• Korean Journal of Head & Neck Oncology
• /
• v.40 no.1
• /
• pp.49-53
• /
• 2024

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma, with an incidence of about 0.8% to 5% per million people per year, accounting for 1% of soft tissue sarcomas. In its early stage, DFSP is typically found as a violet or pinkish macule or patch, and it can develop into a palpable mass with ulceration or bleeding. The standard treatment for DFSP is wide local excision of the tumor with a 2- to 3-cm negative margin, and radiation therapy or chemotherapy can be conducted with surgical treatment. A 35-year-old man had a palpable mass on the left side of his occipital scalp without color change, ulceration, or bleeding, which typically are present in malignancy. A magnetic resonance imaging (MRI) scan showed a 3-cm homogenous enhanced mass without adhesion between the scalp and the mass. Unexpectedly, a biopsy revealed the round mass to be DFSP. A wide excision and rotation of the scalp flap were performed. The patient recovered without any complications and received adjuvant radiotherapy at a dose of 60 Gray (Gy) for six weeks. There was no recurrence through six months of follow-up. Here we report this unique case of DFSP with atypical presentation.

• Journal of the Korean Society of Radiology
• /
• v.83 no.4
• /
• pp.958-964
• /
• 2022

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of borderline or low-grade malignancy, and its prognosis is unpredictable. Herein, we describe the case of a 47-year-old asymptomatic female with a diagnosis of multinodular PEH. During a 7-year follow-up, the nodules with large size and high ¹⁸F-fluorodeoxyglucose uptake in the initial study showed progression with increasing sizes; however, most small nodules (size < 1 cm) demonstrated spontaneous regression with peripheral rim or nodular calcification. The patient underwent surgical resection for an enlarged nodule. Of note, it is unusual for an individual to have mixed progression and regression concomitantly, which may be helpful in predicting the prognosis.

• Korean Journal of Radiology
• /
• v.23 no.2
• /
• pp.280-288
• /
• 2022

Objective: To compare core needle biopsy (CNB) and repeat fine-needle aspiration (rFNA) to reduce the rate of diagnostic surgery and prevent unnecessary surgery in nodules initially diagnosed as atypia/follicular lesions of undetermined significance (AUS/FLUS). Materials and Methods: This study included 231 consecutive patients (150 female and 81 male; mean age ± standard deviation, 51.9 ± 11.7 years) with 235 thyroid nodules (≥ 1 cm) initially diagnosed as AUS/FLUS, who later underwent both rFNA and CNB. The nodules that required diagnostic surgery after the biopsy were defined using three different scenarios according to the rFNA and CNB results: criterion 1, surgery for low-risk indeterminate (categories I and III); criterion 2, surgery for high-risk indeterminate (categories IV and V); and criterion 3, surgery for all indeterminate nodules (categories I, III, IV, and V). We compared the expected rates of diagnostic surgery between CNB and rFNA in all 235 nodules using the three surgical criteria. In addition, the expected rates of unnecessary surgery (i.e., surgery for benign pathology) were compared in a subgroup of 182 nodules with available final diagnoses. Results: CNB showed significantly lower rates of nondiagnostic, AUS/FLUS, and suspicious for malignancy diagnoses (p ≤ 0.016) and higher rates of follicular neoplasm or suspicious for a follicular neoplasm (p < 0.001) and malignant diagnoses (p = 0.031). CNB showed a significantly lower expected rate of diagnostic surgery than rFNA for criterion 1 (29.8% vs. 48.1%, p < 0.001) and criterion 3 (46.4% vs. 55.3%, p = 0.029), and a significantly higher rate for criterion 2 (16.6% vs. 7.2%, p = 0.001). CNB showed a significantly lower expected rate of unnecessary surgery than rFNA for criterion 1 (18.7% vs. 29.7%, p = 0.024). Conclusion: CNB was superior to rFNA in reducing the rates of potential diagnostic surgery and unnecessary surgery for nodules initially diagnosed as AUS/FLUS in a scenario where nodules with low-risk indeterminate results (categories I and III) would undergo surgery.

