A Case of Adenosquamous Carcinoma Ex Pleomorphic Adenoma of Submandibular Gland / 대한이비인후과학회지

We experienced a case of carcinoma ex pleomorphic adenoma arising in the submandibular gland of a 47-year-old male patient. The patient underwent submandibular gland ressection and supraomohyoid neck dissection. Histologic examination revealed that the malignant component of carcinoma ex pleomorphic adenoma was adenosquamous carcinoma. The patient refused postoperative radiation therapy and tumor recurred at the neck and lung about 18 month later. Modified radical neck dissection was carried out, and additional postoperative radiotherapy and palliative chemotherapy were initiated. To the best of our knowledge, this is the first case of carcinoma ex pleomorphic adenoma, of which the malignant component is adenosquamous carcinoma in the submandibular gland. Therefore the authors report this rare case with a literature review.

Differential effects of CXCR4 antagonists on the survival and proliferation of myeloid leukemia cells in vitro

BACKGROUND: Antagonists of CXC chemokine receptor 4 (CXCR4), including AMD3100, induce peripheral mobilization of hematopoietic stem cells and have been approved for clinical use. We explored whether the CXCR4 antagonists affected the survival and proliferation of myeloid leukemia cells in vitro. METHODS: The effects of CXCR4 antagonists AMD3100 and T140 on the survival and proliferation of myeloid leukemia cell lines (U937, HL-60, MO7e, KG1a, and K562) as well as CD34+ cells obtained from patients with AML and CML were analyzed by flow cytometry by using annexin V and a colorimetric cell proliferation assay. RESULTS: AMD3100, but not T140, stimulated the proliferation of leukemia cells in vitro in a dose-dependent manner for up to 5 days (~2-fold increase at a concentration of 10-5 M), which was not abrogated by pretreatment of the cells with pertussis toxin, but was attenuated by RNAi knockdown of CXCR7 transcripts. In contrast, AMD3100 induced a marked decrease in the cell numbers after 5-7 days. AMD3100, but not T140, induced phosphorylation of MAPK p44/p42. AMD3100 increased the number and size of leukemia cell colonies and reduced cell apoptosis during the first 5-7 days of incubation, but the phenomena were reversed during the later period of incubation. CONCLUSION: The effects of CXCR4 antagonists on the proliferation of myeloid leukemia cells are not uniform. AMD3100, but not T140, exerts dual effects, initially enhancing and subsequently inhibiting the survival and proliferation of the cells in vitro.

Acute Low Tone Sensorineural Hearing Loss: Consideration for Progression to Meniere's Disease / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Low tone sensorineural hearing loss is deterioration in audiometric low frequencies (250 and 500 Hz), preservation of high frequencies (2, 4, and 8 kHz). The aim of this study is to find out differences of clinical manifestation and prognosis of acute low tone sensorineural hearing loss (ALHL), a subtype of sudden sensorineural hearing loss, and potential progression to Meniere's diseases. MATERIALS AND METHODS: Among 465 patients with unilateral hearing loss initially diagnosed with sudden sensorineural hearing loss, we analyzed clinical characteristics of 96 patients who had acute low tone sensorineural hearing loss, but had no history of previous ALHL. RESULTS: The clinical features of ALHL include a predominance of female suffers (72.9%), more dizziness (36%), high incidence of sound perception change (16.7%), tinnitus (42.8%), and ear fullness (20.8%). The prognosis shows recovery in 67.7% of patients. However, 24.0% of patients show recurrence of low tone loss, and 15.6% develop Meniere's disease. Specially, if the dizziness symptoms were accompanied, progression to Meniere's disease was more common (31.4%). CONCLUSION: Our RESULTS: appear that clinical characteristics were different in the ALHL patients compared to the idiopathic sensorineural hearing loss patients. Therefore, when dizziness, ear fullness and tinnitus are accompanied with low tone hearing loss, an appropriate patient education on possible progression to Meniere's disease is necessary.

