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장항석,장호진,Hang-Seok Chang,Hojin Chang 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.2
Thyroid cancer is an indolent condition that usually presents as a limited disease in the neck. Invasion to vital organs is rarely observed; however, it can be a major cause of mortality, even in well-differentiated thyroid cancers. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngo-tracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled invasion to vital organs in the neck and mediastinum can cause significant morbidity and affect quality of life and survival. Limited involvement of the aero-digestive tract can be controlled by conservative surgical treatments such as shaving-off procedures, while radical resection and subsequent reconstructive procedures are the best choice for more serious cases. In planning the treatment, the risk-benefit ratio should be carefully evaluated to reduce the morbidity, as well as achieve maximal therapeutic effects. Postoperative adjuvant therapies have been the subject of controversy, but there is a general consensus, especially for high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external beam radiation therapy are unclear, but it should be considered in patients with microscopic residual disease. In conclusion, radical eradication of lesions followed by proper adjuvant therapy is the treatment of choice for locally advanced thyroid cancers.
수술 전 이하선 종괴의 위치파악에 이용하는 해부학적 경계표의 유용도
임치영(Chi Young Lim),김국진(Kook Jin Kim),임성주(Sung Ju Lim),이잔디(Jan dee Lee),남기현(Kee Hyun Nam),장항석(Hang Seok Chang),정웅윤(Woong Youn Chung),최홍식(Hong Shik Choi),박정수(Cheong Soo Park) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1
Background: The location of parotid gland tumors can influence the duration and the difficulty of the operation. If the information about tumor location was available preoperatively, it would allow accurate operative planning and counseling of patients in terms of the length of the operation and the potential morbidity. Methods: This study was based on a retrospective review of 100 patients with parotid gland tumors underwent parotidectomy from January 2000 to October 2005 at Yong-Dong Severance Hospital. Based on computed tomographic(CT) scan findings, 4 landmarks such as facial nerve(FN) line, Utrecht(U) line, Conn's are(CA), and retromandibular vein (RV) were drawn on the scans in same plane. The location of tumors were determined by the landmarks and confirmed by the operative findings. The accuracy of each landmarks was evaluated. To find out the accuracies according to tumor size, the tumors were divided into 2 groups; less than 2 cm and larger than 2 cm in diameter. Results: U line was the most accurate(94%), sensitive(89.3%) and specific(97.7%) in predicting tumor location of the parotid gland. However, in small tumors less than 2cm, FN line (p=0.022) and RV criteria (p=0.028) were more reliable in accuracy. Conclusion: CA, FN line, U line, and RV are all useful landmarks in preoperative prediction for the location of parotid gland tumors. However, U line was the most accurate, but we must consider that proper landmark should be used in prediction according to the size of tumor because the accuracy of landmark may change.
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.
대한갑상선학회 갑상선결절 및 암 진료 권고안 - 외과의 관점
장항석 ( Hang-seok Chang ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2
Recent abrupt increasement of the incidence of thyroid cancers in the world and the social concern about this disease enhanced the publications of the treatment guidelines from the related academic societies in this field. As these guidelines primarily focus on the standardization of the managements for thyroid cancer patients, there can be innate limitations caused by the different socio-ecomomic status of each country and the different situation of each patients. However, the publication of these guidelines will be practically helpful for the patients as well as the clinicians who takes care of the whole process of the management of thyroid cancers. After 3 years from the first publication of the "Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancers" Korean Thyroid Association (KTA) revised its original version on the bases of recently increased scientific evidences. The most important foci of revisions are; The recommendation about the size of thyroid nodules which need practical evaluation with fine needle aspiration biopsy (FNAB), the decision making for the extent of surgery by the size of cancers and risk factors in thyroid cancer patients, and the introduction of 3-grade classification of risk groups of thyroid cancers and the precise pathological classification system of FNAB from recently published Bethesda system. In this article, I would like review the revised KTA management guidelines in the Surgeons' point of view.
