갑상선의 $H\"{u}rthle$씨 세포 종양

정웅윤,김석주,박정수,Chung Woong-Youn,Kim Suk-Ju,Park Cheong-Soo 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

H$\"{u}$rthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the H$\"{u}$rthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the H$\"{u}$rthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of H$\"{u}$rthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were $121.7{\pm}35.3$ and $114.3{\pm}31.7$, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the H$\"{u}$rthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate H$\"{u}$rthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

로봇 갑상선 수술의 현재와 미래

정웅윤,Woong Youn Chung,M,D,Ph,D 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.1

Since the introduction of robotic thyroid surgery in 2007, robotic thyroidectomy has become an effective and acceptable treatment for patients with thyroid cancer. Although Conventional open thyroidectomy is safe; the operative time is short and good oncologic outcomes are attained and robotic thyroidectomy is as yet not greatly advanced, many surgeons now use the modality in routine practice. Moreover, the results of robotic thyroidectomy have generated worldwide interest in minimally invasivesurgery and have encouraged several centers in Korea and the United States to develop aims identical to those set when conventional surgery is employed; the postoperative outcomes are better and cosmetic satisfaction is improved. Robotic procedures originated from open and endoscopic thyroidectomy procedures, and advances in the field should be compared with those of conventional open and endoscopic thyroidectomy. Short- and long-term oncologic outcomes must be assessed carefully, and cosmetic results and functional outcomes, such as voice and swallowing changes, require accurate objective analysis. The clinical reports on the conduct of robotic thyroid surgery via a gasless transaxillary approach showed that robotic surgery performed by experienced specialized endocrine surgeons afforded identical or superior levels of surgical radicality and oncologic safety compared to use of conventional open or endoscopic surgery in patients with thyroid carcinoma. The short-term oncologic effectiveness of thyroid surgery is assessed by measuring serum thyroglobulin (Tg) concentration via [<SUP>131</SUP>I] iodine (<SUP>131</SUP>RI) scanning, whereas long-term effectiveness is evaluated via lack of tumor recurrence. Moreover, functional outcomes increasingly emphasize high scores on validated quality-of-life (QOL) instruments. Several large-volume centers have reported the "functional and QOL" outcomes of patients who have undergone robotic thyroidectomy. In such patients, the clinical benefits of robotic thyroidectomy include excellent cosmetic results, reduced pain, improvement in swallowing function, and low morbidity rates. From the viewpoint of surgeons, robotic surgery shortens the surgical learning curve, and causes less musculoskeletal discomfort compared with the conduct of open or endoscopic surgery. The accumulated evidence to date suggests that robotic thyroidectomy and MRND are both safe and feasible in thyroid cancer patients, and can benefit both patients and surgeons. (Korean J Endocrine Surg 2012;12:1-10)

Parathyroid preservation : How I do it (Robot)

정웅윤(Woong Youn Chung) 대한갑상선-내분비외과학회 2017 대한갑상선-내분비외과학회 학술대회 논문집 Vol.- No.-

여포상 갑상선암종의 종양맥관형성도

정웅윤(Woong Youn Chung),이미경(Mi Kyung Lee),장항석(Hang Suk Chang),박정수(Cheong Soo Park) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

