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Objectives@#. The mitochondrial ribosomal protein L14 (MRPL14) is encoded by a nuclear gene and participates in mitochondrial protein translation. In this study, we aimed to investigate the role of MRPL14 in thyroid cancer. @*Methods@#. We investigated the association between MRPL14 expression and clinicopathological features using The Cancer Genome Atlas (TCGA) and Chungnam National University Hospital (CNUH) databases. Functional studies of MRPL14, including proliferation, migration, invasion, mitochondrial oxidative phosphorylation and reactive oxygen species (ROS) production, were performed in papillary thyroid cancer (PTC) cell lines (B-CPAP and KTC-1). @*Results@#. Based on the TCGA dataset, PTC tissues lost mitochondrial integrity and showed dysregulated expression of overall mitoribosomal proteins (MRPs) compared with normal thyroid tissues. Of 78 MRPs, MRPL14 was highly expressed in thyroid cancer tissues. MRPL14 overexpression was significantly associated with advanced tumor stage, extrathyroidal extension, and lymph node metastasis. MRPL14 increased cell proliferation of thyroid cancer and promoted cell migration via epithelial-mesenchymal transition-related proteins. Moreover, MRPL14 knockdown reduced the expression of oxidative phosphorylation complex IV (MTCO1) and increased the accumulation of ROS. Cotreatment with a ROS scavenger restored cell proliferation and migration, which had been reduced by MRPL14 knockdown, implying that ROS functions as a key regulator of the oncogenic effects of MRPL14 in thyroid cancer cells. @*Conclusion@#. Our findings indicate that MRPL14 may promote cell growth, migration, and invasion by modulating ROS in thyroid cancer cells.
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Background and Objectives@#This study aims to investigate the lip movements area (LMA) and vowel space area according to depression.Materials and Method The participants diagnosed with voice disorders or thyroid cancer before treatment and surgery. All participants completed the depression questionnaire and recorded five vowels (/a, i, u, e, o/) phonation while shooting. Among the total 64 participants, there were 19 participants in the depressive disorders group and 45 participants in non-depressive group. The analysis parameters were LMA, vowel space areas (Area3 & Area5), formant centralization ratio (FCR), fundamental frequency (F0) and voice intensity (intensity). Multivariate analysis of variance (MANOVA) was applied, and age was treated as a covariate to correct for lip movement that could deteriorate as age increased. @*Results@#As a result of MANOVA, there was no significant difference between groups (p=0.517). Looking at the LMA, both male and female in the depressive disorder group showed a lower mean value than the non-depressive disorders group. The Area3 and FCR of the depressive disorder group were higher than those in the non-depressive disorders group, whereas for the Area5, the mean value of female in the depressive disorder group was higher than that of the non-depressive disorder group and the male’s non-depressive disorder group had a slightly higher mean value. @*Conclusion@#The voice intensity according to the presence or absence of depressive disorder was similar, but the depressive disorder group tended to show narrower oral area with smaller lip opening.
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Background@#This study aimed to investigate the changes of incidence and treatment of choice for hyperthyroidism from 2003 to 2018 and explore the treatment-related complications and concomitant comorbidities in South Korea using data from the National Health Insurance Service. @*Methods@#This is a retrospective observational study. Hyperthyroidism was defined as a case having two or more diagnostic codes of thyrotoxicosis, with antithyroid drug intake for more than 6 months. @*Results@#The average age-standardized incidence of hyperthyroidism from 2003 to 2018 was 42.23 and 105.13 per 100,000 men and women, respectively. In 2003 to 2004, hyperthyroidism was most often diagnosed in patients in their 50s, but in 2017 to 2018, people were most often diagnosed in their 60s. During the entire period, about 93.7% of hyperthyroidism patients were prescribed with antithyroid drugs, and meanwhile, the annual rates of ablation therapy decrease from 7.68% in 2008 to 4.56% in 2018. Antithyroid drug-related adverse events, mainly agranulocytosis and acute hepatitis, as well as complications of hyperthyroidism such as atrial fibrillation or flutter, osteoporosis, and fractures, occurred more often in younger patients. @*Conclusion@#In Korea, hyperthyroidism occurred about 2.5 times more in women than in men, and antithyroid drugs were most preferred as the first-line treatment. Compared to the general population, hyperthyroid patients may have a higher risk of atrial fibrillation or flutter, osteoporosis, and fractures at a younger age.
