• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1250-1254
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• 2020

The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is uncommon. Herein, we report a rare case of DSPTC in a 9-year-old girl who initially presented with a painless diffuse goiter. Thyroid peroxidase antibody testing yielded positive results, and the initial clinical diagnosis was Hashimoto's thyroiditis. However, thyroid ultrasonography revealed characteristic findings of DSPTC, which was confirmed through the postoperative histopathological diagnosis. Although thyroid cancers are rare in the pediatric population, DSPTC should be included in the differential diagnosis of goiter in these patients. Moreover, ultrasonography may prevent a diagnostic delay and facilitate the detection of a concomitant malignancy.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.175-182
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• 1993

유두상 갑상선암의 대부분은 서서히 진행하는 양호한 임상경과를 보이나, 일부는 저등급 혹은 미분화 갑상선암으로 전환되는 생물학적 특성을 보인다. 저자는 유두상 갑상선암 환자 358예를 적용된 치료방법과 치료결과를 분석하여 논란이 되고 있는 치료방법들 중에서 적절한 치료방법을 찾고자 본 연구를 시도하였다.% 568예중 동측엽절제술 및 협부 절제술 혹은 갑상선 아전 절제술 220예, 갑상선 전 절제술 혹은 근전절제술 143예, 종양적출술 5예였고, 이중 115예는 여러가지 형태의 경부 곽청술이 추가되었고, 150예는 수술후 방사성 동위원소 치료까지 추가되었다. 또 전 환자에서 TSH 억제를 위한 갑상선 호르몬 투여를 하였다. 추적 기간은 5년에서 12년까지 평균 8.5년이었다. Cady와 Rossia AMES Scoring system에 따라 저위험군과 고위험군으로 나누어 재발율과 사망율을 산출한 결과 저위험군 255예중 재발율 11.0%, 사망율 0.4%, 고위험군 65예중 재발율 36.9%, 사망율 20.0%을 보여 고위험군에서 현격히 불량한 예후를 나타내었다. 따라서 저자들은 유두상 갑상선암의 치료방법 선택은 일률적인 치료방법 보다는 환자 개인의 임상적 특성, 병기 등을 고려하여 저위험군에서는 소극적 수술을, 고위험군에서는 적극적인 수술과 수술후 보조치료를 시행하는 것이 바람직하다고 사료되었다.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.6
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• pp.543-556
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• 2009

Purpose: We studied the patterns of FDG uptake of primary papillary thyroid microcarcinoma (PTMCa) lesions and benign thyroid nodules in dual time point $^{18}F$-FDG PET/CT imaging. Materials and Methods: Consecutive 134 patients (154 lesions) with PTMCa and 49 patients (61 nodules) with benign thyroid nodules equal to or less than 1.0 cm who underwent dual time point $^{18}F$-FDG PET/CT study before surgery were enrolled. We calculated the maximum standardized uptake value of PTMCa and benign nodules in both time points, and percent change of SUVmax (${\Delta}%SUVmax$) and lesion to background ratio of SUVmax (${\Delta}L:B$% ratio) between both time points. The mean time interval between scans was $23.4{\pm}4.4$ minutes (thyroid to thyroid interval: $10.7{\pm}4.4$ minutes). Results: The mean of SUVmax of PTMCa was increased from $4.9{\pm}4.3$ to $5.3{\pm}4.7$ (p<0.001) and ${\Delta}%SUVmax$ was $12.3{\pm}23.6%$. But, the mean of SUVmax of benign nodules was no definite change ($2.1{\pm}1.0$ to $2.1{\pm}1.3$, p=0.686) and ${\Delta}%SUVmax$ was $-0.3{\pm}20.5%$. Of the 154 PTMCa, 100 nodules (64.9%) showed an increase in SUVmax over time, while 19 (31.1%) of the 61 benign thyroid nodules showed an increase (p<0.001). The dual time point $^{18}F$-FDG PET/CT found more PTMCa in visual assessment (62.3% vs. 76.6%, p=0.006), even in smaller than 0.5 cm (38.6% vs. 60.0%, p=0.011). Conclusion: Dual time time $^{18}F$-FDG PET/CT imaging was more useful than single time point $^{18}F$-FDG PET/CT imaging for distinction between PTMCa and benign nodule, especially when nodule showed equivocal or negative findings in single time point $^{18}F$-FDG PET/CT imaging or was smaller than 0.5 cm.

