Endometriosis of the Appendix

Endometriosis is a well-recognized gynecological condition in the reproductive age group. Endometriosis of the appendix is an entity of extragonadal endometriosis. The incidence of appendiceal endometriosis is lower than 1% among pathologies of pelvic endometriosis. Women can present with symptoms mimicking acute appendicitis or chronic pelvic pain. Diagnosis can be made only after a histopathological examination following the operation. We report here a case of appendiceal endometriosis, which were operated on for a prediagnosis of acute appendicitis, but postoperatively diagnosed as appendiceal endometriosis.

Interdigitating dendritic cell sarcoma occured alone in axilla / 대한외과학회지

Interdigitating dendritic cell sarcoma (IDCS) is a very rare disease around the world and its prognosis is known to be aggressive. This reports a case diagnosed as IDCS of the axillary region treated in Soonchunhyang University Hospital. A 57-year-old female visited Soonchunhyang University Hospital with a left axillary mass. The mass was hard and fixed. Computed tomography observed a 7 cm lymph node at the left axilla, and core biopsy suspected sarcoma. In another study, there was no specific finding except the axillary lesion. Left axillary lymph node dissection (level I, II) was conducted and the pathologic report finally showed IDCS. The patient was treated with only radiotherapy and followed up without recurrence for 13 months up to now. IDCS is a very rare sarcoma that is hard to diagnose and progresses fast. Thus, treatment is very difficult. Proper treatment can be better established after more experiences.

Association between Preoperative Serum TSH Level and Papillary Thyroid Cancers / 대한내분비외과학회지

PURPOSE: Recent research has shown that there is a relationship between the level of preoperative serum TSH and a papillary thyroid carcinoma. Therefore, this study examined the correlation between the serum TSH and papillary thyroid carcinoma. METHODS: The preoperative serum TSH level of papillary thyroid carcinoma and nodular hyperplasia of 418 patients from 2009 Jan. to 2011 Dec. was examined. The patients were divided into 3 groups, nodular hyperplasia, less than 1 cm micropapillary carcinoma and more than 1 cm papillary carcinoma, and their TSH levels were compared. RESULTS: Nodular hyperplasia and total papillary carcinoma was found in 98 (23.0%) and 322 (77.0%) patients, respectively. After dividing the patients according to the size of the mass, there were 224 (53.6%) patients with a mass less than 1 cm in size and 98 (23.4%) patients with a mass more than 1 cm in size. The preoperative serum TSH level of the 3 groups showed a significant difference, which was 1.180±1.168 μIU/ml in the nodular hyperplasia group, 1.670±1.224 μIU/ml in the micropapillary carcinoma group and 2.279±2.837 μIU/ml in the papillary carcinoma group (P<0.001). On the other hand, there were no significant correlations between the preoperative serum TSH level and gender, age, metastasis to lymph node, number of masses and extrathyroidal extensions. CONCLUSION: The larger size of the papillary thyroid carcinoma, the higher the preoperative high serum TSH level. Therefore, the stimulation of TSH can affect the progression of papillary thyroid carcinoma but more study will be needed.

Hyalinizing Trabecular Tumor of the Thyroid Gland / 대한내분비외과학회지

A Hyalinizing Trabecular Tumor (HTT) is a very rare tumor. We report one case that was confirmed to be HTT after an operation. A 44-year-old female visited our hospital with about a 1.3-cm-sized mass on the left thyroid. Fine Needle Aspiration Biopsy (FNAB) indicated papillary thyroid cancer. After a left hemithyroidectomy, a frozen section biopsy reported the possibility of HTT. Therefore, we did not proceed with the surgery. According to the final report, she was diagnosed with HTT. Five lymph nodes were dissected and were found to be benign. Thyroid transcription factor-1 and neuron specific enolase were positive, and in addition calcitonin was negative. Ki-67 was recorded to be less than 5%. She was discharged without any complication. HTT is benign in most cases, but the possibility of malignancy should be considered. Because it is hard to differentiate between it and PTC or MTC, an accurate diagnosis through histologic examination of specimens and surgical resection is necessary.

Clinicopathologic change of gastrointestinal stromal tumor after neoadjuvant imatinib followed by surgical resection / 대한외과학회지

A 53-year-old woman was diagnosed with gastrointestinal stromal tumor (GIST) of the stomach. Computed tomography (CT) revealed a huge mass (12 cm in diameter), likely to invade pancreas and spleen. In the operation field, the tumor was in an unresectable state. The patient was then started on imatinib therapy for 4 months. On follow-up imaging studies, the tumor almost disappeared. We performed total gastrectomy and splenectomy upon which two small-sized residual tumors were found on microscopy. In this paper, we describe a case of clinicopathologic change in unresectable GIST after neoadjuvant imatinib mesylate.

C-arm Guided Surgical Excision of Heterotopic Calcification

PURPOSE: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. METHODS: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. RESULTS: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. CONCLUSION: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.

