ABSTRACT
Several types of cyst may occur in the neck. Branchial cleft cyst is the most common cystic lesion, but the first branchial cleft cyst is a very rare disease. Cystic cervical lesions may be mistaken for enlarged lymph nodes or tumors. To avoid interpretation errors, aspiration of all cysts or cystic lesions must be followed by careful palpation and reaspiration of any residual mass. Further, a careful analysis of the patient's clinical data is of value. In questionable cases, surgical excision of the cystic tumor for histologic examination is recommended. We report a case of basal cell adenoma arising in the first branchial cleft cyst. This case support the hypothesis that lymphoepithelial cysts of the major salivary glands arise from inclusions of salivary gland tissue in lymph node.
Subject(s)
Adenoma , Branchial Region , Branchioma , Lymph Nodes , Neck , Palpation , Rare Diseases , Salivary GlandsABSTRACT
BACKGROUND AND OBJECTIVES: Hypothyroidism is a well recognized complication of radiotherapy and surgery in the treatment of head and neck cancer, especially laryngo-hypopharyngeal cancer. Several studies were undertaken to determine the thyroid stimulating hormone (TSH) levels in the population of patients with head and neck cancer, to better characterize clinical factors in the eventual elevated TSH levels. We evaluated the incidence and related factors of hypothyroidism following radiotherapy, surgery and combined treatment for laryngeal and hypopharyngeal cancer. MAERIALS AND METHODS: Forty-four patients who had been treated for laryngeal and hypopharyngeal cancer were divided into three groups according to the types of treatment they received: radiotherapy alone, surgery with partial thyroidectomy, surgery with partial thyroidectomy and postoperative radiotherapy. TSH and free thyroxin (T4) level were examined before and after the treatment. We analyzed the differences according to clinical factors and treatment modalities. RESULTS: The TSH level was higher in hypopharyngeal cancer than in laryngeal cancer (p>0.05). In the advanced stage and during longer follow-up periods, the TSH level were elevated (p<0.05). In patient with combined treatment modalities, the TSH level was higher than in patients who received radiotherapy or surgery alone (p<0.05). CONCLUSION: We concluded that hypothyroidism frequently develops following treatment for laryngeal and hypopharyngeal cancer even when thyroid resection has not been performed. Patient should be evaluated postoperatively and carefully monitored by means of serial thyoid function test.
Subject(s)
Humans , Follow-Up Studies , Head and Neck Neoplasms , Hypopharyngeal Neoplasms , Hypothyroidism , Incidence , Laryngeal Neoplasms , Radiotherapy , Thyroid Function Tests , Thyroid Gland , Thyroidectomy , Thyrotropin , ThyroxineABSTRACT
McCune-Albright syndrome (MAS) is a sporadic disease classically including polyostotic fibrous dysplasia, cafe -au-lait spots, sexual precocity, and other hyperfunctional endocrinopathies. Recent investigations suggest an etiological role for activating embryonic somatic missense mutations in the gene for the a subunit of Gs (Gsa), the G protein that stimulates adenylyl cyclase. DNA from bone, ovary, and blood was analyzed by using polymerase chain reaction and sequenced. A embryological somatic mutation of Gsa gene encoding substitution of a Cys for Arg at amino acid 201 from cells of dysplastic bone and ovary was observed, and the distribution of mutant gene reveals mosaic pattern. We report a case of McCune-Albright syndrome with an activating mutation at codon 201 of Gsa subunit on ovary and bone tissue that was experienced recently.
Subject(s)
Female , Adenylyl Cyclases , Bone and Bones , Codon , DNA , Fibrous Dysplasia, Polyostotic , GTP-Binding Proteins , Mutation, Missense , Ovary , Polymerase Chain ReactionABSTRACT
Renal cell carcinoma takes up 85 per cent of primary malignant renal tumors. It frequently metastasizes to the adrenal gland, lung, bone, liver and nephrectomy site but rarely to the head and neck area. When metastasizes to head and neck area, it involves the gingiva, tongue, palate, parotid gland, uvula, mandible, and lip. When tumors are found in the salivary gland consisting of clear cells, it is impartant to carry out differential diagnosis of various primary tumors with clear cell and metastatic renal cell carcinoma. Patients' medical history, review of system, and pathologic findings would be helpful factors in the differential diagnosis. In this paper, we report on a case of renal cell carcinoma which had metastasized to the psubmandibular gland after a radical nephrectomy.
