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Successful Management of Chyle Leakage Using Thoracic Duct Embolization: A Case Report
Yi Ju Hyeon,Jeong Ho Jung,Lee Jin Seok,Yun Hyeok Jun,Lee Yong Sang,Chang Hang-Seok 대한내분비외과학회 2024 The Koreran journal of Endocrine Surgery Vol.24 No.1
Chyle leakage (CL) is a rare complication of thyroidectomy. Most patients respond to conservative management, whereas some require surgical intervention. In this report, we discuss the case of a 67-year-old male patient diagnosed with papillary thyroid cancer, who underwent bilateral total thyroidectomy with central compartment neck dissection and left lateral neck dissection. Five days after surgery, the patient developed neck swelling. Despite conservative management with daily aspiration, there was no improvement and dyspnea recurred. Thoracic duct embolization (TDE) was performed by lymphangiography. Consequently, the CL improved. There are various treatments, ranging from conservative treatment to surgical treatment, but there is no consensus on the appropriate management of CL. The patient received only conservative treatment for the low-output chyle leak; however, there was no response. TDE has been reported to have a high success rate for treating CL. TDE is an effective nonsurgical intervention for CL after thyroid surgery.
Kang Il Ku,Jung Chan Kwon,Kim Kwangsoon,Park Joonseon,Kim Jeong Soo,Bae Ja Seong 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.4
There are sparse cases of carcinoma arising from the pyramidal lobe (PL). Thyroglossal duct cyst (TGDC), which is the most common anomaly concerning the thyroid gland, is typically where malignant changes arise. Here we report a case of papillary thyroid carcinoma (PTC) occurring in front of the thyroid cartilage, thus mimicking TGDC carcinoma but having a final diagnosis of PL carcinoma. A 52-year-old female presented with a palpable neck mass. Preoperative ultrasound revealed a 3-cm-sized solid and cystic nodule in the infrahyoid area of the neck. Another 6-mm-sized nodule in the left lobe of the thyroid gland was also observed. Fine needle aspiration cytology revealed that both lesions were PTC. A computed tomography scan was performed to determine the extent of surgery, which confirmed the ultrasound TGDC carcinoma diagnosis. The patient underwent a Sistrunk operation and left lobectomy of the thyroid gland. Histopathology showed PTC findings, but no TGDC tissue was present. Thus, PTC arising from the PL was confirmed in the final pathology. PL carcinoma in the neck’s thyrohyoid area should be considered.
Benign Recurrent Primary Hyperparathyroidism After Parathyroid Carcinoma
Jeoffrey Syeda Manahil Haider,McCoy Kristin L.,Gibson Courtney E. 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.4
This report describes the rare occurrence of a parathyroid adenoma 15 years after the resection of a right-sided parathyroid carcinoma, with recurrence of clinical manifestations of hyperparathyroidism. We report the case of a 41-year-old female who returned to the clinic with bone pain, memory difficulties and fatigue. After a thorough assessment, a hyperechoic nodule of parathyroid origin was detected and resected. The resected lesion was located inferior to the left thyroid lobe, measuring 1.3×0.7×0.6 cm and weighing 602 mg; histopathology was consistent with a parathyroid adenoma. Recurrent primary hyperparathyroidism due to benign adenoma, after prior surgery for parathyroid carcinoma, is a rare phenomenon. Early recognition, diagnosis and intervention are essential to prevent and/or reduce associated morbidity and mortality.
In A Lee,Jin Kyong Kim,Cho Rok Lee,Sang-Wook Kang,Jong Ju Jeong,Kee-Hyun Nam,Woong Youn Chung 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.1
Purpose Graves’ disease (GD) is an autoimmune disorder and the most common cause of persistent hyperthyroidism. Recently, robotic transaxillary thyroidectomy has served as a minimally invasive surgical alternative to conventional open thyroidectomy, even for patients with GD. In 2019, we first performed single-port transaxillary bilateral total thyroidectomy using the da Vinci SP robotic system (START). This study aimed to evaluate the technical feasibility of START for GD. Methods This retrospective review included 10 patients with GD who underwent START at our institution between September 2020 and January 2022 by a single surgeon. Results All 10 patients were female, and the body-mass index was 22.3±3.6 kg/m2 (range, 18.6-28.9). Seven patients (70%) had thyroid carcinoma, two (20%) had persistent hyperthyroidism despite medical control, and one patient (10%) had Graves’ ophthalmopathy. The mean operation time was 173.4±26.8 min (range, 128-226), and the mean estimated blood loss was 102.0±185.1 mL (range, 10-600). There were no cases of conversion to open surgery. There were no intraoperative complications and six cases of postoperative complications, including transient hypocalcemia in three cases, bleeding with reoperation in two cases, and transient hoarseness in one case. Conclusions Patients with GD with large goiter and hypervascularity require delicate ligation, even of minor vessels, in a narrow space. START is feasible and safe for GD performed by high-volume expert surgeons.
