Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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v.20
no.2
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pp.136-140
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2009
Background and Objectives: Recurrent respiratory papillomatosis (RRP) is difficult to treat because of its tendency to recur and spread throughout the aerodigestive tract. We aimed to estimate the effect of intralesional injections of cidofovir in patients with RRP. Materials and Method: Within the period from January 2003 to July 2007, 13 patients aged 2 to 61 years were treated with intralesional injections of cidofovir combined with surgical excision of RRP. Cidofovir was injected intralesionaly at a concentration of 5 mg/cc after complete removal of the papilloma with $CO_2$ laser or microdebrider. We evaluated the effect of intralesional cidofovir therapy by comparing pre-treatment mean interval of recurrence with post-treatment interval of recurrence. Results: Of 13 patients, two patients showed complete response during follow up period and four patients showed partial response. Seven patients did not respond to cidofovir at all. Mean pre-treatment mean interval of recurrence was 9 months and mean post-treatment interval of recurrence was 13.1 months (p=0.039). There was a statistical significance between the injected dose of cidofovir and post-treatment interval of recurrence (p=0.009). There were no local or systemic side effects caused by cidofovir. Conculsion : Intralesional injection of cidofovir seems to have a potential of a safe and effective adjuvant therapy of RRP. There was a positive correlation between the injected dose of cidofovir and patient clinical outcomes so that administration of higher doses and more frequency of injections should be needed to reduce recurrence. Further study regarding injection therapy regimen for RRP is required.
Materials and methods: Between 1979 and 1996, 27 patients with primary cardiac tumor underwent surgery at Catholic University Medical College. Mean age of patient was 45.1${\pm}$3.03 ranging from 21 to 67 years old. Twenty-four cases were myxomas, 2 cases were chondrosarcoma, and remained case was angiosarcoma. Diagnosis was confirmed by echocardiography, cardiac angiography, CT scan, and MRI. The most common site of tumor origin was fossa ovalis limbus area(17cases:63%). A biatrial operative approach was commonly used in 15 cases and the tumor was removed through left atriotomy site. Complete excision of the tumor with a cuff of normal tissue was performed. All heart chambers were carefully explored for evidence of multicentric myxomas or other tumor debris. Most of the patients were improved on postoperative period compared to preoperative NYHA functional class. Results: There was one operative death due to low cardiac output syndrome. Follow up period was 3 months to 17 years. There was 2 late deaths due to local recurrences. Conclusion: complete surgical excion is important for increasing cure rate. Malignancy cannot be ruled out even though preoperative echocardiography suggests benign nature. Chest CT or MRI is effective for further evalution in addition to echocardiography. In suspicious of malignancy, more extensive resection is essential and postoperative chemotheraphy or radiotherapy is useful.
The relative importance of various factors influencing the prognosis and survival in the treatment of thymoma is still controversial. Sixty ave patients operated on for thymoma from Jan. 1981 to Dec. 1994 were evaluated, 28 patients (43.1 %) with myasthenia gravis and 37 patients (56.9%) without. Masaoka staging revealed stage I disease in 28 patie ts(4).1%) , stage ll in 1) patients(20.0%), stage 111 In 22 patients(33.8%), stage IVa in 1 patients(1.5%), and stage IVb in 1 patient(1.5%). There was no operative mortality. A complete resection was performed in 48 patients (73.8%) patients, associated in 10 patients (15.4%) with postoperative adjuvant treatment(radiotherapy 5; chemotherapy 1: radio- and chemotherapy 4). Thymomas were found to be predominantly of the epithelial type in 16 patients(24.6%), predominantly Iymphocytic type in 18 patients(27.7%), and mlxed in 22 patients (33.9%). The overall 5- and 10-year survival rates were 87% and 82%, respectively, Factors indicating a poor prognosis included local invasion, incomplete excision, thymic carcinoma, advanced staging and myasthenia gravis. The de- gree of tumor invasion turned out to be the main prognostic factor, and treatment should be planned ac- cordingly. The prognosis is best predicted by the stage of the tumor as determined intraoperatively and is poorer in patie ts with incomplete resection than in those with complete resection of the thynoma. No recurrence developed In patients with stage I disease.