Objectives: We performed an immunohistochemical study to examine the place of neovascularization in the tumorigenic process of follicular thyroid carcinoma and to determine whether tumor angiogenic activity in follicular carcinoma plays a role in tumor aggression. Materials & Methods: We studied 63 follicular thyroid carcinomas and compared with 22 follicular adenomas. The areas of capsular invasion, vascular invasion and cellular atypism of the tumor were confimed on H & E stains. The paraffin embedded tissues were stained by the use of monoclonal antibodies against Ag CD34. Microvesseles were counted in the area of highest vascular density at 200 times magnification. The microvessel densities(MVD) were analized in relation to histologic type and location of the tumors. Results: There were 59 minimal invasive types and 4 widely invasive types of carcinoma. In the histologic specimens of carcinomas, capsular invasion was identified in all the cases, vascular invasion in 46 and cellular atypism in 24. Mean values of the MVDs of the minimal invasive carcinomas, the widely invasive carcinomas and the adenomas were 263.8±69.2, 256.l±49.3 and 241.5±159.4, respectively and there was no significant difference between each group. In follicular carcinomas, there was a regional difference of the MVDs. The areas of tumor showing cellular atypism and adjacent to or penetrating the capsule, in which represents the tumorigenic process of carcinoma, had a higher rate of vascularization, than other areas of the tumor(p<0.05). However, these features were not noted in the follicular adenomas. Conclusion: Although there was no significant difference of the MVD between follicular carcinomas and adenomas, there was a regional difference of the MVD within the carcinomas and the values were significantly higher in the more malignant areas, as indicated by cellular atypism and capsular invasion. Therefore, tumor angiogenic activity measured by MVD may play a role in tumor aggression in follicular thyroid carcinoma.

갑상선의 Hürthle씨 세포 종양

정웅윤(Woong Youn Chung),김석주(Suk Ju Kim),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

Hürthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the Hürthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the Hürthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of Hürthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were 121.7±35.3 and 114.3±31.7, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the Hürthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate Hürthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

이하선 종괴로 발현된 악성 림프종

정웅윤(Woong Youn Chung),이효상(Hyo Sang Lee),서진학(Jin Hak Seo),양우익(Woo Ik Yang),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1

Background: Primary malignant lymphoma of the parotid gland is a rare disease and defined as any malignant lymphoma that first manifests in the parotid gland, regardless of the subsequent stage of the diseases, whether it arises in the parenchyma or intraglandular lymph nodes. This study was performed to review the clinicopathological characteristics of primary parotid lymphoma and identify its optimal treatment modality. Materials and Methods: Six cases with parotid mass as first presentation of malignant lymphoma between 1988 and 2000, were studied on the basis of clinical features, diagnostic tools, treatment modality, treatment outcomes, and clinical stage by Ann Arbor Criteria. All were microscopically reevaluated and classified by NCI working formulation. Results: All patients were males and mean age was 36.7 years (2-66 years). Rapid growing non-tender mass was presented in all the cases and cervical lymphnodes were palpated in 4 cases. However, there was not any evidence of concurrent autoimmune disease such as Sjogren's syndrom or Rheumatoid arthritis. One case was confirmed by surgical specimen after superficial parotidectomy, 2 by excisional biopsy, and 3 by incisional biopsy. The stage of disease by NCI working formulation was IE in 1 patient, IIE in 4 and IV in 1. All were classified into non-Hodgkin' lymphoma, of which there were 5 cases of B-cell type and 1 case of T-cell type. There were 3 diffuse large cell lymphomas, 1 Burkitt lymphoma, 1 MALT lymphoma and 1 T-lymphoblastic lymphoma. Three cases were treated by chemotherapy only, 2 by radiotherapy only and 1 by chemo-radiotherapy. One case with Burkitt lymphoma was died from the disease and one case was lost to follow-up. The others are alive with no evidence of recurrence. Conclusions: Although primary parotid lymphoma is rare and difficult to diagnose preoperatively, most were detected in early stage and showed a relatively good response to the chemotherapy or radiotherapy like other types of extranodal malignant lymphoma.

