• 대한두경부종양학회지
• /
• 제10권2호
• /
• pp.106-111
• /
• 1994

During a 9-year period(March 1985 to February 1994), 111 consecutive total thyroidectomies and modified or radical neck dissections were performed at 81. Vincent Hospital, Catholic University Medical College, for benign and malignant disease. There were three permanent complications, persistent hypoparathyroidism, in total thyroidectomies. Overall complications were observed 20(62.5%) in benign diseases, 47(59.5%) in malignancy. In benign and malignant thyroid diseases. the complications were transient hypoparathyroidisms (28.8%), transient hoarsenesses(21.6%), wound infections (3.6%), bleedings(3.6%), and permanent hypoparathyroidisms(2.7%). Our experience suggests that the morbidity of total thyroidectomy relates primarily to the extracapsular extension, necessitating en bloc exision accompanied by additional lymph node dissection. The low incidence of permanent complications in thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.

• 대한두경부종양학회지
• /
• 제13권1호
• /
• pp.81-85
• /
• 1997

Basal cell adenocarcinoma is a rare, recently described neoplasm of the salivary gland. We have experienced three cases of basal cell adenocarcinoma of the parotid gland. The tumors from patient 1 and patient 2 showed intraparotid growth in superficial lobe without cervical lymphnode metastasis. So, patient 1 and patient 2 underwent only a superficial parotidectomy and subdigastric lymphnode dissection without any adjuvant therapy. They are alive without recurrence or distant metastasis. But that of patient 3 showed widely invasive growth with multiple cervical lymph node metastases. The CT scan showed a $8{\times}7cm$ sized huge mass replacing the parotid gland with irregular margin and multiple lymphnode enlargements along the internal jugular vein. Total parotidectomy with sacrifying the facial nerve and standard radical neck dissection were caried out. Microscopically, the tumor consisted of solid nest and sheet of uniform basaloid cells separated by a fibrous connective tissue stroma with the evidence of lymphovascular invasion. As a result of the lymphnode metastasis and invasiveness of the tumor, radiation therapy was given postoperatively. We thought that close follow-up would be mandatory in this patient because of high risk of possible local recurrence and distant metastasis.

• 대한방사선치료학회지
• /
• 제21권1호
• /
• pp.17-23
• /
• 2009

목 적: 두경부암의 치료에 있어 상부 두경부의 양측면조사면과 하경부의 전방조사면의 접합부위에 균등한 선량을 조사하는 것은 매우 중요하다. 접합부위의 선량분포개선을 위하여 하경부 전방조사면의 치료시 Field-in-Field technique을 이용하여 부족선량(under dose)과 초과선량(over dose)으로 인한 선량불균등을 개선하고 일반치료와의 비교를 통하여 두경부암치료에 적용하고자 한다. 대상 및 방법: 상부 두경부의 양측면 조사시 빔의 확산으로 일어나는 입사점과 출사점의 선량차이를 알아보기 위하여 인체모형팬톰을 이용하였다. 인체모형팬톰을 전산화단층촬영하고 전산화치료계획에서 관심점의 선량비교를 시행하였고, 하경부 접합부위의 선량비율을 계산하여 이를 보정하였다. 조사면 접합부위의 선량분포를 알아보기 위하여 하경부의 접합부위에 저감도 필름을 놓고 일반적인 치료인 상부 두경부의 양측면조사와 하경부의 전방조사시 선량분포를 측정하였다. 또한, 상부 두경부 양측면 조사에 따른 빔의 확산을 고려한 Field-in-Field technique을 이용하여 하경부 전방조사를 할 때의 접합부위의 선량분포 차이를 측정하여 비교하였다. 접합부위의 관심점 선량을 알아보기 위하여 열형광선량계를 이용하여 인체모형팬톰내의 관심점에서의 선량변화를 비교, 분석하였다. 결 과: 전산화치료계획에서 하경부의 접합부위에 Field-in-Field technique을 적용하여 치료계획시 상부 두경부 양측면 조사와 선량합성을 한 경우 부족선량 영역의 선량이 4.7~8.65% 이상 증가하였다. 초과선량 영역의 선량도 2.75~10.45% 감소하였다. 또한, 저감도 필름을 이용한 측정에서는 부족선량영역에서 11.3% 증가, 초과선량영역에서 5.3% 감소한 것으로 나타났다. 열형광선량계를 이용한 관심점선량측정에서도 Field-in-Field technique 적용시 부족선량을 최소 7.5%에서 최대 17.6%까지 보정해주는 것으로 나타나 불균등한 선량분포를 개선할 수 있었다. 결 론: 전산화치료계획시 빔의 확산을 고려한 Field-in-Field technique을 적용하면 접합부위의 선량보정을 통해 냉점(cold spot)과 온점(hot spot)을 줄일 수 있었으며 특히, 빔의 확산에 따른 입사점의 부족선량을 보정할 수 있었다. 본 실험을 통해 Field-in-Field technique의 임상적용시 경부임파절의 저선량으로 인한 임파절전이에 대한 위험도를 감소시킬 수 있을 것으로 사료된다.