Thymic tumors are the most common tumors in the anterior mediastinum. Total resection is the main treatment and predictor of longer survival. Adjuvant radiotherapy alone or in combination with chemotherapy is recommended with incomplete excision or advanced disease. Thirty seven patients with thymic tumors were included in this retrospective study from January 2001 till December 2012. They were studied regarding age, sex, performance status, tumor size and invasion, stage, pathology, treatment given, overall and progression free survival. Myasthenia gravis was present in 18.1% of the patients. Masaoka stage III was diagnosed in 40.5% of the cases followed by stage II in 24.3% and the other stages with lower percentages. Pathology type B3 was the most frequent followed by B2 and B1 with percentages of 27, 24.3 and 21.7 respectively. Complete resection was conducted in 11 cases (29.75%). Partial resection or debulking was done in 15 (40.5%) and a biopsy was taken in 11 cases (29.8%) Adjuvant chemotherapy was given to 14 patients (37.8%) and neoadjuvant to 13 (35.2%). Adjuvant radiotherapy was given to 17 patients (46%) and neoadjuvant to 14 (37.8%). The 5-year overall survival by was 83% for stage I, 71% for stage II, 60% for stage III, and 44% for stage IV (p=0.0426). Five year progression free survival was 71% for stage I, 62% stage II, 42% stage III, and 37% for stage IV (p=0.0532). In conclusion with the rare thymic tumors early stage and complete resection have the highest impact on overall and progression free survival.
Solid and papillary epithelial neoplasm of the pancreas is an uncommon low-grade malignant tumor found predominantly in young females. It is rare in childhood. The origin of the tumor is probably from a multipotential stem cell of the pancreas. Neoplasm usually behave like a very low grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancreas. We report a case of solid and papillary epithelial neoplasm of the pancreas in a 14 year -old girl who presented with intermittent abdominal pain and abdominal mass. CT scan shows a large, about $7{\times}6\;cm$ sized, well-marginated hypodense round mass in the head of the pancreas with some ill defined enhancing solid internal portion. She had taken complete excision of the pancereatic mass and Roux-en-Y pancreaticojejunostomy and histologically comfirmed solid and papillary epithelial neoplasm of the pancreas. A brief review of literature was made.
Purpose: Inflammatory myofibroblastic tumor(IMT) is characterized by clonal proliferation of myofibroblastic spindle cells and accompanied by lymphoplasmacytic infiltration. IMT is an uncommon lesion reported to arise in various organs, and is believed to be a reactive inflammatory condition. IMT forms a spectrum of lesions ranging from benign, infection-related lesions to low-grade malignancies, capable of local recurrences and rarely distant metastasis. IMT occurs mostly in the lung, but rarely in the craniofacial region. Methods: A 28-year-old male with painless swelling in the medial canthal area was referred to our department for the last 2 months. A 2cm sized mass was palpated. He was treated with complete local excision. Results: In the study by computerized tomography, a $2.0{\times}0.8{\times}1.0cm$ mass was found in the subcutaneous tissue layer. Grossly, the mass was well-circumscribed, smooth-surfaced, flesh colored, and hard. The tumor was well demarcated from the other tissues. Histopathologic examinations showed bland spindle-shaped cells loosely arranged with scattered lymphoid cells. Immunohistochemical examinations demonstrated a positive reactivity for alpha-SMA and a negative reactivity for desmin and CD34. No recurrence was noted 12 months after surgery. Conclusion: Emphasis is given to complete resection of the tumor for both diagnostic and therapeutic purposes. Further evaluation to find other lesions in different sites should be considered. Continued follow-up is recommended.
Kim, Sun-Gon;Lee, Jun-Ho;Kim, Myung-Gu;Rho, Myung-Ho
Korean Journal of Bronchoesophagology
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v.13
no.1
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pp.33-38
/
2007
Background and Objectives: A plunging ranula represents a mucus escape reaction occuring because of the disruption of the sublingual salivary gland. It is commonly a condition of young adults, although the reported age range is 6-43 years. There is said to be a slightly female preponderance of about 1.9:1(F:M). Surgical incision has been considered the definite treatment, but sometimes complete excision is very difficult. Non-surgical treatment of these lesions has been attempted, but the results have not been satisfactory. In this study, we present our experiences with picibanil (OK-432) sclerotherapy for a plunging ranula. Materials and Methods: We retrospectively reviewed 41 patients who have undergone sclerotherapy with picibanil for plunging ranula. Information was collected on age, sex, a number of injection, post-sclerotherapy side effect and outcome of treatment. Results: 17 patients (41.5%) showed a complete response, and 20 patients (48.7%) showed inter-mediate response. No response was seen in 4 patients (9.8%). As a side effect of intracystic OK-432 injection therapy, fever (26.8%) and pain(39.0%) were observed. However, fever and pain disappeared after several days in all cases. Conclusion: The results are showing that OK-432 injection is an effective and safe treatment for plunging ranula.