Clinical Characteristics of Papillary Thyroid Microcarcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Most papillary thyroid microcarcinoma (PTMC) carry a favorable prognosis, but a few patients present with aggressiveness. We classified PTMC according to the tumor size, and investigated the treatment, pathological finding and clinical behavior. SUBJECTS AND METHOD: Out of 714 patients submitted to surgical treatment for well differentiated thyroid cancer between 1996 and 2006, 179 (25%) patients had been identified as PTMC. These records were reviewed retrospectively, and followed up for 4 to 114 months (mean 43.3 months). RESULTS: The incidentaloma was 53 from 179 PTMC. The surgical procedures were hemithyroidectomy (n=79) or total thyroidectomy (n=100) including completion thyroidectomy. In the pathologic finding, 46 cases (25%) had extrathyroidal extensions and 37 cases (20%) had lymph node metastasis. In the total thyroidectomy cases, 35 cases had multiplicity, including 18 bilateral cases. When mass sizes were divided into those either bigger or smaller than 5 mm, statistical significance was found only in the extrathyroidal extensions (p=0.023). There were 2 recurrences in the total thyroidectomy cases and 4 in hemithyroidectomy, but without any statistical difference. With respect to size, there was only 1 recurrence in patients whose mass size was smaller than 5 mm and 5 in patients whose mass size was bigger than 5 mm; there was no statistical difference, however. CONCLUSION: Pathologically, extrathyroidal extension was more common in cases with tumor size more than 5 mm. This finding could be the evidence of poorer prognosis in these cases. However, there was no difference in the recurrence rate between the groups of different sizes and thyroidectomy methods. Therefore, surgical options should be carefully decided in the treatment of PTMC.

Role of the "Mini" Caldwell-Luc Operation for Treatment of Chronic Maxillary Sinusitis

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

Usefulness of Sialendoscopy in Unusual Obstructive Salivary Ductal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ductal calculi and stenosis are well known causes of salivary ductal obstructive lesions. As a direct view of the ductal systems was not possible for the surgeons, sialendoscopy has been a convenient tool for finding out these obstructive lesions. This study contains some unusual endoscopic findings that we have found during diagnostic and interventional sialendoscopy. SUBJECTS AND METHOD: Retrospective chart reviews were done, and endoscopic findings were reviewed for patients who received sialendoscopy from September 2003 to January 2007. Sixtyfour patients received sialendoscopy for either diagnostic or interventional method. RESULTS: We found unusual findings in 7 cases (10.9%). Three cases of basin malformation were observed. Two cases had spontaneous ductal perforation, and we also observed 2 cases of occult stone. CONCLUSION: The sialendoscopy is an excellent method in evaluating and treating salivary ductal diseases. We found out that the sialendoscopy made it possible to explore ductal systems completely, as well as to detect unusual findings, and to help in the management of some salivary ductal diseases.

A Comparison of Histopathologic Findings in the Nasal Polyp, Maxillary Sinus Mucosa, and Inferior Turbinate Mucosa

BACKGROUND AND OBJECTIVES: The nasal polyp is the most common form of mass lesion in the nose with an unclear etiology and pathogenesis among patients in Asia. Also, the pathological characteristic of nasal polyps in these patients is eosinophil infiltration. These findings, as reported in Asia, are distinct from those of the West. Moreover, the role of eosinophil is recently found to be on the increase even in Asia. So, we investigated the proportion of eosinophil infiltration in the nasal polyp among patients in Korea. MATERIALS AND METHODS: The study group consisted of 35 patients with a mean age of 43 years (ranging from 6 to 72 years). Tissue samples were taken via endoscopic sinus surgeries from the nasal polyp, inflammatory sinus mucosa, and the inferior turbinate. We compared 5 parameters of mucosal histopathology. RESULT: The incidence of a severe eosinophilic infiltration in the nasal polyp was 70%. Nasal polyp and inflammatory sinus mucosa had a larger eosinophil, lymphocyte and polymorphonuclear leukocyte infiltration than a normal nasal mucosa. Also, the nasal polyp and sinus mucosa had a more severe basement membrane thickening and goblet cell hyperplasia. Distinctively, the nasal polyp had a severe eosinophilic infiltration and a more thickened basement membrane. CONCLUSION: The present histopathologic feature of the nasal polyp among Koreans indicates that cases of eosinophilic nasal polyp seems to be on the increase.