세포검사 결과 여포성 종양으로 진단된 갑상선 결절에서 암의 위험성과 수술 후 소견

김은숙<SUP>1<,SUP>,남궁일성,공경엽<SUP>2<,SUP>,홍석준<SUP>3<,SUP>,김원배,송영기,Eun Sook Kim,M,D,<SUP>1<,SUP>,Il Sung Nam-Goong,M,D,Gyeongyub Gong,M,D,<SUP>2<,SUP>,Suck Joon Hong,M,D,<SUP>3<,SUP>,Won Bae Kim,M,D,and You 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: To assess the prevalence and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. Methods: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Results: Two hundreds and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12∼76). About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 Hürthle cell carcinomas, and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy such as male gender, large tumor size (>4 cm), or age of patients (>45 years), were not associated with increased risk. Diagnosis of Hürthle cell neoplasia on FNA was also not associated with increased risk. Only the extreme age of the patients (below 20 or above 60 years) was associated with increased risk for malignancy. Conclusion: By our hands, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics such as male gender, age, and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery without any further work up. (Korean J Endocrine Surg 2002;2:105-108)

원발성 부갑상선 기능항진증의 치료 경험

김경호,박종대,홍석준,Kyung Ho Kim,M.D.,Chong Dae Park,M.D. and Suck Joon Hong,M.D. 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.1

Purpose: The number of patients diagnosed with primary hyperparathyroidism has been increased owing to the routine biochemical screening of serum calcium since 1970's in the western countries as well as recently in Korea. However, the absolute number of surgically treated patients in Korea is still smaller than other developed countries in the incidence wise, and this could indicate the tendency of relatively late diagnosis and treatment of primary hyperparathyroidism in Korea. This study was performed to investigate the clinical character and post operative results of surgically treated Korean patients. Methods: 80 primary hyperparathyroidism patients surgically treated at Asan Medical Center from Jan 1996 to August 2002 were reviewed retrospectively. Results: The etiological proportion of the primary hyperparathyroidism (single adenoma 80%, hyperplasia or multiple adenoma 10%, MENI 9%, cancer 1%) was similar to the western countries. However, the proportion of the symptomatic patients (82%) to the asymptomatic patients (18%) was much higher compared to the recent data of western countries. 41 patients (single adenoma 36 case, hyperplasia 4 cases, cancer 1case) were followed up more than 3 months after surgery with monitoring the serum calcium and i-PTH. In 23 patients (44%), their i-PTH level was above normal range more than once during follow up period without hypercalcemia. The postoperative serum calcium level was lower and the preoperative i-PTH level was higher in these patients significantly compared to the patients with normal postoperative i-PTH level. The tumor size tended to be larger in these patients but statistically insignificant. These results suggest that these patients had more severe hyperparathyroidism. Conclusion: The proportion of the patients who were symptomatic and has persistent post operative high i-PTH level suggesting severe hyperparathyroidism was relatively high compared to the western countries. Earlier diagnosis and treatment is demanded in Korea. (Korean J Endocrine Surg 2003;3:1-6)

부신갈색종에 의한 Ectopic ACTH Syndrome ⁣증례 보고⁣

홍석준,김원배<SUP>1<.SUP>,Suck Joon Hong,M.D. and Won Bae Kim,M.D.<SUP>1<.SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

A 28-year old female was diagnosed preoperatively to have a pheochromocytoma producing ACTH at other hospital. However the operation was delayed due to poor general condition and abnormal liver function. She revealed severe hypercortisolism, hypokalemic metabolic alkalosis, glucose intolerance and showed rapid downhill course. She was transferred to our hospital for operation but septic complications were strarted already. She was not recovered in spite of desperate operation and died just after moribund discharge. ACTH producing pheochromocytoma is uncommon and literature review indicated high mortality rates due to improper preoperative diagnosis. Proper preoperative recognition and early surgical management is mandatory for better results. (Korean J Endocrine Surg 2002;2:116-119)