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Hyalinizing clear cell carcinoma (HCCC) is a rare, low-grade malignant tumor of the salivary gland. It usually originates from the minor salivary gland, with the most common site being the palate, followed by the lips and the buccal mucosa. The occurrence of HCCC at the base of the tongue (BOT) is extremely uncommon, thus it must be differentiated from other malignant clear cell tumors. Immunohistochemistry is a useful tool to make an appropriate diagnosis. To obtain the best prognosis for HCCC, complete surgical resection is necessary. Here we report a case of a 47-year-old male with a benign-looking neoplasm in the right BOT, presenting with throat discomfort. A simple excisional biopsy revealed proliferative nests of clear cells within a hyalinized fibrous connective tissue. The final diagnosis by immunohistochemistry was HCCC with a positive resection margin. Re-operation secured a safety margin, and the lesion was completely resected.
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Background/Aims@#Recent evidence has identified the significance of type 2 iodothyronine deiodinase (DIO2) in various diseases. However, the role of DIO2 polymorphism in metabolic parameters in patients with hypothyroidism is not fully understood. @*Methods@#We assessed the polymorphism of the DIO2 gene and various clinical parameters in 118 patients who were diagnosed with hypothyroidism from the Ansan-Anseong cohort of the Korean Genome and Epidemiology Study. Furthermore, we systematically analyzed Genotype-Tissue Expression (GTEx) data. @*Results@#A total of 118 participants with hypothyroidism were recruited; 32 (27.1%) were homozygous for the Thr allele, 86 (73.9%) were homozygous for the Ala allele or heterozygous. Patients with hypothyroidism with DIO2 polymorphism without hypertension at baseline had higher incidence of hypertension compared to patients without DIO2 polymorphism. Analysis of the GTEx database revealed that elevation of DIO2 expression is associated with enhancement of genes involved in blood vessel regulation and angiogenesis. @*Conclusions@#Commonly inherited variation in the DIO2 gene is associated with high blood pressure and prevalence of hypertension in patients with hypothyroidism. Our results suggest that genetic variation in the hypothalamic-pituitary-thyroid pathway in influencing susceptibility to hypertension.
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Objectives@#. Thyroid cancer is the most common endocrine tumor, with rapidly increasing incidence worldwide. However, its transcriptomic characteristics associated with immunological signatures, driver fusions, and recurrence markers remain unclear. We aimed to investigate the transcriptomic characteristics of advanced papillary thyroid cancer. @*Methods@#. This study included 282 papillary thyroid cancer tumor samples and 155 normal samples from Chungnam National University Hospital and Seoul National University Hospital. Transcriptomic quantification was determined by high-throughput RNA sequencing. We investigated the associations of clinical parameters and molecular signatures using RNA sequencing. We validated predictive biomarkers using the Cancer Genome Atlas database. @*Results@#. Through a comparison of differentially expressed genes, gene sets, and pathways in papillary thyroid cancer compared to normal tumor-adjacent tissue, we found increased immune signaling associated with cytokines or T cells and decreased thyroid hormone synthetic pathways. In addition, patients with recurrence presented increased CD8+ T-cell and Th1-cell signatures. Interestingly, we found differentially overexpressed genes related to immune-escape signaling such as CTLA4, IDO1, LAG3, and PDCD1 in advanced papillary thyroid cancer with a low thyroid differentiation score. Fusion analysis showed that the PI3K and mitogen-activated protein kinase (MAPK) signaling pathways were regulated differently according to the RET fusion partner genes (CCDC6 or NCOA4). Finally, we identified HOXD9 as a novel molecular biomarker that predicts the recurrence of thyroid cancer in addition to known risk factors (tumor size, lymph node metastasis, and extrathyroidal extension). @*Conclusion@#. We identified a high association with immune-escape signaling in the immune-hot group with aggressive clinical characteristics among Korean thyroid cancer patients. Moreover, RET fusion differentially regulated PI3K and MAPK signaling depending on the partner gene of RET, and HOXD9 was found to be a recurrence marker for advanced papillary thyroid cancer.
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Regional neck metastases in well-differentiated thyroid carcinoma (WDTC) are relatively frequent. The prognostic effects of lymph node (LN) metastases remain controversial. However, it is well known that lateral LN metastasis is related to the recurrence of the disease. In general, when lateral neck LN metastasis is confirmed in WDTC patients, therapeutic lateral neck dissection is recommended. However, the optimal surgical extent of therapeutic lateral neck dissection in WDTC patients with clinical lateral LN metastasis is not clearly presented. Traditional comprehensive neck dissection including level II, III, IV and V even in patients with minimal lateral neck metastases may not be reasonable when considering both oncologic safety and functional aspects. There is controversy whether it is always necessary to perform level II and V LN dissection for all WDTC patients with clinical lateral LN metastasis. This is due to the fact that the likelihood of postoperative complications by the damage of the spinal accessory nerve increases with level II and level V dissection. Therefore, many studies have been reported on the possibility of omitting levels II (especially IIb) and V during therapeutic comprehensive lateral neck dissection.However, there have been no definite conclusions about it, and it is still debate. In this article, we reviewed to find out optimal lateral neck dissection range for WDTC patients with clinical lateral neck metastasis.