Subject(s)
Adrenal Glands , Carcinoma, Renal Cell , Diagnosis, Differential , Gingiva , Head , Lip , Liver , Lung , Mandible , Neck , Nephrectomy , Palate , Parotid Gland , Salivary Glands , Submandibular Gland , Tongue , UvulaABSTRACT
BACKGROUND AND OBJECTIVES: Management of chronic ear disease which affects the only hearing ear has been a topic of much debate since chronic ear disease runs the risk of damage to the inner ear. Cholesteatoma and uncontrolled otitis media can induce the sensorineural hearing loss, therefore, surgical removal of diseased tissue is sometimes unavoidable. MATERIALS AND METHOD: Tympanoplasty with mastoidectomy on the only hearing ears was performed in 9 patients. of whom four had cholesteatoma and five had mastoiditis. RESULTS: Compared to the preoperative air conduction hearing level, 3 cases showed improvement in the postoperative hearing level showed, whereas the remaining 6 cases did not show improvement.
Subject(s)
Humans , Cholesteatoma , Ear Diseases , Ear , Ear, Inner , Hearing Loss, Sensorineural , Hearing , Mastoid , Mastoiditis , Otitis Media , TympanoplastyABSTRACT
BACKGROUND: Human papillomavirus(HPV) is epitheliotrophic virus invading the anogenital tract and the upper aerodigestive tract. HPV produces a diversity of benign and malignant tumors. The wild-type p(53) gene participates in suppressing cell transformation while the mutant forms have tumorigenic potential. Alterations in the structure of p(53) gene represent one of the most common genetic changes associated with human cancers. OBJECTIVES: We evaluated the HPV infection and p(53) overexpression, and analyzed p(53) overexpression according to clinicopathological findings and HPV infection in laryngeal squamous cell carcinomas. MATERIALS AND METHODS: Thirty-nine cases of laryngeal squamous cell carcinomas and ten cases of laryngeal nodules were analyzed for the detection of HPV DNA by in situ hybridization technique and the detection of p(53) overexpression by immunohistochemical technique. RESULTS: 1) HPV DNA was detected in 10(25.6%), and p(53) overexpression was detected in 19(48.7%) out of 39 cases in laryngeal squamous cell carcinomas. 2) The p(53) overexpression was detected in 7(78%) out of 9 cases more than Brinkman index score 1000, and was detected in 12(40%) out of 30 cases less than 1000. 3) HPV positive cases showed 50% of p(53) overexpression whereas HPV negative cases showed 48% overexpression. CONCLUSION: HPV and p(53) gene were thought to be the etiological factors of laryngeal squamous cell carcinomas. The p(53) overexpression was related to smoking regardless of the histopathological findings and HPV infection.
Subject(s)
Humans , Carcinoma, Squamous Cell , DNA , In Situ Hybridization , Smoke , SmokingABSTRACT
BACKGROUND: Squamous cell carcinoma of the supraglottic larynx have a propensity to metastasize earlier to the regional lymph nodes compared to their glottic counterpart owing to their unique embryological origin and abundant lymphatic tissues. However, reliable biological markers for predicting lymph node metastasis with its associated poor outcome is lacking. OBJECTIVES: As a search for biologic markers related to nodal metastasis in supraglottic cancer, the authors have performed immunohistochemical staining of various gene products and tissue factors. The results were analysed to see if these markers influenced the metastatic capability of supraglottic cancers. MATERIALS AND METHODS: Twenty-nine cases of supraglottic cancers were subdivided into node negative group(group I, N=13) and node positive group(group II, N=16). Tumor angiogenesis was assessed by counting the peritumoral microvessels in which the endothelial cells are selectively stained by von Willebrand factor. PCNA-proliferation index(PI) was obtained, and the positivity of nm23 protein, a metastasis suppressor gene product and p53 protein, a tumor suppressor gene product were assessed. RESULTS: The mean vessel counts per high power fields(X 200) were 16.6 and 27.3 for node negative and node positive groups respectively(p=0.001). The mean PCNA-PI was 8.1 in node negative group and 18.4 in the node positive group(p=0.001). The expression of nm23 was 30.8% in the node negative group and 50.0% in the node positive group. p53 expression rate was higher in the node positive group; 50.0% compared to the node negative group; 38.5%, however there was no statistical significance. CONCLUSION: We conclude that the number of new vessels and PCNA-proliferation index, but not the nm23 and p53 expression rate, may be related to the lymph node metastasis in squamous cell carcinoma of the supraglottic larynx.
