A Case of Pleomorphic Hyalinizing Angiectatic Tumor of Neck Mimicking Neurogenic Tumor / 대한두경부종양학회지

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, low grade neoplasm which usually occurs in subcutaneous soft tissue. Histologically, it features ectatic blood filled vessels surrounded by hyalinized stroma and pleomorphic spindle cells. Clinically and histologically, PHAT could be misdiagnosed as such tumor as neurogenic tumor, malignant fibrous histiocytoma. About 100 cases of PHAT have been reported so far, and it is even rarer in head and neck area. We experienced a case of PHAT in 41-year-old male with several months of history of gradually enlarging neck mass which was surgically removed by wide excision.

A Case of Pleomorphic Hyalinizing Angiectatic Tumor of Neck Mimicking Neurogenic Tumor / 대한두경부종양학회지

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, low grade neoplasm which usually occurs in subcutaneous soft tissue. Histologically, it features ectatic blood filled vessels surrounded by hyalinized stroma and pleomorphic spindle cells. Clinically and histologically, PHAT could be misdiagnosed as such tumor as neurogenic tumor, malignant fibrous histiocytoma. About 100 cases of PHAT have been reported so far, and it is even rarer in head and neck area. We experienced a case of PHAT in 41-year-old male with several months of history of gradually enlarging neck mass which was surgically removed by wide excision.

Malignization of Oral Leukoplakia and the Need for Early Excisional Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity.SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites.@*RESULTS@#There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant.@*CONCLUSION@#For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.

Malignization of Oral Leukoplakia and the Need for Early Excisional Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.

Foreign Body Reactions after Using SurgiWrap® (Polylactide Acid Bioresorbable Sheet) / 대한이비인후과학회지

Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. Currently, adhesion barriers are used in many surgical interventions and while they have become a subject of an increasing interest for their effectiveness, there has not been any reports on the adverse effects of these anti-adhesion agents. Three different types of antiadhesive agents (SurgiWrap®, Guardix-Sol®, Interceed®) have been noted as effective in adhesion prevention. We report, with a review of literature, on a patient who had a foreign body reaction that caused a side effect of anti-adhesion SurgiWrap® after thyroid surgery.

The Effectiveness of Fine-Needle Aspiration Conducted by The Otolaryngologists / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To investigate the effectiveness of fine needle aspiration (FNA) conducted by the otolaryngologists, we compared the ultrasound (US)-guided FNA results conducted by a radiologist (RD-US), the US-guided FNA results (ENT-US), and the palpation guided FNA results (ENT-palpation) conducted by an otolaryngologist. SUBJECTS AND METHOD: 1646 patients who underwent FNA were classified according to the site and periods of investigation (2007-2015), and their sampling adequacy was retrospectively reviewed. They were also divided into three groups (ENT-US, ENT-palpation, and RD-US); each group was then investigated for sampling adequacy. Results of further surgical excisional biopsy were compared with the those of the FNA results to investigate the diagnostic accuracy of all three groups. RESULTS: The sampling adequacy identified by the groups showed the result of ENT-US at 87.9%, ENT-palpation at 87.1% and RD-US at 91.3%. The periodical inadequacy rate failed to show any significant differences between the groups. The sensitivity of ENT-palpation was lower than other two groups. Diagnostic accuracy identified by the groups showed the result of ENT-US at 95.2%, ENT-palpation at 93.6%, and RD-US at 97.4%. CONCLUSION: FNA performed by otolaryngologists demonstrates the effectiveness of diagnosis and treatment, and that doing so would improve economic efficiency. Therefore, it is recommended that well-trained otolaryngologists conduct FNA actively.

Sonographic Index for Extrathyroidal Extension of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ultrasonography is the most useful tool for detecting extrathyroidal extension, which is the deciding factor in surgical extension of papillary thyroid carcinoma. However, there are few studies on pre-operative ultrasonographic findings about extrathyroidal extension. This research thus evaluates a predictive sonographic index of extrathyroidal extension. SUBJECTS AND METHOD: 265 patients with papillary thyroid carcinoma who underwent preoperative sonography and surgery were respectively reviewed. Sonographic findings were compared with pathological results. RESULTS: There were no differences among the patents in terms of calcification and echo texture, whereas significant differences were observed in terms of mass size, lymph node metastasis, capsule contact, and degree of capsule contact. These four factors were weighted according to the degree of severity and defined the extrathyroidal index as the total of these scores. The index had high sensitivity, specificity and predictability. CONCLUSION: We suggest that the extrathyroidal extension index with sonography is helpful for drawing pre-operative sonographic diagnosis.

