A Case of Retropharyngeal Abscess Resulting from Infected Paratracheal Cyst / 대한이비인후과학회지

A paratracheal cyst is an air-filled cyst lined by a ciliated epithelium, commonly referred to as a tracheal diverticulum. The most common location of paratracheal cysts is the right side of posterolateral tracheal wall. It occurs in 0.3% to 8.1% of the total population. Most paratracheal cysts are asymptomatic and discovered incidentally on routine radiologic examination. Rarely, however, symptoms such as cough or fever are encountered and chronic infection of the paratracheal cyst usually present itself like a tucoberculosis or a tumor. There are few case reports of deep neck infection caused by a paratracheal cyst. We report a case of retropharyngeal abscess resulting from an infected paratracheal cyst.

Diagnostic Value of SUV in 18F-FDG PET/CT for Papillary Thyroid Cancer

Background and Objectives@#PET/CT is widely used to determine whether metastasis or recurrence will occur following initial treatment of thyroid cancer. However, there are not much research on diagnostic usefulness of preoperative PET/CT imaging for papillary thyroid cancer (PTC). We analyzed the correlation between the preoperative maximum standard uptake value (SUVmax) of PET/CT and prognostic factors of PTC to evaluate the diagnostic usefulness of PET/CT. @*Materials and Methods@#Of the 133 patients who underwent surgery for PTC, 88 patients who had an increased uptake in thyroid mass in preoperative PET/CT were enrolled. They were divided into two groups according to B-RAF gene mutation, extrathyroidal extension (ETE), lymph node metastasis, and recurrence. The average of the SUVmax for each group was analyzed through multiple regression analysis. Correlation analysis were performed on changes in SUVmax according to the size of the thyroid tumor. Statistical analysis was performed to determine whether there were stage differences between the 47 patients who had no increased uptake in PET/CT and the others who had. @*Results@#There were no statistical correlation between recurrence, the presence of central/lateral lymph node metastasis, ETE, stage and the SUVmax in PET/CT (p=0.513, p=0.8, p=0.73, p=0.01, p=0.9). There were statistical correlations between the size of tumor (p=0.001), the presence of the B-RAF mutation (p=0.024) and SUVmax. Statistical correlations between the presence of the hypermetabolic uptake and high stage were found by the chi-square test (p=0.012). @*Conclusion@#The size of tumor, B-RAF are major factors in determining prognosis of PTC. There is a possibility that there is a correlation between preoperative SUVmax and prognosis of PTC.

A Case of Unilateral Vocal Fold Paralysis Caused by Ortner's Syndrome

The causes of vocal cord paralysis include iatrogenic injury during thyroid or cervical surgery, heart and chest surgery, and tumorous lesion such as laryngeal cancer and lung cancer. In addition to these common causes, rarely, cardiovascular disease can also cause vocal fold paralysis. A disease known as Cardiovocal syndrome, or Ortner's syndrome, causes left vocal fold paralysis when the left recurrent laryngeal nerve is compressed by the pulmonary artery and aorta, which is occurred by pulmonary hypertension from heart disease. We report for the first case in Korea the diagnosis of vocal fold paralysis caused by Ortner's syndrome.

A Case of Recurrent Massive Multinodular Parotid Pleomorphic Adenoma / 대한이비인후과학회지

Pleomorphic adenoma is the most common benign neoplasm of the parotid gland and it accounts for approximately 80% of all reported tumor from parotid. Recurrence rate was noted as 20–45% and high risk factors related to recurrence were the following: over 40 years of age, women, over 30 mm mass size, below 10 mm safety margin, tumor puncture and tumor spillage during surgery, relation to the facial nerve, tumor site, surgical procedure. We experienced a 45-year-old woman who presented a huge left parotid mass. She had a huge parotid pleomorphic adenoma that was removed 18 years ago but had recurred 8 years ago. We removed the mass and obtained good postoperative results.

A Case of Adenocarcinoma of the Nasopharynx / 대한이비인후과학회지

The major pathological type of the nasopharyngeal carcinoma is squamous cell carcinoma; on the other hand, adenocarcinoma of the nasopharynx is extremely rare. We report a case of a 68-year old male presenting a nasopharynx mass, which was revealed as adenocarcinoma, which could not be specified as any transoral tumor resection. Additional radiotherapy was applied. There is no evidence of recurrence during the seven years of follow-up.