Purpose: Congenital spinal dermal sinus tract is a rare lesion connecting skin to deeper structures including neural tissue. It results from the failure of the neuroectoderm to separate from the cutaneous ectoderm in the third to fifth week of gestation. The common locations are the lumbosacral and occipital regions. Sometimes it extends to spinal canal. In this paper we report a case of congenital spinal dermal sinus tract in the coccyx. Methods: A 21-month-old male child born after an uncomplicated full-term pregnancy was admitted to our institute with a midline dermal sinus and a cartilaginous protrusion in the coccygeal region. There were no signs of infection. Neurologic examination showed no functional deficit in both lower limbs. He was treated with complete excision of the tract and an underlying accessory cartilage. Results: The spinal dermal sinus tract was extended from the skin to the coccyx. The stalk was loosely attached to the accessory cartilage of coccyx. At that point, it was dissected from the accessory cartilage and resected. The accessory cartilage was also resected at the bone and cartilage junction. During the follow-up period of 6 months, the wound healed well without any complication nor recurrence. Conclusion: Congenital spinal dermal sinus tract is known as a form of spinal dysraphism. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with correction of associated abnormalities is of utmost importance.
The Journal of the Korean bone and joint tumor society
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v.6
no.1
/
pp.22-29
/
2000
Purpose : The purpose of the current study was to report the results of curettage and en bloc excision as well as to introduce how to excise the nidus percutaneously with Halo-mill. Material and Methods : Twenty patients(14 men and 6 women) were evaluated, who had operative treatments after diagnosed as osteoid osteoma from March 1990 to January 1998. These patients ranged in age from 7 to 42 years(average: 20.8 years). Locations were 9 femurs, 6 tibias, 2 vertebras, 1 ulna, 1 maxilla and 1 skull. Nine femoral lesions included 5 proximal metaphysis, 2 neck and 2 diaphysis, while 5 tibial lesions included 3 diaphysis, 1 proximal metaphysis and 1 distal metaphysis. We used simple radiography, bone scan, CT and MRI for the accurate diagnosis and localization. As for surgical treatments, while excision and curettage had to need open-exposure of lesion, the percutaneous excision of nidus did not need openexposure : guided Halo-mill into K-wire inserted to nidus under image intensifier. Results : Simple radiography showed that 10 cases had typical nidus and others had only cortical sclerosis. Bone scan was performed at 14 cases and all had hot uptake except one case. We used CT in 10 cases and MRI in 4 cases as diagnostic methods, of which 1 case didn't reveal nidus at CT. Surgical treatment consisted of 6 curettages, 11 excisions, 2 percutaneous excisions with halo-mill and 1 total elbow arthroplasty. We used 7mm sized Halo-mill. During the follow-up period, all patient relieved symptoms and there were no recurrences. All had histologically typical findings except one which had hyperostosis without nidus. Conclusion : Complete removal of the nidus is the most important factor in the treatment. We could excise the nidus percutaneously in 2 cases with the minimal injury to surrounding soft tissues. If we could evaluate the precise location, size of nidus and percutaneous acccesibility, the percutaneous excision of nidus with Halo-mill could be an alternative method as a treatment of osteoid osteoma.
Kong, Chang-Bae;Lee, Jung-Wook;Koh, Jae-Soo;Song, Won Seok;Cho, Wan Hyeong;Jeon, Dae-Geun;Lee, Soo-Yong
The Journal of the Korean bone and joint tumor society
/
v.20
no.2
/
pp.54-59
/
2014
Purpose: We report the diagnosis, treatment outcomes and prognosis of the patients with soft tissue malignant myoepithelioma in the extremities. Materials and Methods: We retrospectively reviewed 6 patients with soft tissue malignant myoepithelioma in the extremities who were treated at our institution between 2008 and 2014. Two patients received unplanned excision at another hospital and remaining 4 patients underwent the biopsy procedures and received wide excision at our hospital. Results: There were 3 men and 3 women with mean age of 41 (33-54) years. The average follow up was 28 (9-45) months. Among the 6 patients, only 4 patients underwent biopsy procedures under the impression of malignant soft tissue sarcoma. Surgical margins for these 4 patients were negative. Two patients who had unplanned excision received another re-excision and one of them showed no residual tumor in the resected specimen. Local recurrences were developed in all patients and distant metastasis in 4 patients. All 4 patients who developed distant metastasis died due to disease progression. Among the 2 patients who developed local recurrence only, one patient has another local recurrence after re-operation and remaining one patient is no evidence of disease for 2 years after resection of locally recurred mass. Conclusion: Soft tissue malignant myoepithelioma in the extremities is a rare disease and shows an aggressive behavior. Appropriate biopsy under the impression of soft tissue malignancy is necessary and complete surgical resection with wide margins is the recommended treatment of choice.
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