Subject(s)
Biomarkers , Carcinoma, Squamous Cell , Cell Proliferation , Endothelial Cells , Genes, Tumor Suppressor , Larynx , Lymph Nodes , Lymphoid Tissue , Microvessels , Neoplasm Metastasis , Proliferating Cell Nuclear Antigen , Thromboplastin , von Willebrand FactorABSTRACT
BACKGROUND: Bone mineral density (BMD) is under strong genetic control. A recently reported case of severe estrogen resistance caused by a germ-line mutation at the estrogen receptor gene locus suggests the possibility that other variants of the estrogen receptor (ER) gene could be responsible for the heritable components of bone density. METHODS: Two restriction fragment length polymorphisms (RFLPs) at the ER gene locus, represented as PvuII and XbaI, and their relationship to bone mineral density (BMD) and bone turnover markers were examined in 95 healthy premenopausal women. Their mean age was 29 +-6.9 years (mean+-SD). RESULTS: The distribution of the PvuII and XbaI RFLPs was as follows: PP 20 (21.1%), Pp 40 (42.1%), pp 35 (36.8%), and XX 5 (5.3%), Xx 33 (34.7%), xx 57 (60.0%) (capital letters signify the absence of, and lower case letters signify the presence of the restriction site of each RFLP). There was no significant relation between ER genotypes and BMD measured at several sites such as lumbar spine (L2-4), distal forearm, and femoral neck. Also no significant genotypic differences were found in the several biochemical markers and sex hormone status. CONCLUSION: These data indicate that these polymorphisms are not predietive of bone turnover nor BMD in a sample of healthy Korean premenopausal women.
Subject(s)
Female , Humans , Biomarkers , Bone Density , Estrogens , Femur Neck , Forearm , Genotype , Germ-Line Mutation , Osteoporosis , Polymorphism, Restriction Fragment Length , SpineABSTRACT
OBJECTIVES: Bone densitometry is a current method for evaluating skeletal status, assessing osteoporosis, and determining fracture risk. DEXA has rapidly become a dominent method for evaluating skeletal status. But the comparison of patient data among different DEXA scanners is complicated because the instruments show differences in scanner design, bone mineral calibration, and analysis algorithms. The purpose of this study is making standardization of DEXA and comparability among different DEXA system. METHODS: Posteroanterior lumbar spine (L2-IA) measurements of healthy 83 racially homogenous Korean women, age 38-66 years (mean +/- 516, range of BMD 0.624-1.574g/cm) were obtained on a Lunar DPX-L, a Hologic QDR-2000, and a Norland XR-36. All sujects had no spinal deformities, ostophytes, fracture and scoliosis on thoracolumbar spinal X-ray. We performed the measurement of BMD in each subjects with different three scanners at the same time. RESULTS: The results of cross-calibration spinal BMD (L2-4, g/cm2) in patient study (r2=0.972-0.974); Lunar DPX-L=(1.149 X Hologic)+0.008=(1.022 X Norland)+0.137, Hologic QDR-2000=(0.847 X Lunar)+0.019= (0.876 X Norland)+0.124, and Norland XR-36=(0.954 X Lunar)-0.107=1.110 X Hologic)-0.113. The average absolute difference in patients` spinal BMD values (L2-L4) between Lunar and Hologic was 0.146g/cm2 (14%); it was 0.156g/cm2 (15%) between Lunar and Norland and 0.010g/cm2 (1%) between Hologic and Norland. CONCLUSIONS: The formula of this cross-calibration shows good correlation. We conclude that it is possible to compare the different spinal BMD values obtained on the different DEXA scanners.
Subject(s)
Female , Humans , Absorptiometry, Photon , Bone Density , Calibration , Congenital Abnormalities , Densitometry , Osteoporosis , Scoliosis , SpineABSTRACT
BACKGROUND: Since the morning fluoride level of 10 uM is recommended for adults patients being treated for osteoporosis so far, measurement of serum fluoride level is important to detect abnormally high levels or to detect levels below the therapeutic windows. Aims of this study are to determine the normal range of serum ionic fluoride levels in Korean female adults (from 5th to 7th decade), and to evaluate the in vivo fluoride pharmacokinetics of monofluorophosphate in Korean adults. METHODS: Serum level of fluoride was measured from blood samples of 72 female subjects (age 43-69years) using an ion selective electrode. For pharrnacokinetics of monofluorophosphate-calcium (MFP-Ca), 6 subjects (age 27~45 years) were included to be withdrawn the blood hourly for the first S hours and the blood was withdrawn at 24 hours after a single dose of MFP-Ca. RESULTS: Mean level of serum fluoride was 1.64+-0.12uM in 5th, 6th, 7th decades adults, and there was no difference of serum fluoride levels among age groups. Peak serum fluoride level exhibited 5.02+-0.67pM, and returned to basal level on 24 hours after a single dose of MFP-Ca. CONCLUSION: This study shows that mean serutn fluoride of Korean female adults (from 5th to 7th decade) is not different from that of other reports, and a single dose of MFP-Ca does not cause serum fluoride levels above the recommended therapeutic windows of 5-10uM for 24 hours.