유두상 갑상선암의 수술후 재발예측인자로서 혈청 Thyroid Peroxidase의 의의
장항석(Hang Seok Chang),나재웅(Jae Wung Na),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1
Background: Total thyroidectomy and postoperative radiodiodine ablation therapy in differentiated thyroid carcinomas enhance the reliability of serum thyroglobulin(Tg) levels and radioiodine scan in detecting recurrence or distant metastasis. There have been, however, some limitations in using these methods under certain conditions. Recently, several reports have indicated that thyroid peroxidase(TPO) could be used as an alternative tumor marker. We aimed to estimate the significance of serum TPO levels in differentiated thyroid carcinoma. Materials and Methods: Forty-eight patients who had undergone total thyroidectomy due to papillary thyroid carcinomas and who had been followed-up for at least 3 years were classified into two groups: 27 patients without any evidence of recurrence in group 1; and 20 patients with recurrence or distant metastasis in group 2. All patients were examined by radioiodine scans. Serum Tg, TSH, antithyroglobulin antibody, and TPO were measured and the relationships were statistically analyzed. The sensitivity and specificity of 131 I scan, serum Tg, and serum TPO were evaluated. Results: Serum Tg levels were 3.81±5.16ng/mL in group 1 and 147.02±193.75ng/mL in group 2. Only 2 patients in group 1 showed Tg levels exceeding 10ng/mL. In contrast, 4 patients in group 2 were under 10ng/mL. Serum antithyroglobulin antibody and TSH levels showed no statistical difference between the two groups. In group 1, 16 patients showed negative serum TPO results, and 4 patients in group 2 showed negative results. There was no correlation among serum Tg levels, antithyroglobulin antibody titers, and serum TPO levels in each group. In group 2, 4 patients with negative serum Tg levels showed positive TPO results and positive whole body scans. Two cases with false negative 131 I scans showed positive serum TPO and Tg results. In 4 cases showing false negative serum TPO levels, serum Tg levels and 131 I scans were positive. Conclusion: Serum Tg levels, radioiodine scans, and serum TPO levels can be clinically used as complementary methods in the diagnosis of recurrent or metastatic thyroid carcinomas. Serum TPO levels may be helpful when other methods fail to detect recurrences or distant metastasis in highly suspected patients.
장항석(Hang Seok Chang),윤종호(Jong Ho Yoon),정웅윤(Woong Youn Chung),이미경(Mi Kyung Lee),박정수(Cheong Soo Park) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2
The clinical and pathological features of 35 cases of anaplastic thyroid cancer were studied. These tumors occurred in 12 men and 23 women ranging in age from 19 to 83 years(mean age; 61.7 years). A rapidly enlarging thyroid mass was the most common presentation. The duration of the presence of mass varied from 20 days to 12 months with an average of 2.7 months. Systemic metastasis at the time of initial examination was found in 14 patients(40.0%) and the lung was the most common site of involvement. The overall rate of distant metastasis was about 65.7%. The tumors were subdivided morphologically into giant cell type of 10 cases, spindle cell type of 7 cases, epidermoid cell type of 1 cases, and mixed giant cell and spindle cell type of 5 cases. The mean survival period of 6 among 35 patients who had biopsy alone was 1.4 months. The 22 patients underwent the incomplete combined treatment modalities (palliative surgery with or without chemotherpy or radiation therapy) survived for a mean period of 3.0 months, among them, 7 patients who had surgery combined with chemotherapy and radiation therapy showed mean survival period of 3.7 months. The mean survival of 7 patients who had complete combined treatment modality(curative surgery combined with chemotherapy and hyperfractionated radiation therapy) was 6.6 months, only one patient survived for 21 months and one patient has been alive for 1 month after operation, and the others survived for a mean period of 4.8 months. So far, as of July 31, 1998, 34 patients among 35 were died(one has been survived for 1 month) despite the various treatment modalities, and the main cause of death were failure of local control and systemic metastasis. None of the various treatment modalities gave consistently favourable results. However, a combination of surgery, radiation therapy and chemotherapy seemed to have a slight positive effect on survival. Furthermore, the aggressive treatment modalities will be indicated only in the early diagnosed and minimal cases.