뇌 전이 분화 갑상선암

이잔디(Jan dee Lee),윤종호(Jong Ho Yoon),장항석(Hang Seok Chang),박정수(Cheong Soo Park) 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.1

Background and Objectives: Brain metastasis from well-differentiated thyroid carcinoma is uncommon, and the treatment remains controversial. In this study, we analyzed cases of brain metastasis from well differentiated thyroid carcinoma to determine optimal treatment. Material and Methods: From March 1986 to May 2003, we experienced 13 cases of brain metastases from well-differentiated thyroid carcinomas. There were 6 men and 7 women with a mean age of 62.3 years. The time interval detecting the brain metastasis, treatment methods, outcomes, and the prognostic factors were analyzed. Results: In 11 patients, brain metastasis was found at a mean of 96 months after thyroid surgery (range, 1-204months). In 1 patient, brain metastasis was found simultaneously with the thyroid cancer. In the remaining one, brain metastasis was presented as the first sign. Treatment included gamma knife therapy in 2, external radiation therapy (ExRT) in 2, resection and ExRT in 2, gamma knife therapy and ExRT in 2 and intracranial holmium injection in 1. Three patients received no treatment. The mean survival was 20.5months (1-119 months). Only 2 patients with early detection remained alive after treatment (23months and 119months). The age, sex, primary tumor size, combined organs of distant metastasis and treatment methods did not affect the prognosis. There were noticeable symptomatic improvements in patients who received any kind of treatment for brain metastasis. Conclusion: Early detection and treatment of brain metastasis appears to bring symptomatic relief and improve survival. Therefore, early screening for brain metastasis is recommended for patients with symptoms. However, further study is needed to determine the optimal method of treatment.

갑상선 수술시 발견된 비회귀성 후두신경 ; 유형, 동반 혈관 이상, 신경 손상 예방에 대한 고찰

이잔디(Jan dee Lee),남기현(Kee Hyun Nam),임치영(Chi Young Lim),윤지섭(Ji Sup Yun),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park),장항석(Hang Seok Chang) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Purpose: The nonrecurrent laryngeal nerve(NRLN) is a rare anomaly that is associated with the developmentally aberrant subclavian artery. Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for RLN represents a major surgical risk. Three course variations of right NRLN can be distinguished: descending(type I) , horizontal(type II), ascending(type III). This study is performed to characterize the variations of NRLN, associated vascular anomaly, and proper surgical methods for preventing nerve damage. Materials and Methods: Between January 1998 and March 2006 3,381 thyroidectomy were performed at our institution, and during these operations a nonrecurrent laryngeal nerve was observed in 13 cases (0.38%). There were 1 men and 12 women with a median age of 48 years(range 28-57). All of them are identified on the right side. Results: In all cases, there were no clinical symptoms observed preoperatively. The nerve anomaly was diagnosed preoperatively in only one case. There were type I variations of right RLN in 2 cases and type II variations in 11 cases. The retroesophageal aberrant right subcalvian artery; no innominate(brachiocephalic) artery was found and the right common carotic artery was arising directly from the aortic arch, was seen in 12 cases. A vocal cord palaysis caused by NRLN damage during operation was observed in one patient(7.6%) , where the nerve was close to the superior thyroid artery. No other complications were noted. Conclusion: It can be possible to predict NRLN from signs associated with the vascular anomaly; clinical symptoms or imaging studies. When an vascular anomaly is not detected preoperatively, overlooking possibility of NRLN may lead to severe operative morbidity. Hence, It is most important to identify all the thyroid structures carefully during thyroid surgery and to be aware of the possibility of anatomic variations of RLN.

중증 근무력증과 동반된 유두상 갑상선암 2예

임치영(Chi Young Lim),이잔디(Jan Dee Lee),남기현(Kee Hyun Nam),장항석(Hang Seok Jang),김혜령(Hae ryoung Kim),박정수(Cheong Soo Park) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.1

Myasthenia gravis with thymoma is associated with an increased risk of second malignancy, but concurrence of myasthenia gravis and thyroid carcinoma is rarely seen. In the treatment, it is emphasized to operate in two stage to avoid myasthenic crisis after surgery. In general, a thyroid cancer surgery is performed after controlling yasthenia gravis by means of thymectomy or medical treatment with steroids and anticholine esterase. We experienced two cases of thyroid carcinoma coexisting with myasthenia gravis, which is thought to be true first report in Korea.