그레이브스병의 갑상선 절제술후 합병증

박정수(Cheong Soo Park),정웅윤(Woong Youn Chung),김종관(Jong Kwan Kim),장항석(Hang Seok Chang) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Introduction: The surgical treatment of Graves' disease has several advantage such as rapid and long lasting therapeutic effect, relatively low incidence of postoperative hypothyroidism and recurrence. Because of less frequent but serious postoperative complications, the operation have not been casually used for treatment of Graves' disease. Hypoclacemia, hoarseness and hematomas are common complications after operative treatment. However, the causative mechanisms of these complications have not been well explained. Objective: We aimed to analyze the risk factors affecting the occurance of complications in surgical treatment for Graves' disease and to evaluate what are the causative mechanisms of postoperative complications. Patients and Methods: From January 1985 to December 1998, a total of 668 surgically treated patients for Graves' disease were enrolled in this study. The incidence of postoperative complications were analyzed in relation to types of surgery, preoperaive preparation, specimen weight, bleeding amount and remnant weight. Results: Postoperative complication was developed in 108(16.2%) of 668 patients. The most common complication was transient hypocalcemia in 85 cases(12.7%). Other complications were: Hematoma in 9 cases(1.3%), transient hoarseness in 5 cases(0.7%), permanent hypocalcemia in 6 cases(0.9%), permanent hoarseness in 3 case(0.4%). The important etiologic factors affecting the occurance of complications were preoperative preparation, perioperative thyroid weight, and remnant thyroid weight. Since 1993, the incidence of complication was more decreased than that in before. Conclusion: To decrease the incidence of postoperative complications of Graves' disease, the patients should be selected carefully, sufficient preoperative preparation should be achieved, and the operation should be performed by well-experienced surgeons.

이하선의 다발성 소관선종(Canalicular Adenoma) 1예

장항석(Hang Seok Chang),정웅윤(Woong Youn Chung),기정혜(Jung Hae Ki),박정수(Cheong Soo Park) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.1

Canalicular adenoma is a uncommon benign salivary gland tumor and it most frequently involves minor salivary gland of upper lip. It rarely occurs in parotid gland. The canalicular tumor of parotid gland can be manifestes clinically and pathologically as a multifocal lesion, which is not generally seen with other intraoral salivary gland tumors. Recently, we experienced a case of multifocal canalicular adenoma occurred on parotid gland in a 65-year-old woman and report it to support the view that canalicular adenoma occur rarely in parotid gland, and is recognizable entities.

이하선의 Warthin씨 종양

이강영(Kang Young Lee),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.2

Warthin's tumor is a benign and slow growing tumor found exclusively in the parotid gland or the periparotid lymph nodes. It mostly affects males between the age of forty to seventy years and is closely related with smoking history. Between January 1981 and June 1996, 42 patients underwent surgical excision of Warthin's tumor of the parotid gland; which made up 10.6% of all parotid gland surgeries(398 cases) during the same period. Their ages ranged from 36 to 75 years with a mean age of 56 years. There were 33 male and 9 female patients with a 4.3 : 1 male to female ratio. The majority of the tumors were situated in the parotid tail whereas one was in the deep lobe. Bilateral simultaneous involvements of the parotid gland were found in 4 patients(9.5%) ; therefore total of 46 parotid glands were involved. Four(8.7%) of the 46 parotid glands had multifocal tumors ranginging from two to three lumps. Tumor sizes varied from 1.5 to 6.0cm with mean diameter of 3.lcm. Of the 42 patients, 26(61.9%) were diagnosed preoperatively or peroperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 46 tumors, 30 underwent a superficial(n=29) or total(n=1) parotidectomy and for 16 cases with tumors suspected preoperatively or peroperatively of being single Warthin's tumor, only enucleation was performed. No cases of recurrence were identified during the follow up period regardless of type of operation performed, however the postoperative complication rate was much higher in the parotidectomy group(33.3%) than in the enucleation only group(12.5%). We feel that an enucleation procedure may be appropriate for the patients with single Warthin's tumor.

무기하 액와 접근법을 이용한 로봇 갑상선 절제술: 단일 술자에 의한 최초 1년간의 경험

노재형,이정훈,나국영,이잔디,정웅윤<SUP>1<.SUP>,소의영,Jae Hyung Noh,Jeong Hun Lee,Kuk Young Na,Jandee Lee,Ph.D.,Woong Youn Chung Ph.D.<SUP>1 <.SUP>and Euy Young Soh,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

Purpose: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. Methods: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7). Conclusion: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy. (Korean J Endocrine Surg 2010;10:157-162)