Clinical Characteristics of the Hyalinizing Trabecular Tumor
Kim Byung-Chang,Pak Shin Jeong,Cho Jae Won,Kim Won Woong,Lee Yu-Mi,Sung Tae-Yon,Baek Jung Hwan,Chung Ki-Wook 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.4
Purpose: Hyalinizing trabecular tumors (HTTs) are rare tumors of the thyroid gland. They are benign and of follicular origin. However, they are difficult to diagnose and can be misdiagnosed as a malignant thyroid tumor. The aim of this study was to clarify the clinical and radiological characteristics of HTT. Methods: We retrospectively reviewed 7 patients who had been diagnosed with HTT postoperatively at the Asan Medical Center between May 2002 and May 2022. Ultrasonographic findings, including size, echogenicity, shape, and margin orientation, were investigated. Preoperative and intraoperative histological features were compared with the final pathological diagnoses. Results: The median size of HTT was 26 mm. Total thyroidectomy and lobectomy were performed in 2 (28.6%) and 5 (66.6%) patients, respectively. Ultrasonography showed hypoechogenicity in 43% of patients and marked hypoechogenicity in 43% of patients. An ill-defined margin was present in 57% of patients. All tumors were parallel in shape, with non-spongiform components. All tumors had intermediate suspicious features according to the Korean Thyroid Imaging Reporting and Data System. The preoperative diagnosis of most patients was papillary thyroid carcinoma. Intraoperative frozen biopsy confirmed the preoperative diagnosis of medullary thyroid carcinoma in 1 patient. No recurrence or death occurred during a median follow-up of 100 months. Conclusion: HTT is a rare benign tumor. Ultrasonographic findings of HTT resemble those of malignant thyroid tumors. Fine-needle aspiration cytology and intraoperative frozen biopsy are ineffective in diagnosing HTT. Under suspicion of HTT, total thyroidectomy should be avoided because of the indolent biological behavior of HTT.
Kwangsoon Kim,Ja Seong Bae,Jeong Soo Kim 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.1
Purpose Multifocality is frequently detected in papillary thyroid cancer (PTC). However, the prognostic significance of multifocality in PTC remains controversial. This study aimed to investigate the prognostic significance of multifocality in PTC. Methods We assessed 1,577 patients with PTC who underwent thyroid lobectomy from January 2008 to December 2016 at Seoul St. Mary’s Hospital (Seoul, Korea). The clinicopathological characteristics and long-term oncologic outcomes between multifocality and unifocality with PTC were compared. The mean follow-up duration was 97.2±20.0 months. Results Multifocality was observed in 290 (19.1%) patients. Compared with unifocality, multifocality had a significantly higher prevalence of extrathyroidal extension (ETE), vascular invasion, and more advanced N and TNM stages. The recurrence rate was significantly higher in multifocality than in unifocality (P=0.034). Multifocality was identified as a significant risk factor for disease-free survival (DFS) in the multivariate analysis (hazard ratio, 1.895; P=0.043). In the Kaplan-Meier analysis, a significant difference was noted in the DFS between the multifocality and unifocality groups (log-rank P=0.017). Conclusion Multifocality is associated with an increased risk of recurrence. This suggests that multifocality in PTC is a significant predictor of oncologic outcomes. Therefore, we suggest that patients with multifocality receive careful treatment from the initial evaluation to surgery and postoperative period.
A Review of Active Surveillance of Papillary Thyroid Microcarcinoma
Cho Rok Lee 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.1
The incidence of papillary thyroid carcinoma (PTC) has increased remarkably over the past few decades. Given the indolent nature of PTC, active surveillance (AS) has been suggested as an alternative management option to immediate surgery in the management of low-risk papillary thyroid microcarcinoma (PTMC). While there is conflicting evidence regarding potential risk factors for disease progression, many groups have demonstrated the efficacy and safety of AS and proposed risk stratification, which can help to select appropriate patients. This review aims to summarize the data regarding low-risk PTMC as well as important considerations of AS.
Posterior Retroperitoneoscopic Adrenalectomy for Large Adrenal Pheochromocytoma: A Case Report
Sameer A. Rege,Sulay K. Shah,Dhaval Vasa,Dhaval Bhesaniya 대한내분비외과학회 2022 The Koreran journal of Endocrine Surgery Vol.22 No.1
Minimally invasive adrenalectomy has now become the preferred technique for adrenalectomies and can be done via transperitoneal laparoscopic and retroperitoneoscopic approaches. The retroperitoneal approach is generally suitable for <5 cm tumors, whereas the transperitoneal approach is preferred for larger tumors. We report an 8 cm right adrenal pheochromocytoma operated with a posterior retroperitoneoscopic approach without any surgical complications. The posterior retroperitoneoscopic approach for large adrenal tumors (>5 cm) considering its additional advantages is a reasonable alternative to the transperitoneal laparoscopic approach, in experienced hands.