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Background/Objectives@#To evaluate clinical significance of FDG PET-CT for detection of residual cancer cells after curative radiation therapy or chemoradiotherapy for patients with squamous cell carcinoma (SCC) of Head and NeckMaterials & Methods: A retrospective analysis of patients with SCC of Head and neck with curative radiotherapy or chemoradiotherpy between June 2011 and Jan. 2019 was performed. Sixty patients were treated with Intensity-modulated radiotherapy (IMRT). The Metabolic responses were evaluated on the post-treatment FDG PET-CT at 12 weeks after curative radiotherapy completion. @*Results@#Median follow up was 51.5 months (3-102). The overall survival (OS), disease free survival (DFS), local control rate (LCR), and Distant metastasis free survival (DMFS) at 5 years were 80.5%, 80.1%, 87.7% and 89.1%. Metabolic CR was found in 43 (71.7%) and partial metabolic response (PR) was noted in 17 (14.6%). Metabolic CR was significantly correlated with OS, DFS, LCR, and DMFS. On multivariate analysis, Metabolic CR remained significant for DFS and LCR. @*Conclusion@#Metabolic CR on post-radiotherapy FDG PET-CT is highly predictive of increased DFS and LCR in patients with head and neck cancer.
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There are a number of voice analysis programs around the world. Domestic voice analysis is performed by relying heavily on specific commercial program. We intend to develop coding for voice analysis using Praat and apply it to clinical practice. This study consisted of Experiment 1 and Experiment 2. Experiment 1 was the development of automated voice analysis coding based on Praat. The coding was largely divided into a recording, an analysis, and a storage section. Experiment 2 was applied to the voice analysis of 2 male patients pre- and post-operation with this coding. The analysis parameters of this coding provided 26 parameters for vowel /a/, nine parameters for sentence analysis, and a total of 4 parameters for voice range profile analysis. In two male patients, the pitch and the intensity increased, the voice quality improved, and the sentence length decreased after surgery. The coding was well made, so the output was good in real time. The code is automated as much as possible to block manual errors and increases convenience and efficiency by generating the result sheet in real time.
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Background@#Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. @*Methods@#This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. @*Conclusion@#The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.
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Background/Objectives@#To evaluate clinical significance of FDG PET-CT for detection of residual cancer cells after curative radiation therapy or chemoradiotherapy for patients with squamous cell carcinoma (SCC) of Head and NeckMaterials & Methods: A retrospective analysis of patients with SCC of Head and neck with curative radiotherapy or chemoradiotherpy between June 2011 and Jan. 2019 was performed. Sixty patients were treated with Intensity-modulated radiotherapy (IMRT). The Metabolic responses were evaluated on the post-treatment FDG PET-CT at 12 weeks after curative radiotherapy completion. @*Results@#Median follow up was 51.5 months (3-102). The overall survival (OS), disease free survival (DFS), local control rate (LCR), and Distant metastasis free survival (DMFS) at 5 years were 80.5%, 80.1%, 87.7% and 89.1%. Metabolic CR was found in 43 (71.7%) and partial metabolic response (PR) was noted in 17 (14.6%). Metabolic CR was significantly correlated with OS, DFS, LCR, and DMFS. On multivariate analysis, Metabolic CR remained significant for DFS and LCR. @*Conclusion@#Metabolic CR on post-radiotherapy FDG PET-CT is highly predictive of increased DFS and LCR in patients with head and neck cancer.
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There are a number of voice analysis programs around the world. Domestic voice analysis is performed by relying heavily on specific commercial program. We intend to develop coding for voice analysis using Praat and apply it to clinical practice. This study consisted of Experiment 1 and Experiment 2. Experiment 1 was the development of automated voice analysis coding based on Praat. The coding was largely divided into a recording, an analysis, and a storage section. Experiment 2 was applied to the voice analysis of 2 male patients pre- and post-operation with this coding. The analysis parameters of this coding provided 26 parameters for vowel /a/, nine parameters for sentence analysis, and a total of 4 parameters for voice range profile analysis. In two male patients, the pitch and the intensity increased, the voice quality improved, and the sentence length decreased after surgery. The coding was well made, so the output was good in real time. The code is automated as much as possible to block manual errors and increases convenience and efficiency by generating the result sheet in real time.
ABSTRACT
Background@#Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. @*Methods@#This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. @*Conclusion@#The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.
