Insular Component가 공존한 고분화 갑상선암

정웅윤(Woong Yoon Chung),심정연(Jeong Yun Shim),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1

We have experienced 5 cases of unusual well differentiated thyroid carcinoma with insular component during the past 5 years. 4 cases were presented with cervical masses but I case (patient 2.) was initiallty with lung and brain metastasis. The tumors from 4 cases showed invasive growths but that of 1 cases(patient 1.) showed intrathyroidal. Total thyroidectomy and cervical lymphnode dissection(CCND or RND) was performed in 4 cases but only RND was performed in spite of mediastinal metastasis of the tumor in patient 5 under the patient's choice. During the follow-up period, we also performed radical nephrectomy and metastatectomy for the kidney and iliac bone metastasis respectively, in patint 2. Microcsopically, the tumors showed the insular growth patterns, focally(less than 50%) in 3 cases and predominantly(more than 75%) in 2 cases. And the insular componentas were combined with papillary carcinoma in 2 cases and follicular carcinoma in 3 cases. Cervical lymphnode metastases were confirmed in 4 cases. Patient 2 died of disease with metastases to lung, brain, bone and kidney, 52 months after initial therapy. Patient 1, 3 and 4 are alive and have no recurrence and distant metastasis. Patient 5 is also alive with the mediastinal metastasis. In our experience, the well differentiated thyroid carcinomas with insular component showed characteristic histologic features, aggressive behavior in initial presentation and unfavorable prognosis regardless of the percentage of the insular component.

기능성 부갑상선암

조은철,정웅윤,김호근<SUP>1<,SUP>,박정수,Eun Chol Cho,Woong Yun Chung,Hogeun Kim,<SUP>1<,SUP> and Cheong Soo Park 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

중앙 경부 재발 유두 갑상선암으로 수술한 환자의 재발 양상과 수술 합병증

윤지섭(Ji-Sup Yun),이용상(Yong Sang Lee),정종주(Jong Joo Jung),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1

Purpose: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. Methods: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12∼78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. Results: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. Conclusion: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.

갑상선 유두암의 암성 혈전으로 인한 상공 정맥 증후군 1예

윤지섭(Ji-Sup Yun),이잔디(Jandee Lee),임치영(Chi-Young Lim),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Papillary thyroid carcinoma is rarely associated with macroscopic vascular invasion or tumor thrombosis. Especially, superior vena cava syndrome(SVCS) resulted from tumor thrombosis of papillary thyroid car-cinoma is extremely rare. We present herein a case of SVCS caused by tumor thrombosis from papillary thyroid carcinoma which was successfully solved by intravascular placement of self-expandable stent in 74-year-old woman.

유두 미세 갑상선암

이잔디(Jandee Lee),윤지섭(Ji Sup Yun),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),소의영(Euy-Young Soh),박정수(Cheong Soo Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.4

Purpose: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. Methods: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 ㎝ in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 ㎝ in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). Results: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12∼86). During a mean follow-up of 32.5±18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P<0.001), invasion to adjacent structures (P<0.001), and lateral neck node metastasis (P<0.001) than that of group A. However, there were no significant differences in multifocality (P=0.189), bilaterality (P=0.203), the locoregional recurrence rate (P=0.065) and the distant metastasis rate (P=0.325) between the two groups. On multivariate analysis, locoregional recurrent disease was associated with central lymph node metastases (P=0.033) and lateral neck node metastases (P=0.022). Conclusion: Despite PTMC having less aggressive clinicopathologic parameters as compared with clinical cancer (>1 ㎝), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.

갑상선 전절제술 후 저칼슘혈증

남기현(Kee-Hyun Nam),윤지섭(Ji-Sup Yun),이용상(Yong Sang Lee),정종주(Jong Ju Jeong),장항석(Hang-Seok Chang),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and risk factors for postoperative hypocalcemia after total thyroidectomy. Methods: There were 196 consecutive patients undergoing total thyroidectomy for thyroid cancer between September 2004 and February 2005 who were enrolled in this study. Patients were divided into two groups, those remaining normocalcemic (Group Ⅰ) and those who had hypocalcemia requiring treatment (Group Ⅱ). Group Ⅱ was subdivided into a transient hypocalcemic group (Group ⅡA) and a permanent hypocalcemic group (Group ⅡB). All groups were compared with regard to age, gender, histology, coexisting disease, T stage, bilateral lesions, primary total thyroidectomy versus secondary completion thyroidectomy, extent of lymph node dissection, and autotransplantation of the parathyroid gland. Results: Among all patients, 139 (71%) were in Group I, 54 (27.5%) in Group ⅡA and 3 (1.5%) in Group ⅡB. On the multivariate analysis for risk factors compared between Group Ⅰ and Group Ⅱ, the T4 stage was the most significant for the development of postoperative hypocalcemia. On the univariate analysis comparing factors between Group ⅡA and Group ⅡB, the T4 stage and a complete thyroidectomy were significantly related to the development of permanent hypocalcemia. Conclusion: The results of this study showed that the incidence of transient hypocalcemia, after total thyroidectomy, was 27.5%, while permanent hypocalcemia was detected in 1.5% of cases. The parathyroid glands should be preserved more carefully to avoid postoperative hypocalcemia in patients with high risk factors including T4 tumors and complete thyroidectomy procedures.