A Case of Piriform Sinus Fistula Complicated with Suppurative Thyroiditis Treated with Chemocauterization Using Trichloroacetic Acid / 계명의대학술지

A 23 months-old girl visited the hospital because of fever and left neck mass. She was diagnosed as acute suppurative thyroiditis with piriform sinus fistula. Thyroid sonography showed perithyroidal abscess formation and thyroid scan showed decreased uptake of Tc-99m pertechnate of both thyroid glands. Magnetic resonance imaging of neck showed abscess cavity extending to the swollen left thyroid gland. And there was tiny fistula between thyroid and piriform sinus in the barium esophagogram. Streptococcus gordonii was isolated on needle aspiration culture. We report a case of piriform sinus fistula of the neck complicated with suppurative thyroiditis. The fistula was treated with chemocauterization using trichloroacetic acid.

Chemotherapy of Head and Neck Cancer / 대한이비인후과학회지

Head and neck cancers comprise a heterogenous group of cancers that require a multidisciplinary approach. Surgery, radiation therapy, chemotherapy and, more recently, target therapy are often employed in various combinations in an attempt to eradicate both clinically apparent and occult disease. The role of chemotherapy in multimodality treatment for locally advanced head and neck squamous cell carcinoma, although firmly established, presents several unresolved issues. Concomitant platinum-based chemoradiation (CRT) is a standard treatment for unresectable, resectable but nonsurgically treated, and postoperative high-risk patients with locally advanced head and neck squamous cell carcinoma. Cetuximab administered concomitantly with radiotherapy has not been directly compared with CRT but offers a potential different approach using a noncytotoxic systemic agent. In recent years taxanes have been shown activity in head and neck cancers and are being incorporated into neo-adjuvant and concomitant chemotherapy regimens.

Radiofrequency Ablation of Benign Thyroid Nodule / 대한이비인후과학회지

Radiofrequency ablation (RFA) is not only a procedure used in treating malignant liver tumors, but is also a valuable way of treating benign thyroid nodules. RFA can be used in almost every patient, regardless of the contents of the solid component. One of the merits of RFA is that it may be used as an alternative to benign thyroid nodule surgeries. With this method, patients who so only choice in the past were to get surgeries can be treated in another way. This article reviews the indications, pre-procedural evaluations, techniques, results, and complications of thyroid radiofrequency ablation.

Accurate Diagnosis with Chest CT for Bronchial Foreign Body Removal in Young Patient: Report of Three Cases and Review of the Literature / 대한이비인후과학회지

Foreign body aspiration (FBA) is a common accident and remains a serious problem in young children. Undiagnosed and retained FBA could be a life-threatening risk and causes serious complications especially for young children. To prevent complications, prompt diagnosis and removal of foreign body is mandatory. Chest computerized tomography (CT) has recently become a very useful noninvasive diagnostic modality for bronchial FBA. We present here three different patients with bronchial FBA, which had been diagnosed by chest CT and completely removed under ventilating bronchoscopy without complication. The authors reviewed the literature and discussed the usefulness of chest CT on bronchial FBA in children.

Fine Needle Aspiration is a Reliable Screening Procedure to Deetct Toxoplasmosis: Four Case Reports / 계명의대학술지

Lymphadenitis due to toxoplasma infection is not uncommon and should be considered in the diagnosis of unexplained lymphadenopathy at all sites, especially at the cervical region. We report four cases of toxoplasmosis diagnosed by cytologic, histologic and serologic tests. Fine needle aspiration cytologic diagnosis can help the diagnosis of toxoplasma lymphadenitis and eliminate unnecessary hospitalization or surgery.

Two Cases of Charcoal Injection in Recurrent Microcarcinoma of Thyroid Bed after Total Thyroidectomy / 대한이비인후과학회지

Ultrasonograms and thyroglobulin measurements have high sensitivity for evaluation of recurrent thyroid cancer and they allow early detection of recurrent or residual thyroid tumors. Patients treated for thyroid cancer can show recurrent or residual tumors in 5-40% of cases. Radioiodine therapy and surgical excision are effective for recurrent or residual thyroid tumors, but up to 30% of tumors will not reveal iodine uptake, and need further observation or surgical excision. Clinically, patients choose surgical excision rather than observation. During reoperation, the risk of surgical complications is increased because of fibrosis, neovascularization, and modified anatomical relationships. In the past, surgeons have occasionally used methylene blue during reoperation but it tends to spread into the surrounding tissues. Recently, charcoal injection has been used for recurrent thyroid microcarcinoma. The authors successfully used charcoal injection for the removal of tumor in two cases of recurrent microcarcinoma of the thyroid bed after total thyroidectomy.