갑상선 수질암에서 예방적 측경부 림프절절제술의 범위

김연선,홍석준,Yon-Seon Kim,M.D. and Suck-Joon Hong,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.2

Purpose: The extent of prophylactic lateral neck lymph node dissection is very controversial in medullary thyroid cancer. This retrospective study was undertaken to evaluate the efficacy of prophylactic lateral neck lymph node dissection. Methods: A total of 29 patients underwent curative operation for medullary thyroid carcinoma at our institution. Of these 29 patients, 13 patients had prophylactic lateral neck dissection and 16 patients had non-prophylactic lateral neck dissection. Among 13 patients, one-compartment prophylactic lymph node dissection was performed in 10 patients and two-compartment prophylactic lymph node dissection was performed in 3 patients. Postoperative calcitonin level was evaluated between these groups. Results: A normalized calcitonin level was detected after surgery in 74% of patients without lateral neck lymph node metastases, and in 10% of patients with lateral neck lymph node metastases. In comparison of prophylactic node dissection group and non-prophylactic node dissection group, the rate of normalized calcitonin level after surgery is 100%, 66.7% in stage 1, 100%, 50% in stage 2, 0%, 80% in stage 3, 14.3%, 0% in stage 4. In the patients who one-compartment prophylactic lymph node dissection was performed, 40% of patients had positive lymph node metastasis, and 70% had persistent hypercalcitoninemia. However, there was no postoperative hypercalcitoninemia in the patients with two- compartment prophylactic lymph node dissection although lymph node metastasis was not identified with pathologic examination. Conclusion: Prophylactic lymph node dissection was more effective in the early stage of medullary thyroid carcinoma than late stage. The two or more compartment lymph node dissection is more effective than just one-compartment dissection for the normalization of serum calcitonin level. (Korean J Endocrine Surg 2004;4:85-89)

재발성 부갑상선암: 경부 재발의 검사 소견과 수술 소견의 불일치

성태연,윤종호,홍석준,Tae-Yon Sung,M.D.,Jong Ho Yoon,M.D. and Suck Joon Hong,M.D. 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.1

Parathyroid carcinoma is a rare malignancy presenting hyperparathyroidism. At times, diagnosis and localization are difficult. The optimum treatment for parathyroid carcinoma is en bloc resection when malignancy is highly suspicious or diagnosed. However, even after the adequate surgical treatment, persistent or recurrent disease is well encountered. Here we report a case with recurred parathyroid carcinoma presenting discrepancy between image findings and operative findings. (Korean J Endocrine Surg 2011;11:35-37)

제1형 다발성 내분비 선종의 임상양상

김연선,홍석준,Yon-Seon Kim,M.D. and Suck-Joon Hong,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.1

Purpose: Multiple endocrine neoplasia type I is rarely reported in Korea. The purpose of this study is to analyze the clinical features and the treatment of MEN1 which had been carried out in our institution. Methods: Eight patients underwent surgery for MEN1-related hyperparathyroidism, duodenopancreatic tumors and pituitary tumors at our institution and were reviewed retrospectively. Results: Of the eight patients, all patients had hyperparathyroidism. There were 5 total parathyroidectomy patients and 3 subtotal parathyroidectomy patients, none of them had persistent and recurrent hyperparathyroidism after operation. However, one of total parathyroidectomy patients had persistent hypoparathyroidism. Of the 8 patients, seven had duodenopancreatic tumors; four of them had pancreatic islet-cell tumors, two had malignant gastrinoma and one had Zollinger- Ellision syndrome. Pituitary tumors were observed in 6 patients among the 8; four of them had prolactinoma, and 2 had adenoma which was confirmed by magnetic resonance imaging. Of the eight patient, only one patient was confirmed to have another MEN1 family member and the mutation of MEN1 gene on chromosome 11q13 was proved on gene study.Conclusion: The clinical features of these patients were similar to those in other reports and the results of surgical treatment were relatively satisfactory. However, the detection of other MEN1 patients among the family members was relatively poor. Close follow up of family members and gene study will be required. (Korean J Endocrine Surg 2004;4: 31-35)