• Journal of Yeungnam Medical Science
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• 제32권2호
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• pp.122-126
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• 2015

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a monoclonal plasma cell disorder. Patients with POEMS syndrome also have various clinical manifestations including generalized edema, pleural effusion, ascites, papilledema, and sclerotic bone lesions. These manifestations can lead to a misdiagnosis or delayed diagnosis. We recently experienced a 51-year-old male patient with POEMS syndrome whose sclerotic bone lesion was misdiagnosed as malignant bone metastasis of papillary thyroid carcinoma. We reassessed the patient and found polyneuropathy, hepatosplenomegaly, hypothyroidism, partial hypopituitarism, immunoglobulin G lambda-type monoclonal gammopathy, hypertrichosis, ascites, and multiple sclerotic bone lesions, all of which led us to a diagnosis of POEMS syndrome. Treatment with thalidomide and dexamethasone resulted in clinical and radiological improvement. The patient has remained in remission after peripheral blood stem cell transplantation.

• Korean Journal of Radiology
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• 제24권9호
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• pp.903-911
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• 2023

Objective: Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. Materials and Methods: We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. Results: Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. Conclusion: Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.

• 대한두경부종양학회지
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• 제40권1호
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• pp.1-5
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• 2024

The Bethesda System for Reporting Thyroid Cytopathology (TBSRCT) is crucial for cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations and is effective for clear communication with the referring physicians. The new Bethesda System for Reporting Thyroid Cytopathology, the third edition in 2023, provides several key updates. The most important update is the assignment of only single name for each of the six diagnostic categories: (I) nondiagnostic; (II) benign; (III) atypia of undetermined significance; (IV) follicular neoplasm; (V) suspicious for malignancy; and (VI) malignant. An implied risk of malignancy (ROM) for each of six categories has been updated based on extensively published data since the second edition of TBSRTC in 2017 and offers both an average ROM for each category and the expected range of cancer risk. Estimated final ROM after excluding "Noninvasive Follicular Thyroid Neoplasm with Papillary Like Nuclear Features (NIFTP)" for each of six categories has been updated based on the reported mean decreases in the ROM if excluding NIFTP. For atypia of undetermined significance (AUS) category, the subcategorization is simplified and more formalized into 2 subgroups, AUS-nuclear atypia or AUS-other, based on the implied ROM and molecular profiling. For the pediatric thyroid disease, pediatric ROMs and management algorithms are newly added for the same six reporting categories for this age group. New or revised disease nomenclatures including high-grade follicular-derived carcinoma has been updated according to the recently published 2022 World Health Organization Classification of Thyroid Neoplasms. Brand new two chapters are added including clinical perspectives and imaging studies (Chap. 13) and the use of molecular and other ancillary tests (Chap. 14). The atlas is updated with new images to illustrate more effectively for new disease entity and diagnostic criteria.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.3213-3217
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• 2013

Background: P-glycoprotein (Pgp), encoded by the multidrug resistance 1 (MDR1) gene, is an efflux transporter which plays an important role in pharmacokinetics. The current preliminary study was designed to determine associations between a germ-line polymorphism in the MDR1 gene with differentiated thyroid carcinoma (DTC). Materials and Methods: In the current case-control study, 60 differentiated thyroid cancers (DTC)- 45 papillary TC (PTC), 9 follicular TC(FTC) and 6 well-differentiated tumors of uncertain malignant potential (WDT-UMP) were examined. Results were compared to a healthy control group (n=58) from the same population. Genomic DNA was extracted from peripheral blood with EDTA and the target gene was genotyped by real-time PCR. Results: Carriers of the variant allele of MDR1 exon 26 polymorphism were at 2.8-fold higher risk of DTC than the control group (odds ratio [OR]: 0.3805, 95% confidence interval [Cl]: 0.1597-0.9065 (p> 0.046). Conclusions: Presented results suggest that the MDR1 3435TT genotype might influence risk of development of DTC and that the CC genotype might be linked to a poor prognosis. Large-scale studies are now needed to validate this association.

