Clinical Analysis of Cervical Neurilemmoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neurilemmoma is a benign tumor originating from the spinal nerve root, peripheral nerve and all kinds of cranial nerves except the optic nerve and olfactory nerve. Approximately 25% to 40% of all neurilemmomas are found in the neural structures of the head and neck. We performed this study to analyze the clinical features, diagnosis, treatment and prognosis of neurilemmomas. SUBJECTS AND METHOD: Twenty-one patients who were diagnosed with cervical neurilemmoma and had received treatment at the Department of Otolaryngology-Head and Neck Surgeries from 1994 to 2004 were analyzed retrospectively. RESULTS: The mean age of 21 patients was 41.0 years, with 10 being male and 11 female. The most common symptom was palpable neck mass and the mean duration of symptoms was 28.2 months. The most common location of tumor was level II and the most common nerve of origin was the vagus nerve (23.8%). Preoperative diagnostic tools were FNA, CT and MRI. Operation was most commonly performed via transcervical approach. In 10 cases, nerves of origin were preserved, whereas, in 5 cases, nerves of origin were sacrificed and in 6 cases, nerves of origin were not found. The postoperative complications were vocal cord palsy (14.3%), arm weakness (14.3%), facial weakness (9.5%), Horner's syndrome (9.5%), sensory (4.8%) and motor (4.8%) impairment of tongue. The mean follow-up period was 5.3 years and recurrence was not found during this period. CONCLUSION: CT or MRI is more helpful than FNA in the diagnosis of neurilemmoma. In excising neurilemmoma, the nerve must be preserved as much as possible.

Up-regulation of Cathelicidin in Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary secretions and the secreted IgA in the secretions play a critical role in maintaining oral health via innate host defense mechanism. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. LL-37, an antimicrobial peptide, is the only Cathelicidin protein so far identified in humans. The purpose of this study was to examine the expression of Cathelicidin in human salivary glands and to investigate upregulation of Cathelicidin in inflammatory conditions. MATERIALS AND METHOD: Reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, of which 10 were normal and 10 were chronic sialadenitis. RESULTS: Cathelicidin mRNA transcripts were detected in the normal salivary glands and chronic sialadenitis. The level of Cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. Cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. CONCLUSION: The results indicate that Cathelicidin might play an important role in the innate host defense of human salivary glands.

Immunohistochemical Expression of Galectin-3 in Thyroid Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Galectin-3 is a beta-galactoside binding protein that has been reported to be implicated in numerous biologic and pathologic functions including cell growth, cell adhesion, inflammation, neoplastic transformation, and apoptosis. Most previous studies in thyroid tissue have found galectin-3 expression to be a feature of malignant and not of benign or normal tissue. The aim of this study was to investigate the expression of galectin-3 in 57 thyroid lesions, to assess its potential as a marker in the diagnosis and classification of thyroid malignancy. SUBJECTS AND METHOD: The followings were studied: 19 cases of papillary carcinomas, 8 of follicular carcinomas, one anaplastic carcinoma, one medullary carcinoma, 16 follicular adenomas, and 12 nodular hyperplasia. Formalin-fixed paraffin-embedded thyroid tissues were stained immunohistochemically for galectin-3. RESULTS: Galectin-3 expression was found in all cases, however, it was strong in papillary carcinomas than in follicular carcinomas or adenomas. In nodular hyperplasia, galectin-3 expression was very weak and focal. A significant difference was not found in the expression of galectin-3 between follicular carcinomas and follicular adenomas. CONCLUSION: Galectin-3 is a reliable marker of papillary carcinoma but not useful in identifying follicular carcinoma.

A Case of Collision Tumor: Bronchogenic Squamous Cell Carcinoma in Cervical Hodgkin Disease / 대한이비인후과학회지

In the head and neck fields, collision tumor is very rare, especially in the cervical lymph node. Clinical and pathological findings are reported concerning a 56-year-old woman with Hodgkin disease and metastatic bronchogenic squamous cell carcionma within the right supraclavicular lymph node. The primary site of squamous cell carcinoma was diagnosed by transbronchial lung biopsy. Each component retains its own biologic characteristics, so the most suitable treatment must be determined on a case-by-case.

