• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.73-81
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• 1995

The poor survival rates of patients with carcinoma of a tongue, despite of modern therapy, is well recognized. One of the most important prognostic factors is status of the cervical lymph nodes. There have been a long-standing debate about the treatment of cervical lymph nodes in early-stage tongue cancer. There are two major treatment opinion. The one is surgical excision of primary tumor with prophylactic neck dissection, simultaneously, and the other is to delay the cervical therapy until cervical lymph node is palpable. Recently we have experienced the early cervical metastasis in three patients who had been diagnosed as a carcinoma of the tongue. They were T1, T2 lesion and no palpable node was found. But histopathologic examination showed the occult metastasis or delayed cervical metastasis was occured. By the review of literature and clinical experience, we could conclude the prophylactic neck dissection offers a better chance for success than therapeutic neck dissection of palpable lymph nodes, in case of oral tongue cancer.

• Korean Journal of Radiology
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• v.24 no.8
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• pp.739-751
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• 2023

Objective: This systematic review and meta-analysis evaluated the accuracy of preoperative breast magnetic resonance imaging (MRI) features and tumor-to-nipple distance (TND) for diagnosing occult nipple-areolar complex (NAC) involvement in breast cancer. Materials and Methods: The MEDLINE, Embase, and Cochrane databases were searched for articles published until March 20, 2022, excluding studies of patients with clinically evident NAC involvement or those treated with neoadjuvant chemotherapy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Two reviewers independently evaluated studies that reported the diagnostic performance of MRI imaging features such as continuity to the NAC, unilateral NAC enhancement, non-mass enhancement (NME) type, mass size (> 20 mm), and TND. Summary estimates of the sensitivity and specificity curves and the summary receiver operating characteristic (SROC) curve of the MRI features for NAC involvement were calculated using random-effects models. We also calculated the TND cutoffs required to achieve predetermined specificity values. Results: Fifteen studies (n = 4002 breast lesions) were analyzed. The pooled sensitivity and specificity (with 95% confidence intervals) for NAC involvement diagnosis were 71% (58-81) and 94% (91-96), respectively, for continuity to the NAC; 58% (45-70) and 97% (95-99), respectively, for unilateral NAC enhancement; 55% (46-64) and 83% (75-88), respectively, for NME type; and 88% (68-96) and 58% (40-75), respectively, for mass size (> 20 mm). TND had an area under the SROC curve of 0.799 for NAC involvement. A TND of 11.5 mm achieved a predetermined specificity of 85% with a sensitivity of 64%, and a TND of 12.3 mm yielded a predetermined specificity of 83% with a sensitivity of 65%. Conclusion: Continuity to the NAC and unilateral NAC enhancement may help predict occult NAC involvement in breast cancer. To achieve the desired diagnostic performance with TND, a suitable cutoff value should be considered.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.196-200
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• 2005

Objectives: The purpose of this study was to evaluate the incidence and predictive factors of contralateral occult lymph node metastasis in oral cavity squamous cell carcinomas to form a rational basis for elective contralateral neck management. Materials and Methods: We performed a retrospective analysis of 66 N0-2 oral cavity cancer patients undergoing elective neck dissection for contralateral clinically negative necks from 1991 to 2003. Results: Clinically negative but pathologically positive contralateral lymph nodes occurred in 11%(7 of 66) . Of the 11 cases with a clinically ipsilateral node positive neck, contralateral occult lymph node metastases developed in 36%(4 of 10, in contrast with 5%(3/55) in the cases with clinically ipsilateral node negative necks(p<0.05). Based on the clinical staging of the tumor, 8%(3 of 37) of the cases showed lymph node metastases in T2 tumors, 25%(2 of 8) in T3, and 18%(2 of 11) in T4. None of the T1 tumors(10 cases) had pathologically positive lymph nodes. The rate of contralateral occult neck metastasis was significantly higher in advanced stage cases and those crossing the midline, compared to early stage or unilateral lesions(p<0.05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes(5-year disease-specific survival rate was 79% vs. 43%, p<0.05). Conclusion: The risk of contralateral occult neck involvement in the oral cavity squamous cell carcinomas above the T3 stage or those crossing the midline with unilateral metastases was high. Therefore, we advocate an elective contralateral neck treatment with surgery or radiotherapy in oral cavity squamous cell carcinoma patients with ipsilateral node metastases or tumors that are greater than stage T3 or crossing the midline.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.392-396
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• 2013