경부의 주정맥 침범과 암성 혈전을 보인 여포상 갑상선암 2예

임준섭(Jun Sup Lim),이잔디(Jan dee Lee),윤지섭(Ji Sup Yun),임치영(Chi Young Lim),남기현(Kee Hyun Nam),장항석(Hang Seok Chang),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Differentiated thyroid carcinomas are rarely associated with macroscopic vascular invasion and intraluminal tumor thrombus in great cervical veins. The best treatment for such cases appears to be a total thyroidectomy with en-block resection of the involved vessels, followed by postoperative radioiodine therapy(RI). We report two cases of follicular thyroid carcinoma with vascular invasion and intraluminal tumor thrombosis in great cervical veins that were successfully treated using complete surgical resection and postoperative RI.

유두상 갑상선암의 피부전이 1예

임치영(Chi Young Lim),이잔디(Jan dee Lee),남기현(Kee Hyun Nam),권지은(Ji Eun Kwhan),장항석(Hang Seok Chang),정웅윤(Woong Yoon Chung),박정수(Cheong Soo Park) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.2

Skin metastasis from papillary thyroid carcinoma is extremely rare. Due to similar histopathologic features, it is difficult to differentiate skin metastatic papillary thyroid carcinoma and some primary skin neoplasms without a clinical history. However, most of metastatic skin lesions showed a strong reactivity to the antithyroglobulin antibodies unlike primary skin neoplasms. Metastatic skin lesions must be completely removed and radiotherapy can be added. Investigators reported that prognosis of skin metastases from thyroid carcinoma is dismal and the average survival after it's diagnosis was only 19 months because distant metastases were often discovered at diagnosis of skin metastasis or during follow-up period. We report a case of skin metastasis from tall cell variant of papillary thyroid carcinoma. In our case, the anti thyroglobulin antibodies measured from cystic fluid from a skin lesion was more than 2000 IU/ml. Skin metastasis was diagnosed at 20 months after primary surgery for thyroid cancer and brain metastasis at 12 months after diagnosis of skin metastasis. Although skin metastasis is an ominous prognostic indicator in patients with thyroid carcinoma, a radical treatment for skin lesions and early diagnosis of distant metastasis could provide a chance to the patients to improve their survival.

갑상선 유두암 환자의 전절제술 후 부갑상선 기능 저하증의 위험 인자

성지영(Ji Young Seong),이초록(Cho Rok Lee),김민지(Min Jhi Kim),김태형(Tae Hyung Kim),이슬기(Seul Gi Lee),최정범(Jung Bum Choi),반은정(Eun Jeong Ban),강상욱(Sang Wook Kang),이잔디(Jan Dee Lee),정종주(Jong Ju Jeong),남기현(Kee Hyun Nam 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.3

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and predisposing risk factors for postoperative permanent hypocalcemia after total thyroidectomy. Methods: There were 1,247 consecutive patients undergoing total thyroidectomy and complete treatment and observation for differentiated thyroid cancer between January 2012 to December 2012 who were enrolled in this study. Patients were divided into two groups, those remaining normalcalcemic (Group I-824 pts) and those who had hypocalcemia requiring treatment (Groups II-423 pts). Group II was subdivided into a transient hypocalcemic group (Group IIA-409 pts) and a permanent hypocalcemic group (Group IIB-14 pts). Results: Female gender, thyroiditis, preserved parathyroid number, lateral lymph node metastasis, RAI treatment, preoperative parathyroid hormone and preoperative vitamin D were significantly associated with the development of postoperative hypocalcemia by multivariate analysis. Comparing patients with transient versus permanent hypocalcemia, tumor size and multiplicity were significantly related to the development of permanent hypocalcemia by multivariate analysis. RAI treatment and parathyroid hormone level on the postoperative third day were significantly related to recovery from transient hypocalcemia to normo-calcemia. Conclusion: Risk factors of postoperative hypocalcemia were associated with preoperative patient factors and advanced thyroid cancer. Advanced thyroid cancer was a risk factor for permanent hypocalcemia. To prevent postoperative hypocalcemia, we should focus on patient condition and need to preserve parathyroid gland more carefully in thyroid surgery.