• 임상이비인후과
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• 제29권2호
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• pp.316-320
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• 2018

Esophageal diverticulum is very rare disease. Since it usually has no symptoms, it is hard to find and diagnose. Moreover, if the diverticulum is located nearly to thyroid gland, surgeons sometimes misdiagnose as a thyroid nodule. Here, we represent our case which has papillary thyroid cancer and esophageal diverticulum together. In this case, we experienced the surgical procedure and postoperative complications of the esophageal diverticulum. Even though esophageal diverticulum was in preoperative computed tomography and ultrasound, it was neglected before the surgery so that found during the operation. The purpose of this study was to know the preoperative radiological findings of the esophageal diverticulum and to find out what to be aware of during surgery and how to manage the complications after surgery.

• 대한두경부종양학회지
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• 제13권2호
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• pp.260-264
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• 1997

Metastatic cancer presenting as a cervical cyst is uncommon, and often misdiagnosed as branchial cleft cyst. Authors experienced two cases which presented clinically with features of branchial cleft cyst, but were subsequently found to be metastatic cancer. Radiologic examination and fine needle aspiration biopsy proved to be non-diagnostic, and pathologic findings after surgical excision showed metastatic cancer. Further evaluation and examination were made to find out the primary focus, which revealed tonsillar squamous cell cancer and thyroid papillary cancer in each case. When cervical cysts are noted in aged patients, it is mandatory to rule out metastatic cancer until it is proven otherwise. Surgical excision and pathologic diagnosis should be always accompanied to make correct diagnosis and further treatment.

• 대한핵의학회지
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• 제38권3호
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• pp.272-273
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• 2004

We experienced a case with meningioma showing false positive I-131 uptake. A 55-years old female patient underwent high dose (150 mCi) radioactive iodine therapy to ablate remnant tissue after total thyroidectomy for papillary thyroid cancer. in addition to intense tracer uptake in thyroid bed, there was mild but focal abnormal uptake in left frontal lobe of the brain on post-therapy I-131 whole body scan. Subsequent brain MR imaging showed single mass lesion in left frontal lobe and the mass was resected under the impression of brain metastasis of thyroid carcinoma. Pathologic report confirmed meningioma from the surgical specimen.

• 대한두경부종양학회지
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• 제13권1호
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• pp.45-50
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• 1997

Total thyroidectomy has been advocated as the treatment of choice for most well differentiated thyroid carcinomas. Many surgeons have an aversion to total thyroidectomy, however, because of an allegedly high frequency of complications as compared with those resulting from other operation methods. In this report we reviewed our experience with 37 consecutive total thyroidectomy(January 1995 to December 1996). The clinical features are similar to other studies. The sex ratio is 1 : 3.1(M : F), third decade occupies 33% of cases. The anterior neck mass is the most frequent symptom(95%). In the duration of symptom, 35% of patients was within 3 months. Thirty five cases are cancer, and two cases are Hashimoto's thyroditis. The papillary carcinoma is the most common pathologic type(86%). Total thyroidectomy was done in 20 cases, and total thyroidectomy with modified neck dissection was done in 17 cases. The five postoperative complications occurred in 3 patients among 37 patients: postoperative bleeding in 1, transient hoarseness in 2, transient hypoparathyroidism in 2. Thirty four cases received $I^{131}$ scan and therapy, two cases received thyroid hormone replacement, and one case received chemotherapy. We think that total thyroidectomy can be done without additional risk compared with other thyroid operation methods, with meticulous and careful surgical technique.

• Tuberculosis and Respiratory Diseases
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• 제48권5호
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• pp.802-807
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• 2000

본 증례는 갑상선암이 폐전이를 일으킨 예로 처음에 목에 작은 림프절이 있었으나 속립성 결핵으로 진단 후 치료한 경우로 갑상선암보다 먼저 폐전이 양상이 뚜렷하게 나타났고 폐결절이 매우 천천히 진행하는 형태를 보여 더욱 진단이 늦어졌다.

• 대한두경부종양학회지
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• 제33권1호
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• pp.57-59
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• 2017

A non-recurrent laryngeal nerve on the left side is a rare anomaly which is reported in 0.04% and it is associated with abnormal developments of the aortic arch during embryogenesis. Although the possibility is extremely low, it is important to consider the possible existence of a non-recurrent laryngeal nerve to prevent a nerve injury during thyroidectomy. We experienced a 42 year-old male with left thyroid papillary cancer who had right side aortic arch and aberrant left subclavian artery. Even though we found that this patient had a recurrent laryngeal nerve, we present this case of the right aortic arch with an aberrant left subclavian artery variation with a brief review of literature.