Subject(s)
Adult , Female , Humans , Electrodes , Fluorides , Osteoporosis , Pharmacokinetics , Reference ValuesABSTRACT
Decreased glucose tolerance is often found in patients with thyrotoxicosis but the pathogenetic mechanisms are poorly understood. Since the concentrations of free fatty acid are usually elevated due to increased lipolysis in thyrotoxicosis, the preferential oxidation of the free fatty acids may explain the decreased glucose tolerance in hyperthyroidism. The aim of this study was to investigate whether lowering plasma free fatty acid(FFA) by acipimox, a long-acting antilipolytic agent, could affect glucose metabolism in thyrotoxicosis. We performed intravenous glucose tolerance test with acipimox or placebo in 6 untreated thyrotoxicmen and 6 age-and body mass index(BMI)-matched controls. The following results were obtained.1) The basal plasma FFA concentration in thyrotoxic patients were significantly higher than those in controls(997.0+-303.4 uEq/L vs. 290.5+-169.1 uEq/L; p<0.01). 2) Plasma FFA concentrations decreased rapidly with acipimox ingestion in both controls and thyrotoxic patients.3) Plasma glucose concentrations were significantly lower with acipimox ingestion than with placebo in thyrotoxic patients from 17min after intravenous glucose load and to the end of the study.4) Plasma insulin concentrations in thyrotoxic patients with acipimox ingestion were higher at 5, 7 min after iv glucose load.5) In thyrotoxic patients, glucose disappearance rate(K_glucose) in acipimox treatment was significantly higher than that in placebo treatment(2.44+-0.84 vs. 1.58+-0.37;p<0.05). 6) K_glucose values were inversely correlated with basal FFA concentrations(r=-0.58, p<0.05). In summary, in thyrotoxic patients with elevated plasma FFA levels, acipimox lowered plasma FFA, which in turn improved glucose tolerance.
Subject(s)
Humans , Blood Glucose , Eating , Fatty Acids, Nonesterified , Glucose , Glucose Tolerance Test , Hyperthyroidism , Insulin , Lipolysis , Metabolism , Plasma , ThyrotoxicosisABSTRACT
Bilateral inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushing's syndrome and for the preoperative localization of pituitary microadenomas.To evaluate the usefulness of IPSS, we performed the procedure in the 17 cases of ACTH-dependent Cushing's syndrome including 2 cases of macroadenomas, 6 of them with CRH stimulation test. A inferior petrosal sinus-to-peripheral ACTH ratio of 2:1 or greater(3:1 after CRH stimulation) indicates a pituitary source of ACTH hypersecretion, and a ratio of the ACTH level in one inferior petrosal sinus to the ACTH level in the other of 1:4 or greater lateralizes the microadenomas to that half of the pituitary gland.With these criteria, we diagnosed Cushing's disease in 15 of 17 cases of ACTH-dependent Cushing's syndrome, and localized the lesion in 8 of 13 cases of microadenoma.In conclusion, IPSS with CRH stimulation has high diagnostic accuracy in the differential diagnosis of ACTH-dependent Cushing's syndrome, but still has the limitations on the localization of microadenoma.
Subject(s)
Adrenocorticotropic Hormone , Clinical Study , Cushing Syndrome , Diagnosis, Differential , Petrosal Sinus SamplingABSTRACT
It has been reported that receptor-bound blocking type TSH receptor antibody (TRAb) can be converted to the stimulating type by anti-human IgG antibodies. To evaluate the relationship between the conversion of receptor-bound blocking type TRAb to the stimulating type and the biological activity of blocking type TRAb, we compared converting activities of blocking type TRAb from 10 patients with primary nongoitrous hypothyroidism with both the doses of blocking type TRAb which show 50% inhibition of 125I-bTSH binding to the TSH receptor and those which show 50% inhibition of TSH-stimulated cAMP production in cultured rat thyroid cells (FRTL-5). The additions of anti-human IgG antibody to FRTL-5 cell-bound blocking IgGs resulted in the increase in cAMP production in a dose-dependent manner and the converting activities (percent increase of cAMP production) also depended on the doses of blocking IgGs. The converting activities were significantly correlated with the doses of blocking IgGs which showed 50% inhibition of 125I-bTSH binding to the TSH receptor (r = 0.71, p = 0.011). And these converting activities were also significantly correlated with the doses of blocking IgGs which showed 50% inhibition of TSH-stimulated cAMP increase (r = 0.81, p = 0.002), and were negatively correlated with thyroid stimulation blocking antibody activities (r = 0.58, p = 0.02). We have demonstrated that all cell-bound blocking type TRAb were converted to the stimulating type by anti-human IgG antibody and the degree of conversion was negatively correlated with the biological activity of blocking type TRAb.(ABSTRACT TRUNCATED AT 250 WORDS)