• Journal of Chest Surgery
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• v.28 no.12
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• pp.1155-1159
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• 1995

Differentiated thyroid carcinoma is a slow growing tumor with relative good prognosis. But locally advanced thyroid cancer with T4 or N1b is difficult to manage. Between June 1988 and April 1995, we resected 8 advanced thyroid cancers trans-sternally. All patients had direct mediastinal extension [T4 or mediastinal lymph node metastasis [N1b with airway obstruction or dysphagia. We operated all the patients by partial or total sternotomy for mediastinal dissection along with thyroidectomy and radical neck dissection. There were some acceptable morbidities but no operative mortality. Postoperative radioactive iodine therapy was followed without side effects. Follow-up survival period was between 11 months to 81 months with 2 late mortalities [17 month, 30 month . Although definite benefit for routine mediastinal dissection in thyroid cancer has not been established, in locally advanced cases impending airway obstruction or dysphagia who have questionable effect by radioactive iodine therapy alone, aggressive mediastinal mass dissection including lymph node metastasis has the significant role to prevent the patients from suffocation & dysphagia, and to enhance the effect of followed radioactive iodine tharapy.

• The Korean Journal of Cytopathology
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• v.7 no.2
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• pp.122-133
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• 1996

This is a retrospective review of fine-needle aspiration cytology(FNAC) smears of 153 cases of thyroid disease performed during August 1989 to July 1995, which were confirmed histologically following surgical operations. FNAC results showed 63 cases(41.2%) of adenomatous goiter, 45 cases(29.4%) of papillary carcinoma, 29 cases(19.0%) of follicular neoplasm, 4 cases(2.6%) of follicular variant of papillary carcinoma, 4 cases(2.6%) of Hashimoto's thyroiditis, 4 cases(2.6%) of $H\ddot{u}rthle$ cell neoplasm, 2 cases(1.3%) of medullary carcinoma and one case(0.7%) each of subacute thyroiditis and of anaplastic carcinoma. The overall accuracy of cytological diagnosis was 83.7%. These data strongly suggest thyroid FNAC is a reliable preoperative diagnostic tool, but FNAC has been less valuable in the diagnosis of follicular lesions than any other disease of the thyroid. Adenomatous goiter was not infrequently interpreted as follicular neoplasia that requires surgery for diagnostic conformation and vice versa. The following findings are considered to be compatible with follicular neoplasm: 1) microfollicles, 2) nuclear grooving, 3) irregularity of nuclear membrane, and 4) irregular arrangement or crowding of follicular cells in groups. The FNAC criteria of adenomatous goiter are as follows: 1) atrophic follicular cells, 2) presence of macrophages, 3) abundant colloid, and 4) large follicles. It is recommended that aspiration of thyroid lesions in order to analyse with critical clinico-pathological approach and surgery is considered only for nodules that are clinically suspicious or unresponsive to hormone therapy or when a diagnosis of follicular neoplasm is made.

• The Korean Journal of Cytopathology
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• v.7 no.2
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• pp.134-137
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• 1996

Monoclonal antibody(TCM-9) against human thyroid cancers have been studied by screening with human thyroid cancers, normal and benign thyroid tissue, and normal human serum protein. A monoclonal antibody(TCM-9) that is known to have strong specificity for human thyroid cancer but not for Graves' disease, adenoma or normal thyroid does not bind to native or mature human thyroglobulin(Tg). We used to TCM-9 antibody by immunohistochemical staining on 5 follicular cancer, 2 follicular adenoma, 1 follicular neoplasm with suspicious invasion, 2 papillary cancer to ascertain being of help in differentiation between follicular carcinoma and adenoma. Reactivity of TCM-9 was observed in follicular carcinoma and papillary carcinoma but not observed in follicular adenoma. Thus TCM-9 is a novel monoclonal antibody against the thyroid cancer.