A Case of Ectopic Lateral Cervical Thymic Cyst Mimicking as a Second Branchial Cleft Cyst

Cervical thymic cysts are rare lesions of neck mass often misdiagnosed clinically as branchial cleft cyst and are mostly diagnosed, pathologically after surgery. The authors applied surgical resection to a 34-year-old man with right upper neck mass, which was misdiagnosed preoperatively as a second branchial cleft cyst. The pathological tissue examination result showed that the patient was diagnosed with a cervical thymic cyst. The thymic cyst of the lateral neck has not been reported from adult in Korean. Herein, we present the case with review of the related literature.

Efficacy of Percutaneous Ethanol Injection for Benign Neck Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advantages of percutaneous ethanol injection (PEI) were represented by insignificant mortality, minimal damage to normal parenchyma, relatively low cost and easy availability. The objective of the present study was to evaluate the efficacy of ethanol ablation as a minimally invasive management of cystic lesions in the neck or arising from the neck. SUBJECTS AND METHOD: Between August 2010 and December 2015, 28 patients with cystic lesions in the neck were diagnosed and treated with percutaneous ethanol injection. We evaluated the outcome of treatment using the alteration of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. RESULTS: The initial mean tumor volume was 21 mL (range, 1.6-36.9 mL), as shown by ultrasonography. The mean number of the treatment sessions was 3.5 (range, 1-9 sessions). At the last follow-up, the mean volume of the treated neck cyst decreased significantly from 21 mL to 2.7 mL (p<0.001). The average volume reduction rate was 82.4% with the success rate of procedure of 82%. The mean symptoms and cosmetics visual analog scale improved from 5.4 to 2.4 and from 4.8 to 1.5 (p<0.001). No significant complications were observed during follow-ups. CONCLUSION: PEI is simple, easy, safe, and effective without surgical scars and hospitalization for neck cyst patients and favorable outcomes can be achieved without significant complications. It can be used as a substitute for surgery in the treatment of benign neck cyst lesions.

A Case of Cystadenocarcinoma Arising from Parotid Gland / 대한이비인후과학회지

Cystadenocarcinoma, a term established by the 2005 World Health Organization classification system to an entity of cystadenocarcinoma, is a rare malignant neoplasm of the salivary glands. Major locations of this neoplasm are the parotid gland, sublingual gland, and minor salivary glands. We encountered a case of cystadenocarcinoma originating from a parotid gland in a 28-year old man. He received radiation therapy followed by superficial parotidectomy. At 18 months of follow-up, no recurrence is observed. We herein report the case with a review of literature.

Two Cases of Pneumothorax and Subcutaneous Emphysema Associated with Removal of Neglected Tracheal Foreign Body / 대한이비인후과학회지

Tracheal foreign body aspiration, which most commonly occurs in the pediatric population, can lead to a life-threatening event. In many pediatric cases it is difficult to confirm a history of foreign body aspiration, with frequent misdiagnoses of asthma, croup or pneumonia, leading to increased complications and mortality. When a tracheal foreign body is suspected, the treatment principle is to do bronchoscopy under the cooperation of otolaryngologists, pediatricians and cardiothoracic surgeons; the choice between procedures should be made with consideration of factors such as the size, location of foreign body and the condition of the patient. Subcutaneous emphysema and pneumothorax are rarely reported complications of tracheal foreign body, and are known to usually occur after removal of the foreign body. The authors hereby report, with a review of the literature, 2 cases of subcutaneous emphysema and pneumothorax occurring after foreign body removal through bronchoscopy and tracheotomy in pediatric tracheal aspiration patients.

A Case of Milk-Alkali Syndrome in a Patient with Hypoparathyroidism after Total Thyroidectomy / 대한이비인후과학회지

Milk-alkali syndrome (MAS) is a disorder featuring hypercalcemia, renal failure and metabolic alkalosis due to ingestion of large amounts of calcium and absorbable alkali. MAS was first reported after Milk-alkali treatment of peptic ulcer in early 1910. But since the late 20th century, the wide availability and increasing consumption of calcium carbonate and vitamin D supplementation mostly for osteoporosis prevention has been noted as reemerging clinical backgrounds of MAS. We experienced a case of a woman who had taken calcium and vitamin D for a year due to hypoparathyroidism after total thyroidectomy. She was admitted suffering from nausea, vomiting, anorexia and irritability with the triad of hypercalcemia, metabolic alkalosis and acute renal insufficiency. Every abnormal symptom, calcium level and renal function were normalized with fluid and diuretic therapies.

