• 대한후두음성언어의학회지
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• 제29권1호
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• pp.24-29
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• 2018

Background and Objectives : The purpose of this study was to evaluate the impact of surgical extent on voice using acoustic and aerodynamic measurements in a serially followed thyroidectomy patients. Materials and Method : From October 2015 to January 2017, 108 patients who had undergone thyroid surgery and voice test for preoperative, 2, 3, and 6 months postoperatively were classified into five operative types. The radiological stage preoperatively and histopathological stage postoperatively were classified according to the invasion of thyroid capsule and surrounding tissue. For each classification, the results of the voice analysis according to the period were compared and analyzed. Results : The difference of voice according to surgical extent, radiological stage, and histopathologic stage showed significant difference only with Maximal phonation time (MPT) over time. However, in the analysis of interaction between each classification and period, Phonation threshold pressure (PTP) only showed significant results. Conclusion : Differences in imaging and histopathologic stages have no significant effect on recovery of voice symptoms after thyroid surgery. As the extent of operation increases, the pressure to start vocalization is relatively higher, which also varies with time after surgery.

• 대한두경부종양학회지
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• 제36권1호
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• pp.9-14
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• 2020

Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

• 대한기관식도과학회지
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• 제1권1호
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• pp.151-158
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• 1995

Anaplastic carcinoma of thyroid gland account for no more than 10% of thyroid cancer, but it shows extremely poor prognosis. The purpose of this study is to review the outcome of patients with anaplastic carcinoma over the span of 5 years and to determine the patterns of clinical presentation, age, sex and other possible prognostic variables. We analyzed 30 cases of anaplastic carcinoma retrospectively from 1991 to 1995. There were 14 men and 16 women. There age ranged 33 to 75 years with a mean of 61.0 years. Sixteen patients presented with transformationqr of well differentiated carcinoma to anaplastic carcinoma, 1 with rapid in-crease in the size of long standing goiter, 8 with rapidly growing neck mass and 4 with meta static disease. Twenty-eight patients(93.3%) showed cervical lymphnode metastasis at presentation and twenty three patients(76.6%) showed laryngotracheal invasion. Nine patients (30.3%) showed distant metastasis. Treatment modalities included surgical resection, external irradiation, radioactive iodine and systemic chemotherapy. At decision making of treatment plan, we considered completeness of initial surgery, uptake rate of whole body radioactive io-dine scan, locoregional progression and distant metastasis. The median survival was 6.8 months and three cases survived beyond 12 months.

• Asian Pacific Journal of Cancer Prevention
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• 제16권3호
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• pp.1135-1138
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• 2015

Background: The objective of this study was to investigate the MSCT characteristics of PTL in order to enhance the awareness of this uncommon entity among both clinicians and radiologists. Materials and Methods: The clinicopathological data and MSCT images of 27 patients with PTL were retrospectively reviewed. The MSCT appearances were classified into three types: type 1, solitary nodule surrounded by normal thyroid tissue; type 2, multiple nodules in the thyroid, and type 3, enlarged thyroid glands with a reduced attenuation with or without peripheral thin hyperattenuating thyroid tissue. Results: The patients were enrolled in the study with a mean age of 68 years (range, 51-86years) and compression symptoms or enlarged cervical lymph nodes at diagnosis. Hashimoto's thyroiditis was in 20 patients. All patients had non-Hodgkin lymphoma of B-cell in origin, including 22 cases of diffuse large B-cell lymphoma (DLBCL) and 5 of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). For MSCT appearance, type 1 pattern was observed in 2 patients, type 2 in 8, and seventeen type 3 in 17. The lesions occurred in more than one lobe with a mean maximal transverse diameter of 6.9 cm and an ill-defined margin. Most tumors showed a homogeneous attenuation equal to that of surrounding muscles before contrast and obvious enhancement after contrast. Cervical lymph node involvement and invasion of the trahea and (or) esophagus were mainly observed in patients with DLBCL. Conclusions: PTL should be clinically considered in elder patients presenting with a history of Hashimoto's thyroiditis and cervical lymphadenopathy. The MSCT characteristics of PTL includes a mass diffusely affecting more than one thyroid lobe, isointense to muscle and obvious enhancement before and after contrast. DLBCL, the most common histological subtype of PTL, is associated with a higher invasive tendency.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2175-2178
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• 2012

Purpose: Definite diagnosis of follicular thyroid carcinoma (FTC) is based on the presence of capsular or vascular invasion. To date, no reliable and practical method has been introduced to discriminate this malignant neoplasm from follicular thyroid adenoma (FTA) in fine needle aspiration biopsy material. Matrix metalloproteinase-2 (MMP-2), by degrading extracellular matrix, and caspase-3, by induction of apoptosis, have been shown to play important roles in carcinogenesis and aggressive behavior in many tumor types. The aim of this study was to examine expression of MMP-2 and caspase-3 in thyroid follicular neoplasms and to determine their usefulness for differential diagnosis. Method: Sixty FTAs and 41 FTCs were analysed immunohistochemically for MMP-2 and caspase-3. Result: MMP-2 was positive in 4 FTCs (9.8%), but in none of FTAs, with statistical significance (p= 0.025). Caspase-3 was positive in 30 (50%) of FTAs and in 27 (65.9%) of FTCs. Conclusion: Our results show MMP-2 expression only in FTCs and suggest that this protein may be a useful marker to confirm diagnosis of FTC versus FTA with 100% specificity and 100% predictive value of a positive test. We failed to show any differential diagnostic value for caspase-3 in thyroid follicular neoplasms.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1267-1272
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• 2012