Prognostic Significance of COX-2 and VEGF-C Expression in Thyroid Papillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cyclooxygenase-2 (COX-2) may play a role in tumor growth and spread of numerous types of epithelial cancers since it can regulate tumor angiogenesis by modulating the production of several angiogenic factors, including vascular endothelial growth factor (VEGF). We investigated the correlation between COX-2 and VEGF-C expressions and different prognostic factors of thyroid papillary carcinoma. SUBJECTS AND METHOD: Thirty-eight patients with thyroid papillary carcinoma were analyzed by immunohistochemical staining to study the expressions of human COX-2 and VEGF-C and a semiquantitative scoring method was employed to determine their expression levels. The immunostaining scores were compared with different prognostic factors of thyroid papillary carcinoma. RESULTS: The mean scores+/-SD for COX-2 and VEGF-C were 3.9+/-3.6 and 4.7+/-3.1, respectively, and there was a significant correlation between their expressions. Among the prognostic factors of thyroid papillary carcinoma, age, sex, and tumor size made no significant differences between COX-2 and VEGF-C expressions. The expression of COX-2 was significantly associated with tumor stage and extracapsular spread, and VEGF-C with nodal metastasis and extracapular spread. CONCLUSION: Nodal metastasis, tumor stage, and extracapsular spread were found to be associated with the expressions of COX-2 and VEGF-C, and were concerned with the growth and metastasis of tumor. Therefore, COX-2 and VEGF-C may play important roles in the tumor growth and metastasis of thyroid papillary carcinoma, as in other epithelial cancers.

Treatment of Intra-Oral Ranula with Picibanil(R) in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of ranula has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of Picibanil(R) sclerotherapies for treating ranula children. SUBJECTS AND METHOD: Three patients were enrolled in the study conducted during 2002. All patients were not hospitalized. Picibanil(R) was injected into the lesion. One girl and two boys with ages ranging from 8 to 12 years were treated. RESULTS: Disappearance or marked reduction of the lesion and no recurrence of the ranula were observed in all children. Following each injection, local pain at the injection site was observed in 2 children and transient fever was observed in one child, but such problems resolved within a few days and no serious complication was developed. CONCLUSION: Our experience gives a suggestion that intralesional injection therapy using Picibanil(R) for intraoral ranula is relatively safe and can be used as a substitute for surgery in the treatment of ranula.

Cervical Sympathetic Chain Neurilemmoma with Postoperative Horner Syndrome / 대한이비인후과학회지

Neurilemmoma arising from the cervical sympathetic chain is not common. It is most often manifested as a solitary, benign, and slow-growing mass, and its malignant degeneration is rare. Recently, we experienced a case of schwannoma arising from cervical sympathetic chain. A 43-year-old woman presented a left neck mass that was found incidentally. Measuring approximately 3x3 cm, the mass was located medial to the left sternocleidomastoid muscle at the level of the carotid bifurcation. Fine needle aspiration biopsy was performed, but no diagnostic information was given. A computed tomography (CT) scan showed a heterogenous, poorly-demarcated mass in the left poststyloid parapharyngeal space, displacing the carotid artery anteriorly and the internal jugular vein laterally. Tumor was excised via transcervical approach. Postoperatively, the patient exhibited mild miosis with ptosis in the left eye. We report this case with a brief review of literature.

Duration of Chemothrapy for Tuberculous Cervical Lymphadenitis: A Randomized Controlled Study on Six Months versus Twelve Months Chemotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. Foreign guidelines recommend a six-month short course chemotherapy for tuberculous peripheral lymphadenitis as an initial standard regimen. However, there have been some debates about the duration of chemotherapy in South Korea. The aim of this study is to determine the reasonable duration of chemotherapy for tuberculous cervical lymphadenitis in a randomized controlled study. SUBJECTS AND METHOD: We analyzed clinical outcome of 80 patients with tuberculous cervical lymphadenitis treated at Korea University Medical Center from April 1998 to November 2001. All patients were randomized in two groups by treatment regimens. All patients were given antituberculous chemotherapy for 6 or 12 months, starting with isoniazid (H), rifampicin (R), ethambutol (E) and pyrazinamide (P) for 2 months, then continuing with isoniazid, rifampicin and ethambutol for the remaining 4 months or 10 months, respectively. RESULTS: Forty-seven patients were given a 12-month regimen (2 HERZ/10 HRE), and 43 patients (91.5%) were cured. Thirty-three patients were given a 6-month regimen (2 HERZ/4 HRE), and 20 patients (60.6%) were cured. The cure rate of the 12-month regimen appeared significantly higher than that of the 6-month. In both groups, no recurrence was found during the follow up period up to 12 months. CONCLUSION: The 12-month regimen could be recommended as a reasonable chemotherapy regimen for tuberculous cervical lymphadenitis in South Korea. Single lymph node excisional biopsy is an important diagnostic method. but, it has no additional benefits of treatment.