Influences of Hashimoto's Thyroiditis as Prognostic Factor of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a prognostic factor, the association of Hashimoto's thyroiditis (HT) with papillary thyroid carcinoma (PTC) is still controversial. The aim of this study is to compare clinicopathologic parameters between PTC alone and PTC with HT patients. SUBJECTS AND METHOD: We reviewed the medical record retrospectively. 205 patients underwent thyroid surgery from January 2006 to December 2008. Among the 205 patients, 120 patients were included in this study. We compared various clinicopathologic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis, and lateral lymph node metastasis between PTC alone and PTC with HT patients. RESULTS: 18.3% of PTC patients were associated with HT. There were no significant differences in clinocopatholgic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis or lateral lymph node metastasis. Tumor recurrences were found in 6 out of 98 cases of PTC alone and in 3 out of 22 cases of PTC with HT. There was no significance between two groups (p=0.363). CONCLUSION: Results indicate that HT may not be associated with clinicopathologic factors in PTC.

A Case of Adenolipoma of the Thyroid Gland / 대한이비인후과학회지

Adenolipoma of the thyroid gland, also called thyrolipoma or thyroid hamartoma, is an extremely rare neoplasm. It is characterized by encapsulated admixtures of mature adipose tissue and thyroid tissue. The treatment of choice is surgical resection and the prognosis is favorable. We describe a case of adenolipoma of the thyroid gland, incidentally found in a residual gland subsequent to thyroidectomy of a papillary carcinoma.

Two Cases of Thyroid Hematoma Developing after a Core Needle Biopsy / 대한내분비외과학회지

Ultrasound guided fine needle aspiration (FNA) of thyroid nodules is a very common procedure. Its diagnostic adequacy rate is approximately 70%. The adequacy rate for core needle biopsy (CNB) is approximately 80%, so that it was significantly higher than that of FNA. CNB is clinically useful in selected patients when a prior FNA reading is nondiagnostic. Complications from FNA and CNB are rare. We report on two cases of a hematoma of the neck caused by thyroid CNB with a review of literature.

A Case of Solitary Neurofibroma Arising from the Arytenoid Treated by Transoral Laser Surgery / 대한이비인후과학회지

Neurofibroma arising solitarily in the larynx is uncommon. With the branch of the superior laryngeal nerve involved, the aryepiglottic fold is the most common site in endolaryngeal neurofibromas. The recurrence rate for the disease is high unless en bloc excision, the treatment of choice, is taken. We present a case of neurofibroma in a 58-year-old female who complained of throat discomfort and dysphagia. The mass was removed by transoral laser surgery and no recurrence was found after 18 months.

Metastatic Follicular Thyroid Carcinoma in Cervical Spine: A Case Report / 대한내분비외과학회지

Differentiated thyroid cancers are rarely associated with distant metastases and have 10-year survival rates higher than 80%; however, the prognosis deteriorates significantly if metastasis occurs. Bone is the second most common site of metastasis after the lungs in cases of thyroid cancer. Here we describe a case in which a 57-year-old female patient had extremely severe pain on the posterior neck. After magnetic resonance imaging, 18F-FDG PET CT and ultrasonography guided biopsy, right papillary thyroid carcinoma with cervical spine metastasis was suspected; therefore, she underwent surgery for removal of thyroid carcinoma and seventh cervical spine metastasis. Pathologic diagnosis was confirmed as left thyroid follicular carcinoma with seventh cervical spine metastasis and synchronous right thyroid papillary carcinoma. The patient then underwent an additional spinal tumor removal operation, I131 treatment and external radiation therapy. Complete removal of the cervical spine tumor could not be achieved due to intra-operative bleeding and the need to prevent damage to the spinal cord. Following treatment, the patient reported great relief from severe neck pain. This is a rare presentation of follicular thyroid carcinoma with cervical spine metastasis in Korea.

