A Case of Adenosquamous Carcinoma Arising from the Tonsil / 대한이비인후과학회지

Adenosquamous cell carcinoma of tonsil is a rare lesion of head and neck and is often misdiagnosed as squamous cell carcinoma. It has a very aggressive clinical pattern. We encountered a patient with an adenosquamous cell carcinoma of tonsil and performed various treatment modalities including surgical resection, radiation therapy, chemotherapy but the patient expired two years after the first diagnosis. Such case has never been reported earlier in Korea. Herein, we present this rare case with a review of related literature.

A Case of Adenosquamous Carcinoma Arising from the Tonsil / 대한이비인후과학회지

Adenosquamous cell carcinoma of tonsil is a rare lesion of head and neck and is often misdiagnosed as squamous cell carcinoma. It has a very aggressive clinical pattern. We encountered a patient with an adenosquamous cell carcinoma of tonsil and performed various treatment modalities including surgical resection, radiation therapy, chemotherapy but the patient expired two years after the first diagnosis. Such case has never been reported earlier in Korea. Herein, we present this rare case with a review of related literature.

A Case of Lymphoepithelioma-Like Carcinoma in the Thyroid Gland / 대한이비인후과학회지

Lymphoepithelioma-like carcinoma exhibits immunohistochemically similar features to lymphoepithelioma and commonly occurs in the skin, salivary gland, breast, lung, gastrointestinal tract, liver, urinary tract, prostate, vulva and vagina. Lymphoepithelioma-like carcinoma from the thyroid gland is extremely rare. We recently experienced a case of lymphoepithelioma-like carcinoma of thyroid gland in a 28-year-old female, who presented a thyroid nodule that was suspicious of papillary carcinoma. We report this unusual case of lymphoepithelioma-like carcinoma of thyroid gland with a brief review of literature.

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.

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.

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 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.

Factors Associated with Metastatic Lymph Node Ratio, Extranodal Extension in the Central Compartment Node-Positive Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Lymph node (LN) metastasis occurs in 30-80% of patients presenting for initial treatment of papillary thyroid carcinoma (PTC). The presence of LN metastasis is an independent risk factor for recurrence, which can add significant treatment morbidity. The LN ratio (LNR) and extranodal extension (ENE) have been shown to be important prognostic factors in PTC. The purpose of this study was to assess the characteristic features of LNR and ENE. SUBJECTS AND METHOD: We undertook a retrospective study of 411 patients treated between January, 2011 and December, 2013 for central compartment node-positive PTC by thyroidectomy and central compartment neck dissection (CCND) at our institution. We compared various clinicopathologic parameters such as age, gender, tumor size, multifocality, bilaterality, local invasion, extrathyroidal extension and aggressive variants between LNR and ENE. RESULTS: The significant associated factors for high LNR (defined as higher than 0.5) in multivariate analysis were gender (p=0.001, odds ratio=2.285) and multifocality (p=0.027, odds ratio=2.092). On the other hand, the significant associated factors for ENE in multivariate analysis were primary tumor size (p=0.023, odds ratio=1.965) and local invasion (p=0.043, odds ratio=1.870). CONCLUSION: Being male, multifocality, large primary tumor size (defined as larger than 1 cm) and local invasion were revealed as associated factors for LNR and ENE. Therefore, elective CCND should be considered for patients with PTC, for whom a thorough investigation of associative factors should be made before surgery.

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.

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.

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.

The Clinical Effectiveness of the Minimally Invasive Transcanal Myringotomy for the Removal of Early Stage Congenital Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because of the wide application of the endoscopic diagnostic system and increased amount of attention for early stage congenital cholesteatoma (CC) recently, the detection of CC in stages I and II has increased. In this study, we investigated the effectiveness of minimally invasive transcanal myringotomy (MITM), and compared its results with those of postauricular approach (PAA) in early stage CC consisting of stage I and II of Potsic's classification. SUBJECTS AND METHOD: We retrospectively studied 70 patients who were diagnosed with CC after surgery performed by an otologist from June 2006 to June 2013. Thirty-two patients were in early stage CC consisting stage I and II. Of the 32 patients, MITM was performed on 20 and PAA was performed on 12. We analyzed the characteristics of disease, operation time, hospitalization period, recurrence and complications according to the stage and each operation. RESULTS: There were no significant differences between the stages and types of the disease between the MITM and the PAA group (p>0.05). The operation time and hospitalization period for the MITM group were significantly shorter than for the PAA group (p<0.001). There was no recurrence in the two groups during the average follow-up period of 33 months follow-up. Tympanic membrane perforation occurred in one patient in the MITM group. One patient presenting an external aural epidermal cyst in the PAA group was treated with surgical removal. CONCLUSION: The MITM is an efficacious and feasible method to remove early stage CC.

A Case of Adenosquamous Carcinoma Arising from the Base of Tongue / 대한이비인후과학회지

Adenosquamous carcinoma (ASC) of the head and neck is a rare malignancy. This entity was first described in 1968 by Gerughty, et al. Nowadays, ASC is defined in the World Health Organization classification of tumors of the upper respiratory tract and ear as a malignant tumor with histological features of both adenocarcinoma and squamous cell carcinoma. We report a case of adenosquamous carcinoma arising from the base of tongue salvaged by transoral robotic surgery with review of literature.

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.

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.

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.

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.

The Treatment Outcomes of Medullary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the treatment outcomes of medullary thyroid carcinoma (MTC) by retrospective data analysis. SUBJECTS AND METHOD: We conducted a retrospective chart review of 17 cases of pathologically proven MTC patients who were treated from 1998 to 2010 at the department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine. RESULTS: The mean tumor size was 2.32 cm (0.5-3.4 cm). Seventy-one percent of patients were diagnosed with advanced stage (III or IV) of MTC. We performed RET genetic screening in 8 of 17 patients. Hereditary MTC was found in 3 of 17 patients (18%) and sporadic MTC was found in 14 of 17 (82%). The preoperative assessment of basal serum calcitonin (CT) level was performed in 15 of 17 patents. Eleven patients had elevated basal calcitonin levels (>13 pg/mL). After the operation for MTC, the serum CT levels were elevated in 7 patients. Overall 5-year survival rate was 94%. Normalization of serum calcitonin level was accomplished more frequently in the absence of extra thyroidal invasion (p=0.034), multifocal tumor (p=0.02). CONCLUSION: The initial treatment of MTC is total thyroidectomy with central compartment neck dissection with or without lateral neck dissection. To detect recurrence or metastasis, regular checking of serum calcitonin is necessary. A better knowledge of prognostic factors could improve the management of MTC patients.