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.133-137
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• 2007

With the wide use of ultrasonography and fine needle aspiration of the thyroid gland, the incidence of papillary microcarcinoma of the thyroid gland is rapidly increasing nowadays. To improve the diagnostic accuracy of histopathologic findings of papillary thyroid carcinoma, various molecular markers have been used recently. We analysed the expression of galectin-3, cytokeratin 19 and HBME-1, using immunohistochemical technique in 37 cases of papillary microcarcinoma of the thyroid gland to evaluate the diagnostic value of these molecular markers. Immunohistochemically, galectin-3 expression was found in 37 cases of papillary microcarcinoma. Its localization was mostly cytoplasmic. Cytokeratin 19 expression was found in 36 cases. It was mostly localized to the cytoplasm and membrane. HBME-1 expression was found in all cases. Its localization was plasma membrane. The expression of these three molecular markers was negative in the adjacent normal thyroid tissue and accompanying benign lesions, although there are scattered foci of incomplete positive staining in cases of Hashimoto's thyroiditis. Our findings suggest that the immunohistochemical staining using antibodies for galectin-3, cytokeratin 19 and HBME-1 is an useful adjunctive method for the histopathological diagnosis of a papillary microcarcinoma of the thyroid gland.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.235-240
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• 1996

Brain metastasis is extremely rare in thyroid papillary carcinoma which has an indolent clinical course and results in good prognosis. A 24-year-old man presenting with seizure attack is described. He had been treated under the diagnosis of thyroid papillary carcinoma with total thyroidectomy, postoperative internal radiation with radioactive iodine, and thyroid hormone replacement. Although $^{99m}$Tc brain spect and $^{131}$I whole body scan did not revealed any significant lesion, brain CT and MRI showed lcm sized mass in frontal lobe. Stereotactic craniotomy and removal of the tumor, which was histologically proven metastatic lesion from thyroid papillary carcinoma, was done with satisfactory improvement.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.3
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• pp.1260-1269
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• 2011

The purpose of this study was to determine postoperative quality of life(QoL), thyroid specific symptoms(TSSs), self care compliance, anxiety and depression in patients with papillary thyroid cancer and to identify factors influencing their postoperative QoL. 154 patients were surveyed using structured questionnaires and data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple regression with SPSS/WIN 18.0 program. The mean score of postoperative QoL in the subjects was 2.72 and the postoperative QoL score of social/family well being subscale showed the lowest score. Most of the subjects suffered from TSSs such as fatigue, cold intolerance, and mood swings. The most frequent activity for self care compliance was taking thyroid hormone(100%) and OPD follow up was the second activity(99.4%). Anxiety score was 45.3 indicating a medium level however 63% of the subjects were evaluated as depression status. Postoperative QoL in thyroid papillary cancer patients showed significantly negative correlations to TSSs, anxiety, and depression (r=-.573, p<.001; r=-.739, p<.001; r=-.742, p<.001). The factors influencing postoperative QoL were TSSs, anxiety, and depression, which explained about 64.9% of the variance. Thus to improve postoperative QoL in patients with papillary thyroid cancer, health care providers should relieve negative emotions related to long term cancer management, develop the support system and provide practical information to apply patients' physical, and psychological symptoms control.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.32-37
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• 2011