Brown Tumor of the Humerus Associated with Secondary Hyperparathyroidism: A Case Report of Successful Treatment after Subtotal Parathyroidectomy / 대한내분비외과학회지

Brown tumor is a bone disease that arises in the setting of increased osteoclastic activity and fibroblastic proliferation in the involved bone. It is well recognized as serious complication of hyperparathyroidism. Brown tumor is uncommon, and brown tumor with secondary hyperparathyroidism resulting from chronic renal failure has rarely been reported. We recently experienced a case of a 28-year-old Korean woman with chronic renal failure caused by chronic glomerulonephritis, on hemodialysis for nine years. She has been hospitalized with left shoulder pain for two years. Image studies showed multiple cystic masses, and both suspicious marked thinning and partial destruction of the cortex on the head of the left humerus. Histopathologic analysis of the mass lesion showed a fibrotic capsule, hemosiderin pigmentation, and giant cell, all characteristic of brown tumor. A subtotal parathyroidectomy was done without surgery of the bony lesion (brown tumor), with successful results. We report this case with a brief review of the literature.

A Case of the Common Carotid Artery Penetrating Injury by Grass Cutter Fragment / 대한이비인후과학회지

There are many vital structures in the neck, but they are not protected by bone. The neck is vulnerable to injury, and difficult to evaluate the extent of injury. Especially, penetrating neck wounds are potentially dangerous and require emergency treatment. A 56-year-old man with a penetrating neck injury by a grass cutter fragment was transferred from another hospital. There were no immediate life-threatening signs or symptoms. Carotid artery injury was suspected in the computed tomography scan. Emergent exploration was implemented by vascular surgery to remove the grass cutter fragment that had penetrated the left common carotid artery. We report a rare case of common carotid artery penetrating injury that was treated without any complications.

Detection of BRAF(V600E) Mutation using Peptide Nucleic Acid-Mediated PCR Clamping Method in Fine Needle Aspiration Cytology / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate the diagnostic value of a peptide nucleic acid (PNA)-mediated PCR clamping method for the detection of BRAFV600E mutations in fine needle aspiration cytology (FNAC). METHODS: One hundred sixty four patients underwent FNAC to evaluate BRAFV600E mutations between April 2011 and November 2011. Among them, forty-two patients were diagnosed with papillary thyroid carcinoma in a permanent pathologic specimen. A PNA-mediated PCR clamping method and a Dual-Priming Oligonucleotide (DPO)-based Real-time PCR method were used to detect the BRAFV600E mutation. We compared the result of mutation between the two methods. RESULTS: A BRAF mutation was found in 31 samples created by the PNA-mediated PCR clamping method, and in 28 samples in the DPO-based Real-time PCR method. The rate of BRAF mutation was 73.8% in association with the PNA-mediated PCR clamping method, and 66.7% in association with the DPO-based Real-time PCR method. There was no statistical differences between the two methods (P>0.05). CONCLUSION: The PNA-mediated PCR clamping method may be an alternative to the DPO-based Real-Time PCR method for detection of BRAF mutations in thyroid nodules.

A Case of Non-functioning Lingual Thyroid Excised with CO₂ Laser Via Transoral Approach / 대한내분비외과학회지

Lingual thyroid, characterized by presence of thyroid tissue at the base of the tongue in the region between the circumvallate papillae and the epiglottis, is the most common location for ectopic thyroid tissue. Excision of the lingual thyroid is rarely necessary. When a lingual thyroid becomes symptomatic, removal is advocated. Minimally invasive surgical techniques have been proposed for more than two decades. The use of CO₂ laser for removal of lingual thyroid offers advantages over traditional open approaches. We experienced a case of non-functioning lingual thyroid which caused dysphagia in the patient. We successfully excised it with CO₂ laser via transoral approach without any complications.

A Case of Supraglottic Adenoic Cystic Carcinoma Treated by Transoral Laser Excision / 대한이비인후과학회지

Adenoic cystic carcinoma (ACC) is a malignant tumor, occuring in the major and minor salivary glands. Laryngeal ACC is a rare malignancy that constitutes less than 1% of all laryngeal malignancies. ACC is characterized by slow growth, multiple recurrences and late distant metastasis. The treatment of the ACC is by wide excision or by combining wide excision with postoperative radiotherapy. A 33-year-old woman, who had been diagnosed with epiglottic cyst in 2007, complained of throat discomfort that had been aggravating for the past two weeks. The tumor was treated with transoral laser excision. The pathologic report revealed an adnoid cystic carcinoma on the epiglottis; it was composed of cribriform patterned nests and columns of tumor cells. No recurrence was detected until post-operative 16 months by endoscopic examination. Transoral laser excision was suggested for successful treatment for the adenoid cystic carcinoma.