Background The typical clinical symptoms of glomus tumors are pain, tenderness, and sensitivity to temperature change, and the presence of these clinical findings is helpful in diagnosis. However, the tumors often pose diagnostic difficulty because of variations in presentation and the nonspecific symptoms of glomus tumors. To the best of our knowledge, few studies have reported on the usefulness of magnetic resonance imaging (MRI) in diagnosing glomus tumors in patients with unspecific symptoms. Methods The inclusion criteria of this study were: having undergone surgery for subungual glomus tumor of the hand, histopathologic confirmation of glomus tumor, and having undergone preoperative MRI. Twenty-one patients were enrolled. The characteristics of the tumors and the presenting symptoms including pain, tenderness, and sensitivity to temperature change were retrospectively reviewed. Results Five out of 21 patients (23%) did not show the typical glomus tumor symptom triad because they did not complain of pain provoked by coldness. Nevertheless, preoperative MRI showed well-defined small soft-tissue lesions on T1- and T2-weighted images, which are typical findings of glomus tumors. The tumors were completely resected and confirmed as glomus tumor histopathologically. Conclusions Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. Moreover, subungual lesions may be particularly difficult to evaluate on physical examination. Our cases showed that MRI offers excellent diagnostic information in clinically undiagnosed or misdiagnosed patients. Preoperative MRI can accurately define the character and extent of glomus tumor, even though it is impalpable and invisible.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.2
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• pp.98-104
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• 1997

We carried out a prospective study of the effectiveness of a diagnostic strategy in thirty consecutively seen patients who had skeletal metastasis. The diagnostic strategy consisted of the recording of a medical history, physical examination, routine laboratory analysis, plain radiography of the involved bone and chest, whole-body technetium-99m-phosphonate bone scintigraphy, abdominal ultrasound, computed tomography of the chest, abdomen and pelvis, fiberbronchoscopy and fibergastroscopy. After this evaluation, a biopsy of the most accessible osseous lesion was done in twenty four patients. On the basis of the our diagnostic strategy, we were able to identify the primary site of the malignant tumor in nineteen patients(63%). The laboratory values were non-specific in all patients. The history and physical examination revealed the occult primary site of the malignant tumor in one patient(3.3%) who had carcinoma of the breast. Plain radiographs of the chest established the diagnosis of carcinoma of the lung in three patients(9.9%). Computed tomography of the chest identified an additional three primary carcinoma of the lung(9.9%). Fiberbronchoscopy identified an additional one primary carcinoma of the lung(3.3%). Abdominal ultrasound established the diagnosis in three patients(9.9%). Computed tomography of the abdomen and pelvis established the diagnosis in four patients(13.2%). Fibergastroscopy established the diagnosis in two patients(6.6%). Examination of the biopsy tissue established the diagnosis in one patient(3.3%). So we recommend to perform plain radiographs of chest, abdominal ultrasound, chest C-T, abdomino-pelvic C-T, fiber-bronchoscopy, fibergastroscopy sequentially.

• Tuberculosis and Respiratory Diseases
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• v.72 no.2
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• pp.169-172
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• 2012

Melanoma can occur as a metastasis within subcutaneous tissue, lymph nodes, or viscera without a detectable primary tumor. Among patients with metastatic melanoma of unknown primary lesion, those with endobronchial metastasis are exceedingly rare. Herein we report a case of an endobronchial and pulmonary metastasis in a patient with melanoma originating from an unknown primary site. The patient without a previous history of melanoma presented with blood-tinged sputum. Fiberoptic bronchoscopy revealed a black polypoid tumor obstructing the posterior basal segmental bronchus of the right lower lobe. A final diagnosis of the malignant melanoma was made based on an immunohistochemical study of the bronchoscopic biopsy specimen. Skin, ophthalmic, oral, and nasal examinations failed to identify occult primary lesions. Subsequent evaluation including positron emission tomography/computed tomography scans did not uncover any abnormalities other than the metastatic pulmonary melanoma. We also describe the characteristic bronchoscopic features of melanoma.