• 대한두경부종양학회지
• /
• 제15권2호
• /
• pp.222-225
• /
• 1999

Background and Objectives: Medullary thyroid carcinoma(MTC) is a rare tumor derived from the parafollicular C cells of the thyroid gland accounting for 5-10% of all thyroid malignancies. In Korea, there has been a few case report of medullary thyroid carcinoma(MTC) but their clinical analysis were not exactly studied. So, we made clinical study of 10 patients diagnosed as medullary thyroid carcinoma. Materials and Methods: We reviewed clinical data of 10 patients who were diagnosed as medullary thyroid carcinoma(MTC) from April 1973 to August 1998 at National Medical Center. Results: The incidence of MTC was 2.3% of all thyroid cancer and their mean age were 44.2 years old. Preoperative thyroid scan showed cold nodule in all patients and thyroid function test(TFT) was within normal range. Of the 10 patents, only 4 patients had diagnosis of MTC in preoperative fine needle aspiration biopsy. All the patients underwent total thyroidectomy with central neck dissection. Two patients with cervical lymph node metastasis underwent total thyroidectomy, central neck dissection and modified neck dissection. Two patients (20%) showed recurrence at the site of neck, lung, mediastinum, bone and liver. Conclusion: Most MTC is sporadic form and have peak incidence in the fifth decade and female preponderance. Preoperative fine needle aspiration biopsy is considered to be a clinically useful diagnostic method, but its accuracy is not considered as much high as others. Total thyroidectomy with central neck dissection may be an useful surgical modality in treating medullary thyroid carcinoma.

