Analysis of Treatment Results after Thyroid Lobectomy with Prophylactic Ipsilateral Central Neck Lymph Node Dissection for Low-Risk Papillary Thyroid Carcinoma: A Single Institute Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical options for low-risk papillary thyroid carcinoma (PTC) have been in debate. The purpose of this study was to analyze the treatment results of lobectomy and prophylactic ipsilateral central lymph node dissection (cND) for low-risk PTC. SUBJECTS AND METHOD: We retrospectively analyzed 906 patients who were diagnosed as PTC pre- or post-operatively and underwent lobectomy and/or prophylactic ipsilateral cND from 2001 to 2010. Studied variables were clinicopathologic data, complications, sites of recurrence, overall survival, and recurrence free survival rates. RESULTS: Fifty two (5.7%) patients showed recurrence during follow-up. Of the 52 recurrent cases, 32 (61.5%) cases recurred in a remnant thyroid only, 11 (21.2%) cases in a lymph node (LN) only, and 9 (17.3%) cases in a remnant thyroid and the LN. One (0.1%) patient showed permanent vocal cord palsy. Overall survival rate at 10 years was 99.6%. Overall recurrence free survival rates at 5 and 10 years were 97.1% and 81.0%, respectively. Risk factors for recurrences were old age (>45), contralateral nodule(s) at initial surgery, large tumor, no prophylactic cND, and pathological LN metastasis. CONCLUSION: Lobectomy with prophylactic ipsilateral cND may be a good option for low risk PTC patients due to excellent overall survival rates, recurrence rates, and minimal complication rates.

Clinical Features and Outcomes of Papillary Thyroid Carcinoma in Patients Aged under 20 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma rarely occurs in children and adolescents, whose clinical features are diverse, and treatment outcomes are still controversial. The aim of this study was to evaluate the clinical features and the treatment outcomes of papillary thyroid carcinoma (PTC) patients younger than 20 years old. SUBJECTS AND METHOD: This is a retrospective study for patients younger than 20 years old, who were diagnosed as PTC from January 1992 to February 2009. Clinical features, size, pathologic type, extrathyroidal extension, recurrence, multiplicity, extent of surgery, and lymph node metastasis were retrospectively evaluated. RESULTS: Forty patients, of 6 malse and 34 females, were enrolled, with their mean age being 16 years old. The initial operations were total thyroidectomy for 9 patients, unilateral lobectomy for 15 patients, and total thyroidectomy and lateral neck dissection for 16 patients. Cervical lymph node metastases were diagnosed in 25 patients. Extrathyroidal extensions were observed in 30 patients. Postoperative radioactive iodine therapy was performed in 35 patients. During the follow-up period, 8 patients had recurred. All patients were alive at the last follow-up. CONCLUSION: PTC in children and adolescents aged under 20 is a rare disease and tends to present as an advanced disease with low mortality compared to adult PTC. Recurrence had no effect on survival. Aggressive treatment with total thyroidectomy, central neck dissection, and radioiodine therapy may prevent recurrence.

A Case of Parathyroid Carcinoma Presenting as Brown Tumors / 대한이비인후과학회지

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.

A Case of Pancreatitis Associated with Hyperfunctioning Intrathyroidal Parathyroid Adenoma / 대한이비인후과학회지

Both intrathyroidal parathyroid adenoma and acute pancreatitis from hyperparathyroidism are rare disorders. We report a case of acute pancreatitis from hyperfunctioning intrathyroidal parathyroid adenoma in a 40-year-old man with severe abdominal pain. Serum chemistry values show-ed high amylase, lipase, calcium and intact parathyroid hormone level, and abdominal CT revealed acute pancreatitis. A 7 mm lesion was detected inside the left upper pole of thyroid on neck ultrasonography and confirmed to be a parathyroid lesion based on fine needle aspiration cytology. After exploratory parathyroidectomy, symptoms subsided. In patients who present with acute pancreatitis, hyperparathyroidism should also be considered if risk factors such as alcohol ingestion, gallstone, previous endoscopic retrograde cholangiopancreatography, and abdominal trauma do not exist. Exploratory parathyroidectomy should be performed in a case of acute pancreatitis from primary hyperparathyroidism.

Clinical Characteristics of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC) and has been adopted as a histologic variant. Due to the limited number of cases and the heterogeneity of the tumor's clinical behavior, there is no consensus for DSV's optimal treatment and post-operative follow-up. The purpose of this study is to evaluate the clinical manifestation, recurrence and prognosis of 10 patients with DSV. SUBJECTS AND METHOD: We retrospectively reviewed ten consecutive patients in whom DSV was first observed between 2000 and 2012. All patients are presently under active follow-up at Korea Cancer Center Hospital. Patients underwent a total thyroidectomy with central compartment and laterocervical lymph node dissection only when this involvement was documented by pre-surgery ultrasound examination with fine needle aspiration biopsy. RESULTS: The mean observation interval was 41.6 months. The ratio of male to female was 1 : 9, and the age of incidence was 34.2+/-11.4. The average size of mass was measured 2.9+/-1.9 cm. Upon the diagnosis, eight cases had central and lateral neck lymph nodal metastasis, which was confirmed during the operation. There was no distant metastasis, but one case was confirmed with lung metastasis during the follow-up period. There was no mortality during the follow-up periods in all ten cases. CONCLUSION: DSV of PTC has high risk characteristics of large tumor size, extrathyroidal extension, and multiple lymph nodes metastasis. We may expect comparable outcome with classical PTC by proper surgical treatment and postoperative radioactiveiodine ablation.