• Korean Journal of Head & Neck Oncology
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• v.12 no.1
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• pp.43-46
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• 1996

An unusual case of nodal metastases from thyroid neoplasm known as parapharyngeal space mass is likely to be overlooked. And identification of the primary lesion by excisional biopsy calls for a secondary operation. Therefore, it is important to be aware of the possible lymphatic spread of the thyroid neoplasm to the parapharyngeal space. In this case, completion thyroidectomy should be considered. Here, we present a case of thyroid papillary carcinoma masquerading as a parapharyngeal space tumor. The mass was removed by transcervical approach and pathologically diagnosed as a metastatic thyroid papillary carcinoma. Successful results were obtained after additional completion thyroidectomy.

• The Korean Journal of Cytopathology
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• v.9 no.1
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• pp.69-78
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• 1998

There is a lot of difficulty in the diagnosis of follicular lesions of the thyroid by fine needle aspiration cytology(FNAC). The main purpose of this report is offering more guidance regarding the cytologic appearance to distinguish follicular neoplasm from nodular golfer and laying stress on the presence of mixed group. The histologic and cytologic findings of 23 follicular neoplasms and 13 nodular (adenomatous) getters were reviewed. Histologic specimens were classified into the microfollicular(MIF), mixed(MIX), and nodular getter(NG) groups. The comparison of histologic patterns with histologic diagnosis revealed that all the lesions with predominantly microfollicular, trabecular, or solid pattern were follicular carcinoma and all the lesions with predominantly macrofollicular pattern were nodular goiter. The distinguishing cytologic features for the MIF group were irregular cell arrangement in cell groups(100%, p=0.00001), absence of atrophic follicular cells(100%, p=0.0007), abundant microfollicles(100%, 0=0.002), pleomorphic nuclei(100%, p=0.002), not predominant syncytial smear pattern(100%, p=0.002), heterochromatin(100%, p=0.032), absence of macrofollicles(100%, p=0.038), scant colloid(100%, 0=0.04), clear back-ground(83%, p=0.00006), and uniform sized follicles(83%, p=0.014). And regular cell arrangement(honeycomb appearance) in cell groups(85%, p=0.0000), atrophic change of follicular cells(69%, p=0.0002), syncytial smear pattern(54%, p=0.000), monomorphic nuclei(85%, p=0.008), and hemorrhagic background(100%, p=0.027) were characteristic features of the NG group. Seventeen out of 36 cases(47%) were the MIX group composed of combined cytologic features of the MIF and NG groups. Therefore the frequent presence of the MIX group is considered to be main cause of the difficulty in the diagnosis of follicular lesions by FNAC. The mixed morphologic feature may support the hypothesis of a biologic 'continuum' between nodular goiter and follicular neoplasm of thyroid gland.

• The Korean Journal of Cytopathology
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• v.18 no.1
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• pp.74-80
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• 2007

Parathyroid tumors may be difficult to distinguish from thyroid follicular lesions, especially when a tumor is nonfunctioning. We report here two cases of asymptomatic parathyroid carcinoma preoperatively misdiagnosed as thyroid follicular lesions, and one case of parathyroid adenoma showing hyperparathyroidism, and review the cytologic features favoring the diagnosis of parathyroid neoplasm. The cytologic findings that are characterized by clean background, monomorphic small cells, cohesive three-dimensional papillary clusters, small tight clusters with scattered naked nuclei, and well-defined clear cytoplasm favor a diagnosis for the parathyroid lesions. Cytologic findings such as macrofollicular structure, presence of colloid and macrophages, and presence of perivacuolar cytoplasmic granules on May-Grunwald-Giemsa stain support a diagnosis of a thyroid follicular lesion. The cytomorphology of parathyroid tumors is so variable that the distinction from a thyroid lesion cannot be based on the presence or absence of a single feature only but on the cytologic features as a whole.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.40-42
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• 2006

Riedel's thyroiditis is an uncommon disorder of unknown etiology that is characterized by an invasive process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation as a stonyhard, poorly defined enlargement over the thyroid gland and local compression of the trachea, esophagus and recurrent laryngeal nerve can mimic invasive thyroid carcinoma and mask the accompanied thyroid neoplasm. A case of Riedel's thyroiditis in a 59-year-old female patient, admitted with a previous diagnosis of adenomatous goiter, is reported. So, we present this case with the review of literatures.