Clinical Analysis of The Thyroid Papillary Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary carcinoma of the thyroid is the most common malignant neoplasm in the thyroid gland. We performed this study for the purpose of getting further understanding and more supporting ideas for the diagnosis and treatment of thyroid papillary cancer. SUBJECTS AND METHOD: One hundred seventy eight cases of papillary carcinoma of thyroid gland who had been diagnosed and had received treatment at the department of otolaryngology-Head and neck surgery at the Korea university hospital from 1992 to 2001 were analyzed retrospectively. RESULTS: The mean age of cases was 43.6 years in females and 47.9 years in males. The most common symptom was anterior neck mass. Symptoms were usually presented within three months. The size of thyroid mass was not related to the duration of illness. The most frequently performed operative procedure was total thyroidectomy (76.4%). The post operative complications were temporary vocal cord palsy (4.5%), iatrogenic vocal cord palsy (1.7%), temporary hypocalcemia (16.9%) and permanent hypocalcemia (3.9%). Of all patients, 43 (24.1%) had preoperatively metastatic cervical nodes. Of the 175 patients, 52 (29.2%) had postoperative nodal metastasis. Local recurrences had occurred in 17 patients (9.6%). According to the AMES classification, 114 cases (64.1%) fell into the low risk group and 64 cases (35.9%) to the high risk group. The 10-year survival rate was 100% for the low risk group but 91.2% for the high risk group. The 10-year disease free survival rate was 92% for the low risk and 81.2% for the high risk group. CONCLUSION: We reaffirmed that the clinical characteristics of thyroid papillary cancer corresponded with the reports of other foreign studies. We suggest that this study needs to be followed up by a larger, long-term research.

Acute Epiglottitis in Adults: A Review of 85 Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. The incidence of acute epiglottitis in children has declined with introduction of the Haemophilus influenza type b vaccine. However, there have been few reports about acute epiglottitis in adults up until now. The aim of this study was to assess clinical characteristics of adult cases of acute epiglottitis. SUBJECTS AND METHOD: We retrospectively reviewed 85 hospitalized adult patients who had been admitted to the Department of Otolaryngology-Head and Neck surgery, Korea University Hospital from January 1998 to December 2002, and diagnosed with acute epiglottitis. RESULTS: Among the 85 patients, 23 cases (27%) and 24 cases (28%) were found in fourth and sixth decades of age, respectively. The male-to-female ratio was 1.6:1. Monthly distribution showed that 12 cases (14%) were in March and 11 (13%) in July. The most common symptom was in the order of throat pain (78%). Others were dysphagia (68%), voice change (67%) and dyspnea (42%). All patients were treated with antibiotics and steroids. About a half of all cases (54%) were hospitalized for 4 to 5 days. Tracheostomy was performed in 2 patients and orotracheal intubation in one patient. CONCLUSION: Throat pain and dysphagia were most common symptoms of acute epiglottitis. In most cases, therapies using intravenous antibiotics and short-term steroid were effective, but otolaryngologist must also suspect the possibility of sudden upper airway obstruction. We experienced emergency situations regarding airway obstruction in only three cases during the first week of hospitalization.

A Hybrid Carcinoma of Epithelial-Myoepithelial Carcinoma and Adenoid Cystic Carcinoma in Maxillary Sinus

Hybrid carcinoma of the salivary gland is a very rare entity that has been described only in the parotid and palate. The occurrence of a hybrid carcinoma of maxillary sinus has not been reported. The diagnosis of hybrid carcinoma is important particularly when the components of tumor have different biologic behaviors. Diagnosis and treatment require a high index of suspicion, especially when the tumor is an epithelial-myoepithelial carcinoma, pathological effort to look for a more aggressive accompanying tumor, and proper oncologic treatment. We describe a case of 26-yrold woman with a hybrid carcinoma composed of epithelial-myoepithelial carcinoma with an adenoid cystic carcinoma component (cribriform pattern) in the right maxillary sinus with a brief review of the relevant literature.

Clinical Analysis of the 22 Cases of Plunging Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 22 patients treated at Korea University Hospital during a 20-year period. The purpose of this study was to examine the clinical characteristics of plunging ranula in order to provide our experience for its correct diagnosis and treatment. MATERIALS AND METHOD: A retrospective review of 22 patients with this condition was undertaken. Information was collected on age, sex, history of onset, predisposing factors, treatent, post-operative follow-up and outcome of treatment. RESULTS: The patients were all young adults with a median age of 19.8 years old. The sex distribution was male predominant with 15 men and 7 women. Except for one, no patients had any history of preceding trauma to the neck or oral cavity. Six patients had history of previous operation. Managements included 21 surgical approach and one sclerotherapy. There were no recurrences. One patient experienced transient paralysis of the marginal mandibular branch of the facial nerve postoperatively, but it was temporal and was sustained with no further complications. CONCLUSION: The incidence of plunging ranulas was not common. The precise etiology of its predisposition is unknown. Reoval of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition.