• 핵의학기술
• /
• 제14권2호
• /
• pp.181-185
• /
• 2010

갑상선암 환자의 경부 림프절에서 미세침흡인생검술(fine needle aspiration biopsy, FNAB)을 시행하며 얻은 미세침세척액의 티로글로불린(thyroglobulin, Tg)측정법의 진단적 성적과 유용성을 알아보고자 FNAB 세포검사의 결과와 비교하였다. 갑상선암의 경부림프절 전이가 의심되어 초음파 시행한 총 37명의 환자 48개의 FNAB 검체를 대상으로 하였고, 수술 후 조직검사결과 또는 장기간 영상 추적검사를 기준으로 하여 세포검사와 미세침세척액 티로글로불린(FNAB-Tg)측정법을 비교하여, 각 검사의 특이도, 민감도 및 정확도를 평가하였다. 추가적으로 Tg-항체가 양성일때 FNAB-Tg 검사에는 어떠한 영향을 미치는지 Tg-항체 검사를 같이 시행한 34명을 대상으로 분석하여 보았다. FNAB 검체의 세포검사에서 전이 음성인 36개 검체 중 35개 검체에서 음성을 보였고, 전이 양성인 12개 검체 중 9개 검체에서 양성을 보였다. FNAB-Tg측정법의 경우 전이 음성인 36개의 검체 중 32개의 검체에서 음성을 보였고, 전이 양성인 12개의 검체 중 12개 검체 모두 양성을 보였다. 따라서 세포검사의 민감도와 특이도는 각각 75.0% (9/12)와 97.2% (35/36)였고, 위음성이 25% (3/12)였다. 반면에 FNAB-Tg 측정법의 민감도와 특이도는 각각 100% (12/12)와 88.9% (32/36)였고, 위양성이 11.1% (4/36)였다. 정확도는 두 검사 모두 91.7% (44/48)였다. Tg-항체에 대한 검사 결과를 얻을 수 있는 34명을 따로 분석한 결과, Tg-항체의 존재 유무가 FNAB-Tg 측정법의 진단 성능에 영향을 주지 않음을 확인할 수 있었다. FNAB 검체를 이용한 세포검사는 특이도가 높고 반면, FNAB-Tg 측정법은 민감도가 높은 검사임을 확인할 수 있었다. 따라서 림프절 전이가 의심되는 갑상선환자에서 FNAB를 시행할 때 세포검사와 FNAB-Tg 측정법은 동시에 시행되어야 할 상호보완적인 검사들이다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권9호
• /
• pp.4061-4063
• /
• 2015

Background: To evaluate pathological features of head and neck squamous cell carcinoma (HNSCC) and to compare these pathological features in patients younger and older than 40 years. Materials and Methods: All resection specimens of HNSCC between 2010 and 2013 evaluated. Tumor characteristics - grade, location (site) cervical node status, alongwith presence or absence of extranodal extension, lymphovascular invasion, gender and age - were extracted from surgical pathology reports. Results: Among these n=19 patients (21.8%) were 40 years or younger and n=68 patients (78.2%) were above 40 years of age. The mean age was 34 (20-40 years) in the younger group and 56 (42-86) in the older group. The most common location of HNSCC in both groups was the oral cavity. The analysis of histopathological features including grade of tumor, tumor size, extranodal extension and comparison between two groups do not show any significant difference. Conclusions: There are no specific pathological characteristics of HNSCC in young patients. An interesting observation is that exposure to expected risk factors is similar in both groups, in younger patients they have less time to act and yet tumors are the same in terms of tumor size, lymph node status and lymphovascular invasion. Therefore further research is recommended to look for potentiating factors.

• 대한두경부종양학회지
• /
• 제16권1호
• /
• pp.9-13
• /
• 2000

Objectives: To determine the tumor interstitial fluid pressure(TIFP) in patients with head and neck cancerand predict radiotherapy outcome.Materials and Methods: In 12 biopsy proven primary head and neck cancer patients with accessible by direct inspection and palpation, and of sufficient thickness(>1cm) to permit accurate needle placement, we measured TIFP at cervical lymph node before and during radiotherapy using a modified wick-in-needle technique. Tumor size was measured clinically and radiologically. Results: The mean preradiotherapy TIFP was 23.4mmHg. Preradiotherapy TIFP had significant relationship with tumor size(p=0.0009). Preradiotherapy TIFP was not different between complete response group and partial or less response group(p=0.114). Radiotherapy outcome was not different between group with above and group with below average TIFP(p=0.09). Conclusion: The mean TIFP was elevated with 23.4mmHg before radiation therapy. Preradiotherapy TIFP had significant relationship with tumor size. It is not definitive that TIFP could be prognostic indicator of radiation response.

