갑상선암 동반 가능성을 고려한 하시모토 갑상선염의 수술 적응증

최성림,유봉옥,김인수<SUP>1<,SUP>,김윤규<SUP>1<,SUP>,Sung Lim Choi,M,D,Bong Ok Yoo,M,D,In Soo Kim,M,D,<SUP>1<,SUP> and Yoon Kyoo Kim,M,D,<SUP>1<,SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1

Purpose: This study was performed to further refine the indications for operative treatment of patients with Hashimoto's thyroiditis, and also to present the better histopathologic diagnosis method for Hashimoto's thyroiditis. Methods: The authors evaluated retrospectively 130 patients with surgically proven Hashimoto's thyroiditis at presbyterian medical center in Chonju and Yonsei hospital in Masan from Jan. 1995 to Feb. 2002. Results: The sensitivity of gun biopsy for the diagnosis of Hashimoto's thyroiditis was significantly higher than the one of fine needle aspiration (83.3% vs 46..2%, P<0.001). There were 26 cases (13.8%) of coexistent carcinoma of 130 patients. The incidence of carcinoma in men (6 in 9, 66.6%) was significantly higher than in women (20 in 121, 16.5%, P<0.05). The incidence of carcinoma in antithyroglobulin antibody negative group (8 in 10, 80%) was significantly higher than in antibody positive guoup (16 in 111, 14.4%, P<0.001). There was no significant difference in the incidence of carcinoma between positive and negative lymphadenopathy groups (22.6% vs 20.0%, P=0.681). As for ultrasonographic findings, patients with irregular-marginated dominant nodule or calcification had significantly higher incidence of carcinoma than those without so findings had (P<0.001). As for the distribution patterns of lymphocytes infiltration, the incidence of carcinoma in nodular or localized pattern groups is significantly higher than in diffuse group (24.5% vs 8.3%, P<0.05). Conclusion: For histopathologic diagnosis of Hashimoto's thyroiditis, gun biopsy is more sensitive than fine needle aspiration. And the incidence of concurrent carcinoma in patients with Hashimoto's thyroiditis is increased under the circumstances as follows: men, negative antithyroglobulin antibody results on serologic test, ultrasonographic findings such as irregular-marginated dominant nodule, increased vascularity or calcification, and nodular or localized patterns of lymphocytes infiltration on histopathologic examination. (Korean J Endocrine Surg 2002;2:10-14)

갑상선 여포암의 조직학적 침범 정도와 예후

이종근,박영삼,김철승,유봉옥,Jong Geun Lee,Young Sam Park,Cheol Seung Kim and Bong Ok Yoo 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.2

Purpose: Follicular thyroid carcinoma (FTC) is the second most common malignancy of the thyroid after papillary thyroid carcinoma, constituting about 10% of all thyroid malignancies. The objective of the current investigation was to determine whether there was a direct relationship between the histologic degree of invasion, tumor recurrence, and patient survival. Methods: We retrospectively reviewed the records of 55 patients with a histologic diagnosis of pure follicular carcinoma of the thyroid who were treated from 1990 to 2003 at the Presbyterian Medical Center in Jeonju, Korea. Their mean follow-up period was 8.4 years (range, 1∼15 years). The following criteria were used to histologically define malignant follicular neoplasms: 1) minimally invasive, tumor invasion through the entire thickness of the tumor capsule; 2) moderately invasive, tumor with angioinvasion (with or without capsular invasion); and 3) widely invasive, broad area or areas of transcapsular invasion of thyroid and extrathyroid tissue. Results: Among 33 patients with capsular invasion only, 2 patients (6%) developed recurrent disease. Of the 16 patients who had angioinvasion with or without capsular invasion, 4 patients (25%) developed recurrent disease. Among 6 patients who had widely invasive FTC, 5 patients (83%) developed recurrent disease, and 2 of those 6 patients (33%) with widely invasive FTC died of the disease. Patients who had widely invasive FTC had greater recurrence rates than patients who had a capsular or angioinvasion (P<0.001). The overall death rate for patients with widely invasive FTC was 33%. Conclusion: This study shows that patients with widely invasive FTC had greater recurrence rates and poorer survival than patients who had capsular or angioinvasion; this difference was statistically significant. The authors conclude that patients who had widely invasive FTC need close follow-up and active treatment. (Korean J Endocrine Surg 2006;6:94-97)

喉頭 類表皮癌

박윤규(Yoon Kyu Park),유봉옥(Bong Ok Yoo),설대위(David J Seel),이영식(young Sik Lee),천경두(Kyung Doo Chun) 대한두경부종양학회 1987 대한두경부 종양학회지 Vol.3 No.1

This study is limited to epidermoid carcinoma arising in the larynx. The 623 patients in this series comprised 1.6% of all malignant neoplasms seen during the 20 -year period .from 196.5 to 1984; it comprised 13.2% of all cancers of the head and neck registered during this period. The male: female ratio was 11: 1, and the highest incidence was in the fifth decade of life. Analysis by anatomical site revealed that 51.7% were supraglottic, 36.1% glottic, and 6.8% subglottic in oriain. One - hundred eighty - nine(79%) were clinically Stage III or Stage IV lesions at the time of the first visit. Of the total of 263 cases, 113 refused treatment, 4 definite radiation for T1 lesion, 21 underwent palliative therapy only, and 125 underwent surgical management with int- ent to cure. This surgical category included 53 patients who had surgical treatment only and 72 who underwent combined therapy (preoperative radiation, postoperative radiation, or inductive chemotherapy followed by surgery and postoperative radiation). The surgical management vari- ed from partial laryngectomy to widefield laryngectomy and ipsilateral neck dissection. In 14.4% pathologically positive node or nodes were found in the clinically negative contralateral neck nedes. Such contralateral spread was most common in supraglottic site of origin (22.2%). Combined modality of management was compared to single therapy. Although results at three years showed no difference in determinate disease - free survival between patients treated by surgery only and those treated by surgery followed by postoperative radiation therapy. at 5 years a statistically significant difference emerged, only 36% of those receiving surgery alone surviving as compared to 65.4% in the surgery with radiation group.

