thyroid disease are not uncommon and a regular ultrasonic follow-up with selective aspiration cytologic examination is recommaned to enhance their diagnostic accuracy.

Background: Completion thyroidectomy can most accurately be described as reexploration of the neck to remove the contralateral thyroid lobe. This procedure has commonly been performed when the histopatholoic condition of the ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Because of a definitely increased risk of complications with completion thyroidectomy, avoiding its routine use is important. But this operation is safe procedure with minimal morbidity by coinsidering interval, surgical approach, surgeon's experience. The purpose of this review is to define the indication, and the safety of completion thyroidectomy. Materials & Methods: Recent 2 years(1995. 1 to 1996. 12), we have performed 161 thyroid operations. Fourteen of these patients were treated by completion thyroidectomy. The patients ranged in age from 21 to 66 years. We have routinely used ultrasound guided needle biopsy and intraoperative frozen section. Result: The completion thyroidectomized specimen contained papillary carcinoma in 12 (86%), follicular carcinoma in 1(7%) and follicular adenoma(no residual tumor) in 1(7%). The complication of completion thyroicetomy was absent, although case number was a few. The indication of completion thyroidectomy in our study was defined recurrence in 9 and staging in 5. The site of recurrence consists of residual thyroid in 7 and residual thyroid added cervical lymph node in 2. The staging consists of incomplete thyroidectomy 3, questionable frozen biopsy 1, and huge follicular carcinoma. Conclusion: The incidence of completion thyroidectomy appear to be increasing by application of ultrasonogram in follow-up of thyroidectomized patients, especially, for the improving of well differentiated thyroid carcinoma. Experience suggests that the morbidity of completion thyroidectomy is low, so we recommend completion thyroidectomy as an efficient and safe method of surgical treatment.

혈관외피세포종(Malignant hemangiopericytoma)은 난원형의 혈관외피세포(pericyte)들로 구성된 매우 드문 혈관종의 일종으로 대개 사지 및 후복막에 발생되며, 안면부와 경부에도 약 25%가량의 발생율이 보고되어 있다. 성별 발생빈도의 차이는 없고 $20{\sim}50$대에서 호발하며, 종양은 대부분 서서히 성장하고 경계가 명확한 무통성의 고형 종괴로 나타난다. 악성과 양성의 구별은 조직학적 소견과 주변 조직으로의 침습, 원격전이 여부 등을 고려하여 판단하지만, 양성으로 진단된 경우에도 수년 내에 재발 및 원격전이가 나타나는 경우가 다수 보고되므로 악성과 양성의 감별이 매우 어렵고. 양성인 경우에도 악성 잠재성이 존재하는 것으로 알려졌다. 치료는 수술적 완전절제가 유일한 방법이나 절제가 불완전한 경우는 수술 후 외부 방사선 조사를 한다. 항암제 투여는 효과면에서 논란이 있지만, 원격전이나 수술과 방사선 치료가 실패한 경우 시행할 수 있다. 저자들은 최근 안면부에 발생한 악성 혈관외피세포종 환자 1예를 치험하였기에 보고하는 바이다.

Pleomorphic adenoma is the most common tumor in the parotid gland and a parotidectomy with preservation of the facial nerve is a widely accepted treatment. With the advanced imaging methods such as CT scan or MRI and the developed surgical technique, the incidence of complications in parotid surgery declined considerably. However, when the tumor forms a huge mass after a prolonged period, surgeons tend to hesitate surgical treatment regarding the possibility of facial nerve injury and incomplete resection due to a malignant transformation of the tumor. And this is more likely when the huge tumor arised in the deep lobe of the parotid gland. We present a case of 39-year old man with a giant pleomorphic adenoma arising in the deep lobe of the parotid gland who was treated successfully by total parotidectomy without any complications. The size and weight of the tumor were 20x15x15cm and 1,100gm, respectively. In our experience, because pleomorphic adenoma is well encapsulated and not invasive to the adjacent tissue, even a giant pleomorphic adenoma arising in the deep lobe of the parotid gland can be treated by careful surgical resection with the preservation of the facial nerve.