서 론 : 미세갑상선유두상암종 환자에서 불필요한 예방적 중앙 림프절절제술을 피하기 위해서 림프절 전이를 수술 전에 예측하는 수단이 필요하다. 림프관 생성 및 성장의 조절에 VEGF-C/D, VEGFR-3 pathway, podoplain이 관여된다는 사실이 밝혀져 있다. 림프관 생성 및 성장과 관련된 인자인 VEGF-C/D, podoplanin에 대한 면역조직화학염색과 반정량적 분석을 통해 미세갑상선유두상암종에서 림프절전이와의 관련성을 확인하고자 하였다. 대상 및 방법 : 2006년 9월부터 2008년 6월까지 본원에서 미세갑상선유두상암종으로 진단받고 1인 술자에 의해 갑상선 전 절제술 및 예방적 중앙 림프절절제술을 받은 104명의 환자 중 중앙 림프절 전이가 있었던 환자와 없었던 환자를 각각 25명씩 무작위로 선별하여 종양부위에 면역화학염색을 실시하여 림프관생성인자의 발현 정도를 비교하였다. 결 과 : 대상군 50예 중 VEGF-C/D는 50예(100%) 모두 발현이 되었고 podoplanin은 33예(66%)에서 발현이 되었다. 그 중 VEGF-C는 10예(20%)에서 약한 양성, 37예(74%)에서 중등도 양성, 3예(6%)에서 강한 양성소견을 보였고 VEGF-D는 9예(18%)에서 약한 양성, 37예(74%)에서 중등도 양성, 4예(8%)에서 강한 양성소견을 보였다. 중앙 림프절 전이 음성 환자 군과 양성 환자 군으로 분류하였을 때 VEGF-C/D의 발현율의 차이는 p-value가 각각 0.48, 1.00으로 통계적으로 유의한 차이를 보이지 않았다. 50예 전체를 대상으로 하여 종양의 개수, 최대크기, 검출된 전체 림프절의 수, 양성 림프절의 수, 주변조직 침범여부에 따른 VEGF-C/D의 발현도 통계적으로 유의한 차이를 보이지 않았다. Podoplanin의 경우 염색 여부에 따라 양성군과 음성군으로 나누어 분석하였을 때 종양의 개수, 최대크기, 검출된 림프절의 수, 양성 림프절의 수, 주변조직 침범여부도 통계적으로 유의한 차이를 보이지 않았다. 결 론 : VEGF-C/D는 대상군 전체(100%)에서 발현이 되었고 podoplanin은 66%에서 발현이 되었다. 림프관 생성인자로 알려진 VEGF-C/D및 podoplanin이 미세갑상선유두상암종에서 많이 발현이 되는 것으로 보아 위 인자들이 림프절 전이를 일으키는 인자 중 하나로 생각된다. 하지만 미세갑상선유두상암종에서 중앙 림프절 전이를 예측할 수 있는 인자로 부적합 한 것으로 생각되며 향후 더 많은 증례를 통해 관련성 여부에 대한 연구가 필요하고 또 다른 인자의 관련성에 대해서 연구가 필요하겠다.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.594-599
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• 1995

Although papillary carcinoma of the thyroid generally follows an indolent course characterized by slow growth and the absence of distant metastases, several available reports suggest that metastasis to bone and/or lung parenchyma may occur infrequently. But pleural metastases are known to be very rare, so there have been only two case reports about the pleural metastases of papillary thyroid carcinoma in the literatures. Even the case of occult papillary thyroid carcinoma presenting as a metastatic pleural effusion has been never been reported. Recently we experienced a case with the chief complaint of dyspnea due to massive pleural effusion, the cytologic examination of which revealed the papillary carcinoma with psamomma bodies. The examination of the thyroid revealed no definite primary tumor. The total thyroidectomy was done with the plan of post-operative radioactive iodine treatment and the pathologic result confirmed the occult papillary microcarcinoma as expected. With the present case report, the extension of the clinical spectrum. of metastatic papillary carcinoma of the thyroid is expected.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.18-21
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• 2015

기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.