• The Korean Journal of Cytopathology
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• v.2 no.2
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• pp.79-89
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• 1991

Metastatic tumors occur more frequently in the liver than in any other organ. Guided percutaneous fine-needle aspiration (FNA) of the liver is often recommended for confirmative diagnosis of the metastatic lesion, because of its simplicity, high yield, and reasonable safety. The authors studied retrospectively cytologic findings of 110 cases of metastatic tumors to the liver. The frequent primary sites were the stomach (23 cases), pancreas(19 cases), gallbladder(12 cases), and periampullary lesions(6 cases). Most of the metastases were carcinoma (106 cases). There were only 4 cases of sarcoma. The characteristic cytologic findings of FNA of meatastatic tumors were dirty background, abrupt change between hepatocytes and malignant cells, and desmoplasia. Some tumors displayed rather distinctive cytologic appearance that suggests primary sites. For example, the colonic adenocarcinoma showed tall columnar cells with a palisading arrangement, adenocarcinoma of gallbaldder showed focal squamous differentiation in some cases, and metastatic renal cell carcinoma and neuroblastoma showed also distinctive cytologic findings. Because the cytologic features of metastatic tumor are very similar to those of primary tumor, correct cytologic typing may be helpful in pursuit of an occult primary site of metastatic liver lesions, reducing extensive diagnostic investigation in poor prognostic patients.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.707-711
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• 2013

Purpose: To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with a background of benign disease. Method: A total of 709 patients with papillary thyroid carcinoma undergoing surgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroid disease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examination of surgical specimens but were not detected by preoperative imaging studies. In the other group, according to the pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified as concomitant PTC and 309 cases were clarified as dominant PTC. Results: Incidental PTC was more common in women, about 85.7%, the mean age was $47.6{\pm}11.3$ years old. Average tumor diameter was $4.4{\pm}2.2$ mm, multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147). After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), there was no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10 and 14 year respectively. Conclusion: Incidental PTC with a background of benign lesions is common, and the generally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperative finding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, but with a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomy or immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unless lymphadenectasis is present.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.6
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• pp.282-288
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• 2018

Objectives: The purpose of this study was to evaluate the neck node metastasis pattern and related clinical factors in oral cavity cancer patients. Materials and Methods: In total, 76 patients (47 males, 29 females) with oral squamous cell carcinoma (OSCC) who had no previous malignancies and were not undergoing neoadjuvant concomitant chemoradiotherapy or radiotherapy were selected for analysis. Results: Occult metastases were found in 8 of 52 patients with clinically negative nodes (cN0, 15.4%). Neck node metastases were found in 17 patients (22.4%). There was a statistically significant relationship between neck node metastasis and T stage (P=0.014) and between neck node metastasis and distant metastasis (Fisher's exact test, P=0.019). Conclusion: Neck node metastasis was significantly related to tumor size and distant metastasis during follow-up.

• Journal of Digestive Cancer Research
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• v.1 no.2
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• pp.95-99
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• 2013

MicroRNA (miRNA) dysregulations are associated with various types of human cancers, and miRNAs can function as tumor suppressors and oncogenes. Emerging evidence has shown that miRNA pathway is also altered during colorectal tumorigenesis. The detection of cancer-related miRNAs in stool samples may become useful diagnostic marker for colorectal cancer, because miRNAs in stool samples has high stability, and maintains a high portion of its original level. Recent studies reported that stool-based miRNAs can offer more sensitivity and specificity than currently used stool-based screening methods for CRC. In addition, unlike fecal occult blood test, sampling on consecutive dates and special dietary restrictions are not required. In this review, the authors discuss stool-based miRNA for the early diagnosis of CRC and perspectives on future application.