측경부 림프절 청소술을 요하는 갑상선암 환자에서 척수부신경 상측 림프절 청소술이 필요한가?

성태연,윤지섭,정종주,이용상,남기현,정웅윤,장항석,박정수,Tae Yon Sung,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Kee-Hyun Nam,M,D,Woong Youn Chung,M,D,Hang Seok Chang,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2

Purpose: Controversy still exists concerning the extent of neck nodedissection in thyroid carcinoma patients. A modified neck dissection is usually performed for the treatment of thyroid carcinoma patients with positive lateral neck nodes. When performing a neck dissection, removal of the nodes superior to the spinal accessory nerve (level IIB) is difficult and time consuming. This study was performed to determine whether level IIB node dissection is always necessary in therapeutic neck dissection for metastatic papillary thyroid carcinoma. Methods: A total of 200 neck dissections were performed in 175 papillary thyroid carcinoma patients with positive lateral neck nodes between September 2005 and June 2007. The patterns of lateral neck metastasis were analyzed with respect to neck level, but the level IIB nodes were studied as separate specimens. Potential factors predicting level IIB node metastasis were also evaluated. Results: The most common site of metastasis was level III, showing 95.0% (190/200), followed by level IV 66.0% (132/200), level IIA 54.0% (108/200), and level V 15.5% (31/200). Level IIB metastases were seen in 12 necks (6.0%) and seen only in the necks with positive level IIA nodes. In 11 of the 12 necks, the primary tumors were located in the upper pole of the thyroid. Conclusion: Level IIB node dissection is not necessary when there is no level IIA metastasis. Even when there is level IIA metastasis, level IIB node dissection is not always necessary, unlessthe primary tumors are located in the upper pole of the thyroid. (Korean J Endocrine Surg 2007;7:88-93)

성인에서 발생한 갑상선 농양 1예

한윤대,이용상,윤지섭,정종주,남기현,장항석,정웅윤,박정수,Yoon Dae Han,M,D,Yong Sang Lee,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3

It is well known that the thyroid gland is resistant to infection due to its anatomic and physiological characteristics. Thyroid abscess in an adult is extremely rare. It is more commonly found in children than in adults. The treatment goal of this disease is to eliminate the source of infection by incision and drainage, or by a thyroidectomy and administration of antibiotics, depending on the clinical findings.We report a case of thyroid abscess found in a 29-year-old woman. The patient presented with a painful mass in the left thyroid for 6 days duration. The patient had a history of subacute thyroiditis that was treated with steroidsand thyroid hormone. Computed tomography showed a large, fluid contained, cystic predominant mass in the left thyroid. Aspiration of the cystic fluid confirmed the presence of the thyroid abscess. Under local anesthesia, an incision and drainage was performed. The patient improved dramatically after surgery and the patient was discharged 8 days later. (Korean J Endocrine Surg 2007;7:161-163)

척추 전이가 최초 증상으로 발현된 분화 갑상선암 2예

김국진,이잔디,윤지섭,임치영,남기현,장항석,정웅윤,박정수,Kuk-Jin Kim,M,D,Jandee Lee,M,D,Ji Sup Yun,M,D,Chi-Young Lim,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.1

Bone metastases as the first manifestation of thyroid carci- noma are extremely rare. Interestingly, evaluation at appropriate initials and proper treatment will lead to satisfactory long-term survival. We report here on two such cases; the patients presented with back pain and fine needle aspiration cytology of spine lesion revealed a metastatic carcinoma. A wide excision of the bone lesion was carried out and the histopathology was consistent with features of metastatic carcinoma of the thyroid. The management of thyroid carcinoma and the subsequent bone metastases is reviewed and the controversial points are highlighted. (Korean J Endocrine Surg 2006;6:46-49)

유두 갑상선암의 액와 림프절 전이 1예

이용상,정종주,윤지섭,남기현,장항석,정웅윤,박정수,Yong Sang Lee,M.D.,Jong Ju Jeong,M.D.,Ji-Sup Yun,M.D.,Kee-Hyun Nam,M.D.,Hang Seok Chang,M.D.,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3

Although breast carcinoma has a predilection for metastasis to auxiliarylymph nodes, auxiliary nodal metastasis from papillary thyroid carcinoma is extremely rare, and to our knowledge, only 6 cases have been reported worldwide. Here, we report an extremely rare case of auxiliary lymph node metastasis from papillary thyroid carcinoma. A 41-year-old woman presented with palpable masses in her left axilla. Fourteen years previously, she had presented with a 3.0-cm sized mass in the left supraclavicular fossa, which was found to be metastatic papillary thyroid. At that time, she underwent a total thyroidectomy along with a left modified radical neck dissection. Histopathologic examination at that time revealed the presence two papillary microcarcinoma of the thyroid and multiple metastatic nodes in the left lateral neck (5 of 32, T1N1bM0). Following her recent presentation, imaging studies, including magnetic resonance imaging and positron emission tomography, revealed the presence of a small metastatic focus in the left upper lung and multiple metastatic nodes in the left auxiliaryregion. She underwent a wedge resection of the lung mass and a left radical auxiliarylymph node dissection. Histopathologic findings confirmed that both lesions were metastatic poorly differentiated papillary thyroid carcinomas. (Korean J Endocrine Surg 2007;7:168-172)