Clinical Experience with Nasolabial Cysts Using the Sublabial Approach

PURPOSE: A nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst arising anywhere on the face inferior to the nasoalar region. It is thought to arise from either epithelial remnants trapped along the lines of fusion during the development of face or the remnants of the developing nasolacrimal duct. This study examines various features of nasolabial cysts with bony involvement to provide a basis for correct diagnosis and treatment. METHODS: Eight cases of nasolabial cyst treated in Soonchunhyang Hospital between March 2002 and July 2010 were examined in terms of their clinical features and radiological and histological findings. Seven patients underwent surgical excision of the cyst via an intraoral, sublabial approach. One underwent incision and drainage. RESULTS: Our eight patients were seven women and one man. The most frequent symptoms and signs were facial deformity and swelling of the nasolabial fold. Computed tomography(CT) showed a well-circumscribed cystic mass lateral to the pyriform aperture. Seven cases had erosive lesions on CT, and the intraoperative findings were consistent with a nasolabial cyst with a bony defect. Typical histopathological findings showed that these cysts were most frequently lined with respiratory epithelium with ciliated columnar cells and cuboid cells. No patient developed complications or recurrences. CONCLUSION: A nasolabial cyst is often unrecognized or confused with other intranasal masses, including fissural and odontogenic cysts, midface infections, or swelling in the nasolabial area. Therefore, a careful clinical and radiological evaluation should be preformed when considering the differential diagnosis. We present eight patients with nasolabial cysts treated via a gingivobuccal approach with excellent functional and cosmetic results.

A Case Report of Vacuum-assisted Management for Esophageal Perforation after Total Thyroidectomy / 대한내분비외과학회지

A careful approach is required for managing esophageal perforation after thyroidectomy, and esophageal perforation can cause serious infectious complications. However, reports on the treatment and management of esophageal perforation after thyroidectomy are lacking. We report here on a case of esophageal perforation that was successfully managed using vacuum-assisted closure. A patient underwent total thyroidectomy for papillary carcinoma. Near the lower pole of the left thyroid, a metastatic lymph node with direct invasion to the esophagus was detected. The esophageal wall, which was injured during lymph node dissection, was repaired. An esophageal leak occurred on the 5th postoperative day, and a 1 cm sized esophageal wall defect was identified. After irrigation, the defect was primary repaired, and the wound was closed using a vacuum assisted closure system. The patient was kept in a oral-fasting state, and subsequent wound dressing with vacuum change was repeated every 3~4 days. During this period, gradual formation of granulation tissue was noted. After negative leakage was confirmed by an esophagogram on the 18th postoperative day, the patient resumed an oral intake. The wound was closed successfully on the 22nd postoperative day, and the patient was safely discharged one week later. In conclusion, vacuum assisted wound closure could reduce the risk of infection and also induce granulation tissue. We think this could be an alternative treatment strategy for esophageal perforation after thyroidectomy.

The Correlation of Serum HER-2/neu and CA15-3 in Patients with Metastatic Breast Cancer / 한국유방암학회지

PURPOSE: The extracellular domain (ECD) of the HER-2/neu oncoprotein, whose molecular weight is the range from the 95 kD to 105 kD, is shed into the blood from the cell surface via, proteolysis by a metalloprotease. A monoclonal antibody immunoassay has been developed for measuring the circulating concentrations of serum HER-2/neu ECD (following serum HER-2/neu). Serum HER-2/neu has been reported to be correlated with an increased tumor volume in those patients suffering with breast cancer. We measured the serum CA15-3 level, which is a surrogate marker of the tumor burden, we analyzed the correlation of the serum CA15-3 with the serum HER-2/neu and we analyzed the association of both markers with the clinical outcomes. METHODS: The sera for the analysis of both HER-2/neu and CA15-3 were obtained from 99 healthy Korean women, 66 primary breast cancer patients and 43 metastatic breast caner patients. The serum HER-2/neu level was measured quantitatively with using an ADVIA Centaur(R) automated immunoassay analyzer (Bayer Health Care LLC, Diagnostics Division, Tarrytown, New York, USA) and the CA 15-3 level was measured via radioimmunoassay. RESULTS: The serum HER-2/neu level was increased 23 metastatic cancer patients (53%). On the analysis of the correlation of serum HER-2/neu and CA15-3, the correlation coefficient (r) was 0.8072. Thus a positive serum HER-2/neu test in breast cancer patients was highly associated with the CA15-3 level for assessing whether metastasis was present or not. For the relationship between primary breast cancer and metastatic breast cancer, the former was classified as the control group and the latter as the patient group. The results of the Receiver Operation Characteristic (ROC) curve for serum HER-2/neu and CA15-3 showed no statistically significant differences (p=0.176) but the diagnostic efficacy of the serum HER-2/neu test was measured more exactly than that of CA15-3 and CA15-3 a tool for measuring a tumor marker for the diagnosis of whether metastasis was present or not. CONCLUSION: Serum HER-2/neu is a significant independent predictive prognostic factor for metastatic breast cancer patients. In view of the results we have achieved so far the serum HER-2/neu level in metastatic breast cancer patients may play an important roll as an independent tumor marker.

Management of Cecal Diverticulitis

PURPOSE: Diverticular disease of the cecum and ascending colon is a relatively uncommon disease, and is often difficult to diagnose. The purpose of this study was to investigate the clinical features of patients who underwent surgical treatment for cecal diverticulitis. METHODS: A retrospective review was conducted between January 1998 and December 2002 of 44 patients treated at the Department of Surgery, Soonchunghyang Gumi Hospital. RESULTS: All patients presented with right lower quadrant pain and tenderness. Preoperatively, 34 patients were diagnosed with acute appendicitis. The surgical procedures for cecal diverticulitis were an appendectomy only (5 cases), a diverticulectomy with appendectomy (31 cases), and a right hemicolectomy (8 cases). Postoperative complications were found in 17 cases: wound infection (13 cases), and partial intestinal obstruction (2 cases). CONCLUSIONS: When cecal diverticulitis is found at the time of an operation, surgical management is a safe treatment with low morbidity and a low recurrence rate. A diverticulectomy with appendectomy is a safe and effective procedure for the treatment of cecal diverticulitis if there is no evidence of free perforation or abscess formation. If the diverticulitis is complicated, undistinguishable from a malignancy, a resection (ileocecal resection, right hemicolectomy) should be considered for the surgical treatment.