A Case of Granular Cell Tumor of the Larynx / 대한이비인후과학회지

Granular cell tumors are relatively uncommon benign laryngeal lesions thought to originate from Schwann cells. The granular cell tumor occurs everywhere in the body, especially in the oral cavity. Most oral cases are located in the tongue. It has no preference for race, sex, and age. Because pseudoepitheliomatous hyperplasia is frequently associated with granular cell tumors, it should be differentiated from squamous cell tumors. Confirmative diagnosis should be made histopathologically and supported by immunohistochemical staining using S-100. Treatment of a granular cell tumor consists of a wide local excision by the endoscopic, transoral or laryngofissure methods. Recently, CO2 laser has been used to remove granular cell tumor with clear resection margin. We have recently experienced a granular cell tumor of larynx, so we report it with a review of literatures.

Effect of Smoking to Warthin's Tumor of Parotid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Warthin's tumor is known to be the second most common benign tumor of the parotid gland. Recent reports describe epidemiological changes of Warthin's tumor in other nations, however its clinical manifestations are still the mainstay of domestic studies. The purpose of this study is to investigate the prevalence of this tumor from various standpoints and the correlation between smoking and the development of Warthin's tumor. MATERIALS AND METHOD: A retrospective review of medical records was carried out on 135 patients who underwent parotid surgery from January 1991 through December 2000 and were diagnosed pathologically as Warthin's tumor and pleomorphic adenoma. RESULTS: The overall incidences of Warthin's tumor and pleomorphic adenoma of parotid gland were 15% and 57% of all parotid tumors, respectively. The male to female ratio for Warthin's tumor was 3.8:1 and the median age at presentation was 57.4 years old. Smoking is significantly associated with the development of Warthin's tumor (p=0.0054). CONCLUSIONS: In this study, smoking seems to be a risk factor in the pathogenesis of Warthin's tumor.

Role of Superoxide Dismutase in Eustachian Tube of Rat with Acute Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Superoxide dismutase (SOD) is an important protective enzyme against biochemical injury associated with inflammatory reaction. SOD are found in the epithelium of the normal middle ears and lesser amounts are found in infected ears. However, the localization of the SOD in the Eustachian tube in the normal and infected ear has been poorly studied. This study attempted to determine the distribution of SOD and how it changes from normal to infected. MATERIALS AND METHODS:We used fifty male Sprague-Dawley rats to observe the SOD expression and the change of its amount in the Eustachian tube using immunohistochemical method and western blotting. RESULTS: In normal rats, SOD was found in the epithelium of Eustachian tube and lower amounts were found in the connective tissue layers. In the streptococcus-infected ears, SOD was found in the similar pattern, but the infected tubal mucosa showed extensive submucosal edema and stained poorly with SOD, compared to the normal Eustachian tube mucosa. The amounts of SOD was 1.48+/-0.44ng/mg of protein in the normal mucosa and decreased markedly to 0.62+/-0.37ng/mg in the infected cosa. CONCLUSION: SOD was identified in the normal Eustachian tube; the amount decreased during the infected period. This finding suggests that SOD may have a protective role in the pathogenic state.

Expression of Fos Protein in Brainstem Vestibular Nuclei of Rat-II. Sinusoidal Acceleration Stimulation- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fos, the protein product of c-fos gene, has been known to be rapidly expressed in neurons following various external and internal stimuli and this protein expression has been used as a neural activation marker in many fields. This experiment was performed to examine the afferent pathway of the lateral semicircular canals following sinusoidal acceleration. MATERIALS & METHODS: To stimulate the lateral semicircular canals, animals received rotary stimulation for 90 minutes with 2.0Hz sinusoidal acceleration. Thirty minutes after stimulation, the subjects were sacrificed and their brainstems were processed for immunohistochemistry to detect Fos expression. RESULTS: Fos proteins were strongly expressed in the superior, dorsal medial vestibular and inferior vestibular nuclei. However, there was no expression in the lateral and ventral portion of medial vestibular nuclei. CONCLUSION: This finding suggested that the afferent pathway from peripheral vestibular end-organ can be successfully mapped by detection of Fos expression and Fos is an useful neural activity marker in the vestibular system.

Primitive Neuroectodermal Tumor of Nasal Cavity: Case Report

The primitive neuroectodermal tumor is a highly malignant small round cell tumor characterized by neuroectodermal origin and poor prognosis. The thoracopulmonary region is known to be the most common site of the disease, with peak incidence during adolescence. Primitive neuroectodermal tumors are very rarely reported in the head and neck area, and there have been only a few involving the nasal cavity. We treated a 60 year-old female patient who had nasal obstruction over a three-month period with radical surgery and postoperative radiation therapy. This paper presents our diagnostic workup and approach in treating this unique tumor, and the immunohistochemical findings. A guideline for the treatment of this aggressive neoplasm is reviewed with our experiences in treating this primitive neuroectodermal tumor of the nasal cavity by combined treatment modalities.