• Journal of Breast Cancer
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• v.21 no.4
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• pp.463-467
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• 2018

Metastasis from primary cancer to the thyroid is uncommon in breast cancer. Here we present a case of lobular breast carcinoma that metastasized to the thyroid. A 54-year-old woman without symptoms was admitted to our institution for staging of the lymph node above the left clavicle. An $^{18}F$-fluoro-deoxy-D-glucose positron emission tomography scan was performed for staging, and low uptakes were observed in the left supraclavicular and cervical lymph nodes. High uptake was seen in the posterior and lower left lobe of the thyroid. Histologic findings indicated lobular breast carcinoma (positive GATA3, loss of E-cadherin expression) metastatic to the thyroid with a luminal profile. Immunohistochemical analysis was negative for primary thyroid or parathyroid carcinoma. To our knowledge, this is the first report of a patient presenting a metastatic invasive lobular carcinoma in the thyroid and lymph nodes without a prior diagnosis of breast cancer.

• The Korean Journal of Cytopathology
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• v.7 no.2
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• pp.111-121
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• 1996

Fine needle aspiration cytology(FNAC) is preferred because of simplicity, safety, and reliability in the evaluation of patients with thyroid nodule or hyperplasia. However, there are a few limitations such as false-negative or false-positive cases and non-diagnostic material. To evaluate the usefulness of FNAC in thyroid lesions, we reviewed 704 FNAC cases of thyroid nodules from 1988 to 1994 at Soonchunhyang University Hospital. The results are as follows. 1. Among 704 FNAC cases of thyroid gland, 571(81.1%) cases were benign, 12(1.7%) were suspicious, 71(10.1%) were malignancy, and 50(7.1%) were material insufficiency. The cytologic diagnoses of the benign lesions included 168 cases of follicular neoplasm, 139 cases of adenomatous goiter, 162 cases of follicular lesion such as follicular neoplasm or adenomatous goiter, 61 cases of Hashimoto's thyroiditis, 13 cases of subacute thyroiditis, and 28 cases of colloidal nodule or benign nodule. The malignant lesions included 68 cases of papillary carcinona, two medullary carcinomas and a case of metastatic colon cancer. 2. The average number of cytologic smear slides was $4.12{\pm}1.81$ in material insufficiency and $5.63{\pm}1.79$ in diagnostic cases. This difference was statistically significant(p<0.00001). 3. Histological assessment of 150 cases revealed 2 false negative and 1 false positive cases. The false negative cases were a case of marked sclerosis in papillary carcinoma and an occult case of papillary carcinoma. The false positive case resulted from pseudo-ground glass nuclei due to marked dry artifact. 4. Comparison between the FNAC and the histologic diagnosis revealed that FNAC had a sensitivity of 93.5%, a specificity of 99.2%, a false negative rate of 6.6%, a false positive rate of 0.8%, and an overall diagnostic accuracy of 98.0%. Therefore, FNAC of thyroid gland is a very reliable diagnostic method with excellent accuracy rate.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.113-116
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• 2010

The initial presentation of distant metastases in patients with papillary thyroid carcinoma is quite rare. Most distant metastases are solid nodular lesions. A 67-year-old man who complained of severe dyspnea underwent surgery due to a large mediastinal cystic mass compressing the trachea and great vessels. Pathologically, the cystic mass was a metastatic thyroid papillary carcinoma. The thyroid evaluations were compatible with a well differentiated thyroid carcinoma. An occult thyroid carcinoma presenting as a large mediastinal cystic lesion is extremely rare.