Background and Objective: The optimal resection extent for clinically unilateral papillary thyroid microcarcinoma (PTMC) remains controversial. The objective was to investigate risk factors associated with occult contralateral carcinoma, and put emphasis on the predictive value of preoperative BRAF mutation. Materials and Methods: 100 clinically unilateral PTMC patients all newly diagnosed, previously untreated were analyzed in a prospective cohort study. We assessed the T1799A BRAF mutation status in FNAB specimens obtained from all PTMC patients before undergoing total thyroidectomy (TT) and central lymph node dissection (CLND) for PTMC. Univariate and multivariate analyses were used to reveal the incidence of contralateral occult cancer, difference of risk factors and predictive value, with respect to the following variables: preoperative BRAF mutation status, age, gender, tumor size, multifocality of primary tumor, capsular invasion, presence of Hashimoto thyroiditis and central lymph node metastasis. Results: 20 of 100 patients (20%) had occult contralateral lobe carcinoma. On multi-variate analysis, preoperative BRAF mutation (p = 0.030, OR = 3.439) and multifocality of the primary tumor (p = 0.004, OR = 9.570) were independent predictive factors for occult contralateral PTMC presence. However, there were no significant differences between the presence of occult contralateral carcinomas and age, gender, tumor size, capsular invasion, Hashimoto thyroiditis and central lymph node metastasis. Conclusions: Total thyroidectomy, including the contralateral lobe, should be considered for the treatment of unilateral PTMC if preoperative BRAF mutation is positive and/or if the observed lesion presents as a multifocal tumor in the unilateral lobe.

• 대한두경부종양학회지
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• 제14권1호
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• pp.54-60
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• 1998

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.

• 대한두경부종양학회지
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• 제33권1호
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• pp.47-52
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• 2017

Anaplastic thyroid cancer is a rare disease entity consist 2% of whole thyroid cancer but once diagnosed, it is too fatal to survive. Airway obstruction is a leading cause of death in anaplastic thyroid cancer, which may be caused by both vocal cord palsy, mass effect of the cancer or direct invasion of the cancer itself to the tracheal lumen. Tracheal stent insertion can be a solution for airway compromised cases where surgical excision cannot be performed. The advantage is that the airway problem can be solved without invasive procedure. In this case, we tried expandable tracheal stent insertion for 66 years-old man with anaplastic cancer who visited ER for small amount of hemoptysis and dyspnea. There was severe tracheal narrowing and deviation due to the anaplastic thyroid cancer, ECMO (Extra Corporal Membrane Oxygenation) was used instead of a tracheal intubation for general anesthesia.

• 대한두경부종양학회지
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• 제10권2호
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• pp.102-105
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• 1994

The indolent course of most thyroid papillary carcinomas, even the presence of regional lymph node metastasis, make them unique among human malignant head and neck cancers. Age, sex, extracapsular invasion and anaplastic change are known to be correlated with prognosis. The purpose of this study is to clarify the significance of DNA content analysis as a prognostic factor. Twenty five thyroid papillary carcinomas were possible to be examined by flow cytometric analysis using fresh surgical specimens and three nodular hyperplasias and seven follicular adenomas were included as control group. The results were as follows: l) All of twenty five thyroid papillary carcinomas showed diploidy. 2) S-phase fraction was $1.94{\pm}2.77%$ in normal control group and $2.60{\pm}2.66%$ in papillary carcinoma group. The proliferation index was $8.44{\pm}3.89%$ in normal control and $7.70{\pm}3.63%$ in papillary carcinoma group with even low value. 3) Age, sex, extracapsular spread and lymph node metastasis showed no significant difference. In conclusion, low proliferative activity of thyroid papillary carcinomas are thought to be related with good prognosis.

• BMB Reports
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• 제46권4호
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• pp.201-206
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• 2013

Sulforaphane [1-isothiocyanato-4-(methylsulfinyl)-butane] is an isothiocyanate found in some cruciferous vegetables, especially broccoli. Sulforaphane has been shown to display anti-cancer properties against various cancer cell lines. Matrix metalloproteinase-9 (MMP-9), which degrades the extracellular matrix (ECM), plays an important role in cancer cell invasion. In this study, we investigated the effect of sulforaphane on 12-O-tetradecanoyl phorbol-13-acetate (TPA)-induced MMP-9 expression and cell invasion in MCF-7 cells. TPA-induced MMP-9 expression and cell invasion were decreased by sulforaphane treatment. TPA substantially increased NF-${\kappa}B$ and AP-1 DNA binding activity. Pre-treatment with sulforaphane inhibited TPA-stimulated NF-${\kappa}B$ binding activity, but not AP-1 binding activity. In addition, we found that sulforaphane suppressed NF-${\kappa}B$ activation, by inhibiting phosphorylation of $I{\kappa}B $ in TPA-treated MCF-7 cells. In this study, we demonstrated that the inhibition of TPA-induced MMP-9 expression and cell invasion by sulforaphane was mediated by the suppression of the NF-${\kappa}B$ pathway in MCF-7 cells.