• Archives of Plastic Surgery
• /
• v.51 no.2
• /
• pp.202-207
• /
• 2024

Background Ingrown toenail is a common condition that results in chronic pain, recurrent infections, and difficulty in performing daily activities. Our aim is to compare two surgical methods for the treatment of ingrown toenails: wedge resection with curetting versus wedge resection curetting followed by electrocauterization of the nail bed. Methods A prospective, comparative study that included 130 patients with ingrown toenails. All patients had stage II or III disease. We divided the participants into two groups according to the type of surgery and all patients were followed up for 6 months. The outcomes measured were the incidence of postoperative bleeding and infection, recovery time, patient satisfaction, and recurrence rate 6 months after surgery. Results Of the 130 patients included, 59 (45.4%) underwent excision and curetting of the nail matrix (group 1) and 71 (54.6%) underwent excision, curetting, and electrocauterization of the nail matrix (group 2). The postoperative infection rates were 20.3 and 4.2% in the first and second groups, respectively (p = 0.004). Patient satisfaction was 76.3% among the first group, while 91.5% of patients in the second group were satisfied with the results of surgery. Six months postoperatively, recurrence rates were 25.4 and 4.2% in the first and second groups, respectively (p = 0.001). Conclusion Wedge excision and curettage, followed by electrocauterization of the ingrown toenail is a safe treatment modality with a high success rate, that is evident by a lower recurrence rate, and greater patient satisfaction, with no effect on postoperative pain score or recovery time.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.27 no.4
• /
• pp.372-379
• /
• 2023

Backgrounds/Aims: While single-incision laparoscopic cholecystectomy (SILC) has advantages in cosmesis and postoperative pain, its utilization has been limited. This study raises the possibility of expanding its indication to acute cholecystitis with the novel method of solo surgery under retrospective analysis. Methods: We compared the outcomes of SILC (n = 58) to those of three-incision laparoscopic cholecystectomy (TILC; n = 117) for acute cholecystitis, being performed from March 2014 to December 2015. Results: Intraoperative results, including the operation time, did not differ significantly, except for drain catheter insertion (p = 0.004). Each group had 1 case of open conversion due to common bile duct injury. There was no significant difference in the length of hospital stay. Either group by itself was not a risk factor for complications, but in preoperative drainage for intraoperative perforation, 3 factors of intraoperative perforation, biliary complication, and history of upper abdominal operation for additional port, only American Society of Anesthesiology (ASA) scores for postoperative complication of Clavien-Dindo grades III and IV were significant risk factors. Conclusions: Our study findings showed comparative outcomes between both groups, providing evidence for the safety and feasibility of SILC for acute cholecystitis.

• Korean Journal of Radiology
• /
• v.2 no.3
• /
• pp.151-158
• /
• 2001

Objective: To determine the ability of MR imaging to detect the pathological changes occurring in radiofrequency (RF) thermal lesions and to assess its accuracy in revealing the extent of tissue necrosis. Materials and Methods: Using an RF electrode, thermal lesions were created in the livers of 18 rabbits. The procedure involved three phases. In the acute phase, six animals were killed the day after performing thermal ablation with RF energy, and two on day 3. In the subacute and chronic phases, eight rabbits underwent percutaneous hepatic RF ablation. After performing MR imaging, two animals were sacrificed at 1, 2, 4, and 7 weeks after the procedure, and MRpathologic correlation was performed. Results: In the acute phase, the thermal ablation lesions appeared at gross examination as well-circumscribed, necrotic areas, representing early change in the coagulative necrosis seen at microscopic examination. They were hypointense on T2-weighted images, and hyperintense on T1-weighted images. Gadolinium-enhanced MR imaging showed that a thin hyperemic rim surrounded the central coagulative necrosis. In the subacute phase, ablated lesions also showed extensive coagulative necrosis and marked inflammation at microscopic examination. Beyond two weeks, the lesions showed gradual resorption of the necrotic area, with a peripheral fibrovascular rim. The size of lesions measured by MR imaging correlated well with the findings at gross pathologic examination. Conclusion: MR imaging effectively demonstrates the histopathological tissue change occurring after thermal ablation, and accurately determines the extent of the target area.

