Enucleation for the Management of the Parotid Warthin's Tumor

PURPOSE: Warthin's tumor is a slow growing tumor found exclusively either in the parotid gland or the periparotid lymph nodes. Although surgical resection is the treatment of choice, the extent of surgery which is most beneficial has remained contraversial. We performed a comparative study of the results between enucleation and parotidectomy groups to evaluate the effectiveness of the enucleation procedure for the surgical management of parotid Warthins tumor. METHODS: Between January 1981 and July 2001, 74 patients underwent surgical resection of parotid Warthin's tumor. We reviewed the clinicopathological characteristics retrospectively and compared the operation time, postoperative complication rate, duration of postoperative hospital stay and recurrence between the enucleation group and the parotidectomy group. RESULTS: The mean age was 57.0 years (19~86 years) and the male to female ratio was 5.7: 1. The majority of the tumors were situated in the lower region of the superficial lobe (89.2%). Bilateral simultaneous involvements of the parotid gland was found in 5 patients (6.8%) and therefore a total of 79 parotid glands were involved. Four (5.4%) of the 79 parotid glands featured multifocal tumors of two or three lumps. Tumor sizes varied from 0.5 to 13.0 cm with a mean diameter of 3.5 cm. Of the 74 patients, 51 (68.9%) were diagnosed preoperatively or perioperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 79 glands, 46 underwent a superficial (n=39), partial (n=2) or total (n=5) parotidectomy, while enucleation was performed for the remaining 33 cases with single Warthin's tumor. Only one case of recurrence was identified during the follow up period. However the operation time, the postoperative complication rate, and the duration of postoperative hospital stay were all significantly reduced in the enucleation group (P<0.05). CONCLUSION: The enucleation procedure may represent a safe and appropriate surgical method for patients with single Warthin's tumor that is diagnosed preoperatively.

Hyperfunctioning Parathyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Most cases of primary hyperparathyroidism are due to either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We undertook a retrospective study in 4 patients with functioning parathyroid carcinoma, with the aim of conveying experience from management of this rare cause of kyperparathyroidism. METHODS: Clinical simptoms, biochemical laboratory, radiologic, and intraoperative findings, extent of surgical resection. histologic findings, local recurrence and distant metastasis were analysed in 4 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 1998. RESULTS: Mean age was 46.7 years (33~51 years) and male to female ratio was 1:3. Neck mass was found in 3 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidsm in all the cases, mean serum calcium level was 11.1 mg/dl (10.5~12.0 mg/ dl), slightly elevated. Laboratory values after surgery were within the normal range in 3 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 2 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During followup period, any local or systemic recurrence were not evident in all the cases. CONCLUSION: Although functioning parathyroid carcinoma is a rare disease and its preoperative diagnosis, in general, cannot easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important fo the management of the parathyroid cancer.

Hyperfunctioning Parathyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Most cases of primary hyperparathyroidism are due to either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We undertook a retrospective study in 4 patients with functioning parathyroid carcinoma, with the aim of conveying experience from management of this rare cause of kyperparathyroidism. METHODS: Clinical simptoms, biochemical laboratory, radiologic, and intraoperative findings, extent of surgical resection. histologic findings, local recurrence and distant metastasis were analysed in 4 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 1998. RESULTS: Mean age was 46.7 years (33~51 years) and male to female ratio was 1:3. Neck mass was found in 3 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidsm in all the cases, mean serum calcium level was 11.1 mg/dl (10.5~12.0 mg/ dl), slightly elevated. Laboratory values after surgery were within the normal range in 3 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 2 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During followup period, any local or systemic recurrence were not evident in all the cases. CONCLUSION: Although functioning parathyroid carcinoma is a rare disease and its preoperative diagnosis, in general, cannot easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important fo the management of the parathyroid cancer.

Extraovarian Granulosa Cell Tumor

A 54-year-old woman was admitted to our hospital complaining of postcoital bleeding. Sonography of the abdomen showed a 8.2 x 8.9 cm-sized solid heterogeneous mass occupying the cul-de-sac, which appeared to be in no way connected with the ovary. On exploratory laparotomy, the tumor mass protruded from the posterolateral retroperitoneum of the pelvic cavity and severely replaced the uterus and adnexa with the outer surface being grossly intact. It grossly measured 10 cm in maximal diameter. The histologic features closely resembled those of ovarian granulosa cell tumor. The primary extraovarian granulosa cell tumor is extremely rare such that in the English literature only 7 cases have been reported to date. Of those granulosa cell tumors are especially rare and only two cases have been reported to arise from retroperitoneum. We herein present a case of retroperitoneal granulosa cell tumor with special regard to differential diagnosis from other solid tumors with similar histology.