Clinical Behavior of Papillary Thyroid Carcinoma Smaller than 1.5 cm / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the increasing use of high resolution sonography and fine needle aspiration biopsy, the proportion of newly diagnosed thyroid papillary carcinomas have increased. However, it is not entirely clear whether microcarcinomas detectable by the above technology the should be considered a threshold for risk evaluation. The purpose of this study is to evaluate the clinical behavior of papillary carcinomas smaller than 1.5 cm. SUBJECTS AND METHOD: A retrospective chart review was conducted for 181 patients who underwent surgery for thyroid cancer and was proven to have papillary carcinoma smaller than 1.5 cm in size from 1997 to 2006. The patients were divided into 3 groups according to cancer size. The patient's gender, age, surgical method, pathology, initial neck node and neck recurrence was analyzed by chi-square test, analysis of variance (ANOVA) test and multinomial logistic regression analysis. RESULTS: Progressively increasing frequency of signs of tumor aggressiveness (multifocal, bilateral, extracapsular spread) was observed with increasing size. The rate of lymph node metastasis increased also, but it did not reach a significant value. Despite the increasing rate of aggressiveness and lymph node metastasis, there was no significant difference in recurrence between these groups. CONCLUSION: Although the long term outcome does not seem to directly depend on tumor size in these small thyroid cancers, a progressing frequency of aggressiveness with increasing cancer size at presentation is evident.

Peripheral Blood Eosinophilia: An Unusual Presentation of Bone Marrow Involvement in a Patient with Relapsed Thyroid Papillary Carcinoma

Peripheral blood eosinophilia is a well-known paraneoplastic manifestation, but its underlying mechanism is still unclear. Bone marrow metastasis may be a cause of malignancy-associated eosinophilia. However, there is limited evidence of the relationship between bone marrow metastasis and eosinophilia. Herein, we present a unique case of peripheral blood eosinophilia associated with bone marrow invasion in a patient having a history of papillary thyroid carcinoma. A 68-year old woman showed peripheral blood eosinophilia (91,525/mm3). Since the time she was initially diagnosed as having papillary thyroid carcinoma, eosinophilia had never been found and the other causes of eosinophilia were excluded. A bone marrow study revealed cancer cell infiltration; multiple lymphadenopathies and liver metastasis were also detected. We treated her with steroid; however, her eosinophilia did not respond to steroid and the patient died due to disease progression. Although peripheral blood eosinophilia and bone marrow metastasis are rare findings in patients with papillary thyroid carcinoma, we suggest that eosinophilia might be a sign of the bone marrow metastasis of papillary thyroid carcinoma.

Result of Stent Insertion into Iliac Arterial System: Based on Transatlantic Inter-Society Consensus (TASC) Morphologic Stratification

PURPOSE: The recommended treatments for iliac arterial occlusive disease are an endovascular procedure in TASC type A patients, but surgery in TASC type D patients. However, in TASC type B and C patients, more evidence is required to make any firm recommendations about the best treatments. This study aimed to evaluate the best treatments for patients classified using the TASC morphological stratification. METHOD: A retrospective review of the patients who had undergone stent insertion into iliac arterial occlusive lesions, between 1995 and 2004, at the Chonnam National University Hospital, was performed. All patients were also classified using the TASC morphologic stratification. The TASC type was determined from the initial peripheral angiography findings. Also, the stenosis-free patency was used as an objective end point to evaluate the hemodynamic outcome of stent insertion. RESULT: A total of 86 patients were included in the study. The number of patients classified as TASC types A, B, C and D were 1 25, 17, and 43, respectively. Stent insertion was successfully performed in all patients. The mean follow up period was 26 months. The 1-year stenosis-free patency rates were 94.4, 74.0, and 19.1% in TASC type B, C, and D, respectively. The 5-year patency rates were 50.4, 18.5, and 6.0% in TASC type B, C, and D, respectively. CONCLUSION: The TASC morphological stratification was a useful prognostic factor in relation to the short and long-term iliac stent patency. For TASC types B and C, more evidence and experience of endovascular therapy are needed to confirm the best treatment. For TASC type D, surgical treatment is strongly recommended.

Clinical Analysis of The Thyroid Papillary Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary carcinoma of the thyroid is the most common malignant neoplasm in the thyroid gland. We performed this study for the purpose of getting further understanding and more supporting ideas for the diagnosis and treatment of thyroid papillary cancer. SUBJECTS AND METHOD: One hundred seventy eight cases of papillary carcinoma of thyroid gland who had been diagnosed and had received treatment at the department of otolaryngology-Head and neck surgery at the Korea university hospital from 1992 to 2001 were analyzed retrospectively. RESULTS: The mean age of cases was 43.6 years in females and 47.9 years in males. The most common symptom was anterior neck mass. Symptoms were usually presented within three months. The size of thyroid mass was not related to the duration of illness. The most frequently performed operative procedure was total thyroidectomy (76.4%). The post operative complications were temporary vocal cord palsy (4.5%), iatrogenic vocal cord palsy (1.7%), temporary hypocalcemia (16.9%) and permanent hypocalcemia (3.9%). Of all patients, 43 (24.1%) had preoperatively metastatic cervical nodes. Of the 175 patients, 52 (29.2%) had postoperative nodal metastasis. Local recurrences had occurred in 17 patients (9.6%). According to the AMES classification, 114 cases (64.1%) fell into the low risk group and 64 cases (35.9%) to the high risk group. The 10-year survival rate was 100% for the low risk group but 91.2% for the high risk group. The 10-year disease free survival rate was 92% for the low risk and 81.2% for the high risk group. CONCLUSION: We reaffirmed that the clinical characteristics of thyroid papillary cancer corresponded with the reports of other foreign studies. We suggest that this study needs to be followed up by a larger, long-term research.

A Case of Parathyroid Cancer with a Local Metastatic Focus Revealed by 99mTc-sestamibi scan / 대한내분비학회지

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.

Camprison of Diagnostic and Therapeutic scans in Patients with Differentiated Thyroid Cancer / 대한내분비학회지

Background: Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.

A Case of Bilateral Macronodular Adrenocortical Hyperplasia / 대한내분비학회지

Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.