• Korean Journal of Radiology
• /
• v.1 no.1
• /
• pp.38-42
• /
• 2000

Objective: The purpose of this study was to determine the utility of preoperative CT in predicting early recurrence of hepatocellular carcinoma after partial hepatic resection. Materials and Methods: Preoperative three-phase helical CT scans in 53 patients with hepatocellular carcinoma were retrospectively reviewed by two radiologists. In 27 patients (group I), HCC had recurred within six months, while 26 (group II) had remained disease free for at least two years. In each group, preoperative CT findings were evaluated in each group for the tumor size and number, the presence or absence of capsule, distinctness of tumor margin, perinodular extension, and the presence or absence of portal vein thrombosis. Results: In group I, a tumor capsule of tumor was seen in five of 27 patients (19%), and in group II, in 16 of 26 (62%) (p = .001). The tumor margin was distinct in eight patients (30%) in group I and in 20 (77%) in group II (p = .001). Multiple tumors, perinodular extension, and portal vein thrombosis were more frequently seen in group I but the differences were not statistically significant (p > .05). Tumor size was similar in each group (p > .05). Conclusion: Preoperative CT findings that may help predict the early recurrence of hepatocellular carcinoma after surgical resection are an absence of capsule of tumors and an indistinct margin. Reference to these findings during preoperative CT can guide clinicians in their choice of treatment.

• Journal of Cardiovascular Imaging
• /
• v.31 no.4
• /
• pp.159-168
• /
• 2023

BACKGROUND: The gold standard for diagnosis of cardiac tumours is histopathological examination. Cardiovascular magnetic resonance (CMR) is a valuable non-invasive, radiation-free tool for identifying and characterizing cardiac tumours. Our aim is to understand CMR diagnosis of cardiac tumours by distinguishing benign vs. malignant tumours compared to the gold standard. METHODS: A systematic search was performed in the PubMed, Web of Science, and Scopus databases up to December 2022, and the results were reviewed by 2 independent investigators. Studies reporting CMR diagnosis were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health. RESULTS: A total of 2,321 results was obtained; 10 studies were eligible, including one identified by citation search. Eight studies were included in the meta-analysis, which presented a pooled sensitivity of 93% and specificity of 94%, a diagnostic odds ratio of 185, and an area under the curve of 0.98 for CMR diagnosis of benign vs. malignant tumours. Additionally, 4 studies evaluated whether CMR diagnosis of cardiac tumours matched specific histopathological subtypes, with 73.6% achieving the correct diagnosis. CONCLUSIONS: To the best of our knowledge, this is the first published systematic review on CMR diagnosis of cardiac tumours. Compared to histopathological results, the ability to discriminate benign from malignant tumours was good but not outstanding. However, significant heterogeneity may have had an impact on our findings.

• Journal of the Korean Society of Radiology
• /
• v.84 no.6
• /
• pp.1373-1377
• /
• 2023

Immunoglobulin G4 (IgG4)-related lung disease can have various clinical courses. To our knowledge, reports of IgG4-related lung disease with waxing and waning pulmonary infiltrates only are very rare. A few lung nodules and ground glass opacities were incidentally found in a pre-operative evaluation in a 36-year-old female. The lung lesions showed waxing and waning in the follow-up chest CT. She underwent a surgical biopsy, and IgG4-related lung disease was confirmed.

• Journal of the Korean Society of Radiology
• /
• v.84 no.6
• /
• pp.1384-1390
• /
• 2023

Primary masses rarely originate from the heart and great vessels, and a malignant peripheral nerve sheath tumor (MPNST) is extremely rare. A 76-year-old male with pleural effusion underwent contrast-enhanced computed tomography, which revealed a hypoattenuating mass involving the right pulmonary vein and left atrium. Ultrasonography showed that the mass originated from the right pulmonary vein. Surgical resection confirmed an MPNST that originated from the pulmonary vein. We report the first Korean case of a primary MPNST originating from the pulmonary vein. We have also described the radiologic findings suggestive of a pulmonary vein mass.