• 대한두경부종양학회지
• /
• 제15권1호
• /
• pp.29-34
• /
• 1999

Objectives: This study was carried out to analyze the clinical profile and the results of treatment of a series of patients with extramedullary plasmacytoma(EMP) of the head and neck. Materials and Methods: The clinical features, treatment and survival of 14 patients with EMP seen at Yonsei Medical Center between 1970 and 1998 were carefully reviewed. Results: The median age was 48 years(range 15-75) and there was a male predominance(M:F 1.8:1). Nasal cavities and paranasal sinuses account for 50% of the primary sites and the most common symptom was airway obstruction(50%). Five patients(36%) showed evidence of adjacent bone destruction, one patient had lymph node involvement and one patient had an IgG monoclonal gammopathy at the time of diagnosis. All 5 patients treated with radiotherapy alone achieved local control. Of 5 patients treated with surgery alone, 2 patients(40%) had local failure. Of 3 patient treated with a combination of surgery and radiotherapy, one patient had local recurrence. A total of7 patients(54%) had local, distant or nodal relapses after primary treatment. Six of them received salvage treatment. With salvage treatment of surgery and/or radiotherapy, local control was achieved in 4 of 6 patients. Conversion to multiple myeloma was seen in one patient. Conclusion: Radiotherapy should be recommanded as treatment of choice for EMP of the head and neck. Surgery should be reserved for radioresistant or recurrent tumors, but tumors that are localized and can be removed relatively easily with little morbidity may be treated by primary surgery.

• International journal of thyroidology
• /
• 제11권2호
• /
• pp.123-129
• /
• 2018

Background and Objectives: Hypermethylation of the tumor suppressor gene RASSF1A and activating mutation of BRAF gene have been recently reported in thyroid cancers. To investigate the role of these two epigenetic and genetic alterations in thyroid tumor progression, methylation of RASSF1A and BRAF mutation were examined in thyroid tumors. Materials and Methods: During 2007 to 2017, 69 papillary carcinomas, 18 nodular hyperplasia, 3 follicular carcinomas, and 13 follicular adenomas were selected. The methylation-specific polymerase chain reaction (MSP) technique was used in detecting RASSF1A methylation and polymerase chain reaction (PCR)-single-stranded conformation polymorphism and sequencing were used for BRAF gene mutation study. Results: The hypermethylation of the RASSF1A gene was found in 84.6%, 100% and 57.9% of follicular adenomas, follicular carcinomas, and papillary carcinomas, respectively. Nodular hyperplasia showed a hypermethylation in 33.3%. The BRAF mutation at V600E was found in 60.7% of papillary carcinoma and 27.0% of nodular hyperplasia, but none of follicular neoplasms. The BRAF mutation was correlated with the lymph node metastasis and MACIS clinical stage. There is an inverse correlation between RASSF1A methylation and BRAF mutation in thyroid lesions. Conclusion: Epigenetic inactivation of RASSF1A through aberrant methylation is considered to be an early step in thyroid tumorigenesis, and the BRAF mutation plays an important role in the carcinogenesis of papillary carcinoma, providing a genetic marker.

• 대한영상의학회지
• /
• 제81권6호
• /
• pp.1486-1491
• /
• 2020

기쿠치병은 주로 아시아에 거주하는 젊은 여성에서 경부 림프절 비대와 열을 주소로 나타나는 조직구 괴사성 림프절염이며 자연적으로 치유되는 양성질환이다. 기쿠치병이 전형적으로 발현하는 위치가 아닌 림프절에서 발생하면 진단이 어려워지고 악성 질환으로 오인되기도 한다. 저자들은 2주간 지속되는 발열을 주소로 내원하여 시행한 초음파와 CT, 18F-fluorodeoxyglucose PET/CT에서 비장 종대와 경부, 액와부, 복강, 후복강, 서혜부 림프절 비대를 보여 림프종을 의심하였던 15세 여자 환아 증례를 보고한다. 복강 림프절 절제술로 기쿠치병을 진단하였다. 이후, 환자는 스테로이드로 보존적인 치료를 받고 발열 증상이 호전되어 퇴원하였다.