CANCER OF THE NASAL FOSSAE

설대위(David J Seel),유봉옥(Bong Ok Yoo),박윤규(Yoon Kyu Park) 대한두경부종양학회 1986 대한두경부 종양학회지 Vol.2 No.1

Nasal fossae의 암이란 비강과 부비동들에서 발생하는 것으로서 환자를 가장 괴롭히며 또한 가장 믿을수 없는 악성종양들중의 하나이다. 비록 본 예수병원 암환자등록부에 의하면 전 암환자의 2.2% 발생빈도로서 주요한 발생빈도를 보이지는 않지만, 이 부위의 암을 치유하는데는 세심하고 철저한 모든 진단적 검사와 과감한 외과 및 치료방사선의 병합치료가 요구된다. 저자들은 지난 22년간 비강 및 부비동(Nasal fossae)에서 발생한 원발성 악성종양중 지유목적의 근치수술을 시행한 68 예를 임상고찰 하였다. 근치수술을 시행했던 68예중 91%에서 제 3 병기 또는 4 병기의 진행된 경우 이었다. 외과적 수술은 한예의 사골동(篩骨洞)종양적출술 및 부분上顎洞절제술 한예를 제외한 66예 모두에서 全上顎洞절제술 (total maxillectomy ) 또는 확장 全上顎洞절제술(extended total maxillectomy) 을 시행하였다. 저자들은 疫學的, 病理學的, 病期및 치료, 재발율과 생존율들을 분석 고찰하였으며 3까지 치료형태를 서로 비교하였다. 즉 수술만 시행한 군, 수술전 방사선 치료 및 수술병합군, 수술과 수술후 방사선치료 병합 군으로 나눴다. 저자들의 예비적(preliminary) 관찰 결과는 2 년간 무병생존율(disease-free 2-year survival )만을 볼때, 수술만 시행한 군에서 40%로써 통계학적으로는 가장 좋았으나 실제는 수술만 시행한 군에서는 단지 40%만이 제 4 病期의 진행된 경우였으나 수술전 방사선치료 또는 수술후 방사선 치료등의 병합치료에서는 제 4 病期의 진행된 상태가 무려 60%나 되었다. 전체적 인 재발율(Overall recurrence rate) 은 68.2%로써 무서울 정도로 높았으며 전체적인 2년 무병율은 23.7%였다. 저자들은 이 분야에서 실패의 원인분석과 치료방법의 선택등에 대한 지침을 제시하고저 한다.

1 ㎝ 이하 갑상선 결절의 임상적 고찰

우종기(Chong Kee Woo),유봉옥(Bong Ok Yoo),김세중(Sei Joong Kim),안승익(Seung Ik Ahn),홍기천(Kee Chun Hong),신석환(Seok Hwan Shin),우제홍(Ze Hong Woo) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.56 No.2

외상성 십이지장 창상

추교운(Kyo-Woon Choo),유봉옥(Bong-ok Yoo),정을삼(Eul-Sam Chung) 대한외과학회 1992 Annals of Surgical Treatment and Research Vol.43 No.2

頭頸部 領域의 原發病巢 不明癌

박윤규(Yoon Kyu Park),김창수(Chang Soo Kim),유봉옥(Bong Ok Yoo),정을삼(Eul Sam Chung),설대위(David J Seel) 대한두경부종양학회 1986 대한두경부 종양학회지 Vol.2 No.1

During the past 14years 267 patients presented with a lump in the neck proven to be metastatic cancer histologically. In most cases the primary site was discovered by thorough physical examination, E.U.A.(examination under anesthesia) and radiodiagnostic studies. However in 31 cases complete diagnostic evaluation failed to reveal the primary site. This paper discusses the characteristics of this group of patients in terms of the frequency of the ultimately discovered primary sites, policies for diagnosis, methods of management, and the ultimate prognosis for such cases in Korea. The male: female ratio was 6.8: 1 and 84% of all cases occurred in the 51∼70 age group. The majority of these cancers were epidermoid carcinomas(67.7%) and 22 of the 31(71%) were Stage IV lesinos(17 N3A lesions and 5 N3B lesions). Surgical management was employed in 7 cases only, and in 5 cases this was combined with rediotherapy, chemotherapy, or both. Nevertheless, the only patients who survived disease free for two years or more (one for over 5 years) were two patients in this management group. None of the patients treated by radiotherapy or chemotherapy of a combination of these two modalities survived. Occult primary sites were eventually discovered in 5 of the 31 cases, two in the nasopharynx, and one each in the base of tongue, pyrifrom sinus, middle ear. Of the 21 cases with epidermoid carcinoma which presented in the neck, 2 are free of disease for 3years or more. Of those who underwent radical surgery two of five survived. This study thus confirms the principle enunciated by MacComb in 1972 that surgical treatment in the form of radical neck dissection is the cornerstone of management whenever feasible.

남성 다유두증

김태균(Tae-Kyoon Kim),박영삼(Young Sam Park),김철승(Chul Sung Kim),유봉옥(Bong Ok Yoo) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.70 No.2

외상성 십이지장 창상

추교운,유봉옥,정을삼 예수병원 1992 예수병원학술지 Vol.13 No.-