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Schwannoma, also known as neurilemmoma, is a benign neoplasm that originates from any nerves wrapped with a sheath made of Schwann cells. Schwannoma occurring in the head and neck region is not rare, but schwannomas of the anterior neck, especially ansa cervicalis, are extremely rare that only 7 cases have been reported to date worldwide. Although rare, it should be considered in differential diagnosis of anterior cervical mass and may be confused with other cervical and thyroid mass. We report a case of intramuscular schwannoma in the sternohyoid muscle. Preoperative diagnosis was established with an ultrasound-guided core needle biopsy. Although it was removed entirely without connection to any other nerves identified or any complication, clinically, the mass was thought to be derived from the nerve. To our knowledge, this is the first case of the intramuscular schwannoma occurring from ansa cervicalis reported in the literature.
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Background and Objectives@#The association between multifocal papillary thyroid carcinoma (PTC) and tumor aggressiveness remains controversial. The aim of study is to evaluate molecular subtypes of multifocal PTCs using multiplatform genomic analysis. @*Materials and Methods@#Statistical analysis and genomic analysis were performed for gene expression data and clinical data of multifocal PTCs in The Cancer Genome Atlas data. Clinicopathologic findings, recurrence-free survival (RFS), copy number alteration and somatic mutation status in patients in relation to molecular subtypes were analyzed. @*Results@#Multiplatform genomic analysis revealed that multifocal PTCs (n=226) were divided into two distinct molecular subgroups. Participants in cluster 2 showed significantly increased risk of extrathyroidal extension, lymph node metastasis, and BRAFV600E mutation compared to patients in cluster 1. To exclude the effect of BRAF mutation and RAS mutation on tumor aggressiveness, we compared clinical parameters between two clusters in patients without BRAF or RAS mutation. Cluster 2 showed significantly higher risk of lymph node metastasis compared to cluster 1. @*Conclusion@#Multifocal PTC has two distinct molecular subtypes with distinctive clinical behaviors. Our data suggested the clinical implications of the transcriptomic signature to predict clinical outcomes of multifocal PTC.
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Langerhans cell sarcoma is a rare, proliferative tumor of Langerhans cells, which shows cytologic characteristics and clinical features of malignant tumor. Langerhans cell sarcoma primarily occurs in lymph nodes, skin, lung, liver, and spleen. However, very few cases have been reported in the head and neck region. Because of its rarity, an optimal treatment approach is unknown; however, Langerhans cell sarcoma grows aggressively and shows a poor prognosis, such that a more aggressive and multi-modality treatment approach is necessary. Here, we report the case of a 36-year-old male with Langerhans cell sarcoma, who presented with a mass in the submandibular gland area and was treated with wide excision and postoperative radiotherapy.
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PURPOSE@#Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies and frequently patients with this syndrome respond poorly to antiepileptic drugs. The aim of this study was to evaluate the treatment outcomes of vagus nerve stimulation (VNS) in LGS patients with drug-resistant epilepsy.@*METHODS@#We analyzed the clinical files, collected over 5 years, of children with LGS who received VNS treatment.@*RESULTS@#Seven children were included in this study (four males, three females; mean age of VNS insertion 12.4±3.5 years). All the patients had generalized tonic seizures and there were various other seizure types including myoclonic seizures, atonic seizures, and atypical absence seizures. Although two patients had normal imaging, five patients had abnormalities on imaging, including pachygyria, cortical dysplasia, kernicterus, and a chromosomal anomaly. Comparing the baseline seizure frequency to the frequency after the VNS surgery, the seizure frequency at the last follow-up showed a decrease of 57.2% (0% to 100%) on average (P=0.028) and one patient achieved seizure free status. Only two children were given additional antiepileptic drugs with the aim of managing their seizures. There was no mortality or complications related to the VNS therapy except one case requiring intensive care unit admission due to pneumonia. Comparing the results before and after VNS surgery, the VNS therapy also had a tendency to have a positive effect on quality of life (P=0.066).@*CONCLUSION@#In LGS patients with drug resistant epilepsy who are not candidates for a corpus callosotomy or resective surgery, VNS could be an effective, low-risk adjunct therapy for decreasing seizure frequency.
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Osseous choristoma is a rare, benign proliferative osseous lesion, which is defined as the growth of normal tissue in an abnormal location. The etiopathogenesis for its formation is unknown, but various hypotheses have been proposed. Treatment of choice is en-bloc resection, and no recurrence has been reported. Here, we report the two cases of osseous choristoma, presented with a mass on the base of the tongue with/without globus symptom and were treated with surgical excision.
Subject(s)
Choristoma , Osteoma , Recurrence , TongueABSTRACT
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.