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.

악하선 암의 치료성적과 예후인자

임치영(Chi Young Lim),남기현(Kee Hyun Nam),이잔디(Jan Dee Lee),장항석(Hang Seok Chang),정웅윤(Woong Youn Chung),차인호(In Ho Cha),이창걸(Chang Geol Lee),최은창(Eun Chan Choi),박정수(Cheong Soo Park) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.2

Purpose: Submandibular gland tumor is rare, less than 6% of head and neck tumor. The purpose of this article is to analysis the clinical experience and treatment outcomes of malignant submandibular gland tumor, suggesting a guideline of management. Methods: We retrospectively evaluated 26 patients who underwent operation for malignant submandibular gland tumor at Severence hospital between 1986 and 2004. Statistical analysis was performed by Kaplan-Meier method, log rank test, Chi-square test, Fisher's exact test using SPSS v12.0 for Windows. Results: They consisted of 18 males and 8 females whose median age was 47 years(range: 20-71). 10 cases of adenocystic carcinoma, 8 cases of carcinoma ex pleomorphic adenoma, 4 cases of mucoepidermoid carcinoma, 1 case each for acinic cell carcinoma, undifferentiated carcinoma, adeno carcinoma, epithelioid hemangioendothelioma. Sialoadenectomy only was performed in 10 cases(36.5%) and sialoadenectomy with neck node dissection was performed in 16 cases(63.5%). Adjuvant radiotherapy was done in 22 cases(84.6%). 10 year disease free survival rate for malignant submandibular gland tumor was 63.1 % and 10 year overall survival rate for malignant submandibular gland tumor was 70.1%. In univariate analysis, prognostic factors affecting recurrence of malignant submandibular gland tumor was initially papable lateral neck node in physical examination and metastasis of lateral neck node in pathologic confirmation. The prognostic factors affecting survival of malignant submandibular gland tumor was tumor size, TNM stage, recurrence and type of recurrence. Conclusion: In this study, prognostic factors affecting recurrence of malignant submandibular gland tumor was initially papable lateral neck node in physical examination and metastasis of lateral neck node in pathologic confirmation. The prognostic factors affecting survival of malignant submandibular gland tumor was tumor size, TNM stage, recurrence and type of recurrence. To prevent recurrence and to improve survival, early diagnosis and aggressive surgery must be considered.

경부와 종격동에 발생한 캐슬만씨 병(Castleman's Disease)

남기현(Kee Hyun Nan),김승일(Seung Il Kim),이잔디(Jan dee Lee),임치영(Chi Young Lim),최현호(Hyun Ho Choi),홍순원(Soon Won Hong),박정수(Cheong Soo Park),장항석(Hang Seok Chang) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.1

Objectives: Castleman's disease(CD) is a lymphoproliferative disorder of unknown etiology. To elucidate the clinicopathologic characteristics of CD, we retrospectively reviewed our experience. Methods: Fifteen patients with CD of the neck and mediastinum were identified. Patients were divided into two groups: group I had an unicentric CD and group II had multicentric CD. The histology of CD was divided into 3 subtypes: hyaline-vascular(HV), plasma cell(PC), and mixed. Results: The study included 12 cases of group I, 3 cases of group II in the clinical aspect and 10 cases with HV, 3 cases with PC, 2 cases with mixed type in the histologic aspect. Of group I patients who underwent complete surgical excision, all are currently free of disease. The clinical course of group II patients was variable. Of two patients with multicentric plasma cell CD who were treated, one remain free from disease and the other had a local recurrence in the neck. One patient with multicentric mixed CD died of disease after 30 months of presentation. Conclusion: Surgical resection is recommend for patients with the unicentric CD, regardless of histologic subtype. Patients with multicentric disease do not benefit from surgical resection and should be candidates for multimodality therapy.