Preoperative Subclinical Hyperthyroidism in Patients With Papillary Thyroid Carcinoma

OBJECTIVES: Numerous studies have reported the effects of subclinical hyperthyroidism on the cardiovascular system, osteoporosis, and metabolic syndrome. However, there are few studies examining the relationships between subclinical hyperthyroidism and thyroid cancer. The aim of this study was to investigate the relationships between preoperative subclinical hyperthyroidism and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC) in terms of thyroid-stimulating hormone (TSH) levels and TSH receptor antibody (TRAb) values. METHODS: Between January 2001 and December 2007, 462 patients were eligible for analysis in our study; we compared the clinicopathological characteristics of 39 preoperative subclinical hyperthyroidism patients with those of 423 euthyroid patients. RESULTS: There were no statistical differences between the 2 groups with respect to age, male to female ratio, primary tumor size, extrathyroidal extension (ETE), multifocality, lymph node metastasis, TNM and AMES stages, recurrence, and survival, despite significant difference in TSH concentrations between the 2 groups. In the evaluation for TRAb, primary tumor size was significantly larger in patients with normal TRAb than in patients with elevated TRAb. When the patients were subdivided into 4 categories according to TRAb values (15.0%), tumor size and ETE were significantly different. However, we could not find linear relationships in the increase or decrease of TRAb values. CONCLUSION: The results of our study suggest that subclinical hyperthyroidism is not independently associated with tumor aggressiveness and prognosis in PTC in spite of reduced TSH levels and increased TRAb values as compared with euthyroid patients.

Oncocytic Sialolipoma of the Submandibular Gland

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.

A Case of Kaposi's Sarcoma on Oropharynx and Hypopharynx in Human Immunodeficiency Virus-Negative Patient / 대한이비인후과학회지

The number of patients diagnosed with Kaposi's sarcoma has grown steadily since it was first discovered in 1972 by Moric Kaposi, a Hungarian dermatologist. Kaposi's sarcoma can be classified into four subtypes according to clinical form, epidemiology, and prognosis: idiopathic, endemic or African, immunosuppresion related, and acquired immunodeficiency syndrome related or epidemic Kaposi's sarcoma. A single idiopathic Kaposi's sarcoma in the head and neck area is very rarely found in an immunocompetent person. We experienced a case of Kaposi's sarcoma of the oropharynx and hypopharynx. The patient was healthy 70-year-old man and had no signs of being human immunodeficiency virus positive or immunocompromised. The patient was treated with inductive chemotherapy using capecitabine (Xeloda(R))/cisplatin followed by radiotherapy to a total 54 Gy.

Inadvertent Parathyroidectomy during Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. MATERIALS AND METHODS: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. RESULTS: Inadvertent parathyroidectomy was identified in 7.4% of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size, coexisting Hashimoto's thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon's experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size > or =1 cm and surgeon's experience or =1 cm and short surgical experience of surgeons, especially in the case of TT with CND. Therefore, we suggest that more accurate risk stratification should be made for routine CND, when it is performed by young surgeons.

A Case of Unilateral Absence of the Submandibular Gland Secondary to Sialolithiasis / 대한이비인후과학회지

Absence of major salivary glands, especially those of occurring unilaterally or secondary to Wharton's duct stone, is a rare disorder, A case of unilateral submandibular gland absence occurring secondary to Wharton's duct stone was presented in a 51-year-old male. Using the ultrasonography (USG) and computerized tomography (CT), the absence of the submandibular gland was confirmed. The patient had long-term history of sialolithiasis of the right submandibular gland, so the right submandibular gland was suspected of having acquired a change due to sialolithiasis. The present case would be a second report demonstrating a case of unilateral submandibular gland absence occurring secondary to stones, suggesting that, without ligation of submandibular nerves, the obstruction of excretory duct of a submandibular gland could lead to a complete atrophy of the gland in human.