Effect of Botulinum Toxin A Injection into the Salivary Glands for Sialorrhea in Children with Neurologic Disorders

OBJECTIVE: To determine the 9 month period effect of botulinum toxin A (BoNT-A) injection into the salivary gland in children with neurologic disorders and sialorrhea by qualified parent/caregiver-administered questionnaires. METHOD: A total of 17 patients (age 7.6+/-4.24 years) were enrolled in this study. The degree of sialorrhea was assessed at the baseline, 2 weeks, 1, 2, 4, 6 and 9 months after injection. The Drooling Count (DC) was assessed as an objective measurement. The Drooling Frequency and Severity Scale (DFS) and the Teacher Drooling Scale (TDS) were evaluated as a subjective measurement. BoNT-A (0.5 unit/kg) was injected into each submandibular and parotid gland under ultrasonography-guidance. RESULTS: DC, DFS and TDS showed significant improvement at 2 weeks, 1, 2, 4, 6, and 9 months follow-up (p<0.05). Twelve of 17 cases (70.5%) showed more than 50% reduction in DC from the baseline value. CONCLUSION: Ultrasonography-guided BoNT-A injection into the submandibular and parotid gland was a safe and effective method to treat sialorrhea in children with neurologic disorders.

A Case of Myopericytoma in the Neck / 대한이비인후과학회지

A myopericytoma is a rare mesenchymal neoplasm composed of oval to spindle-shaped myoid appearing cells with a striking tendency for concentric perivascular growth. The vast majority of lesion is in the dermis and subcutaneous tissue of extremities. Very few cases have been reported in other locations. We hereby present, with a literature review, a case of myopericytoma in the neck.

A Case of Metastatic Renal Cell Carcinoma in Parotid Gland / 대한이비인후과학회지

The salivary gland most frequently involved with secondary cancer is the parotid gland. Metastases are responsible for 21-42% of malignant parotid tumors. Malignant melanoma and squamous cell cancer are the two most common tumors to metastasizing to the parotid gland. Renal cell carcinoma takes up 85% of primary malignant renal tumors. It rarely metastasizes to the head and neck area. When metastasis to head and neck area occurs, it involves the gingiva, tongue, palate, parotid gland, uvlua, mandible, and lip. When tumorous areas arefound in the salivary gland consisting of clear cells, it is important to carry out differential diagnosis of various primary tumors with clear cells and metastatic renal cell carcinoma. In this paper, we report on a case of renal cell carcinoma which had metastasized to the parotid gland after a radical nephrectomy.

A Case of Ancient Schwannoma of the Submandibular Gland / 대한이비인후과학회지

Ancient schwannoma is a benign neoplasm of nerve origin and may cause difficulties in the differential diagnosis with other benign or malignant tumors. It is also a rare variant of schwannoma with atypical tumor cells with nuclear pleomorphism and hyperchromatism. In this report, a 44-years-old female patient with an ancient schwannoma of the submandibular gland is presented, discussed, and the literature is reviewed for head and neck location of this tumor.

Gastrointestinal Autostapler(GIA)-Assisted Zenker's Diverticulectomy / 대한이비인후과학회지

Zenker diverticulum is rare and symptoms of diverticulum are atypical. This is most commonly seen at the Killian's triangle. This is caused by altered motility, which results in abnormal intraluminal pressure and the pushing of the mucosa through weakness of the wall. Treatment is surgical via an endoscopic or external approach. Previous external approaches are associated with high com-plication rates and morbidity. We report a new external surgical approach using the gastrointestinal autostapler (GIA) instrument.

Nodular Fasciitis Presenting as a Retroauricular Mass / 대한이비인후과학회지

Nodular fasciitis is a benign myofibroblastic proliferative lesion of the soft tissue. It appears typically as a rapidly growing painless solitary mass over several weeks' duration. It may be confused with a malignant tumor, especially with a sarcomatous lesion due to its aggressive clinical behavior and histological features. Only 7-20% of theses tumors are located in the head and neck since the retroauricular lesion is extremely rare. We report on a patient with nodular fasciitis as a retroauricular mass with a review of literature.

Effect of Triptolide and Cisplatin Combination on Apoptosis in AMC-HN4 Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cisplatin (CP) is a widely used agent for chemotherapy of head and neck squamous cell carcinoma but some tumor cell shows resistance to CP. Accordingly, it is necessary to seek a method to increase the sensitivity of tumor cell to CP. This study was conducted to investigate whether Triptolide (TP) is effective in the inhibition of proliferating head and neck cancer cell and sensitizes cancer cells to CP. MATERIALS AND METHOD: To assess how the combination of TP and CP influence apoptosis of head and neck cancer cell, AMC-HN4 cells were treated with different concentrations of TP and/or CP. Then, their growth was analyzed by XTT assay and the degree of apoptosis was analyzed by flow cytometry. RESULTS: The combination of TP and CP increased suppression of the growth of tumor cells more significantly and enhanced apoptosis more than that of TP or CP alone, and suppressed expression of anti-apoptotic protein. CONCLUSION: This study showed that TP alone had antitumor activity in AMC-HN4 cells, and the combination of TP or CP also might sensitize head and neck cancer cell to CP by suppressing the expression of antiapoptotic protein.