Age and Tumor Size is a Prognostic Factor in Pediatric/Adolescent Differentiated Thyroid Carcinoma / 대한두경부종양학회지

Background/Objectives@#To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents.Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. @*Results@#Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. @*Conclusion@#For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.

Age and Tumor Size is a Prognostic Factor in Pediatric/Adolescent Differentiated Thyroid Carcinoma / 대한두경부종양학회지

Background/Objectives@#To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents.Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. @*Results@#Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. @*Conclusion@#For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.

Postoperative Thyroid-Stimulating Hormone Levels Did Not Affect Recurrence after Thyroid Lobectomy in Patients with Papillary Thyroid Cancer

BACKGROUND: Thyroid-stimulating hormone (TSH) suppression is recommended for patients who undergo thyroidectomy for differentiated thyroid cancer (DTC). However, the impact of TSH suppression on clinical outcomes in low-risk DTC remains uncertain. Therefore, we investigated the effects of postoperative TSH levels on recurrence in patients with low-risk DTC after thyroid lobectomy. METHODS: Patients (n=1,528) who underwent thyroid lobectomy for papillary thyroid carcinoma between 2000 and 2012 were included in this study. According to the mean and dominant TSH values during the entire follow-up period or 5 years, patients were divided into four groups (<0.5, 0.5 to 1.9, 2.0 to 4.4, and ≥4.5 mIU/L). Recurrence-free survival was compared among the groups. RESULTS: During the 5.6 years of follow-up, 21 patients (1.4%) experienced recurrence. Mean TSH levels were within the recommended low-normal range (0.5 to 1.9 mIU/L) during the total follow-up period or 5 years in 38.1% or 36.0% of patients. The mean and dominant TSH values did not affect recurrence-free survival. Adjustment for other risk factors did not alter the results. CONCLUSION: Serum TSH levels did not affect short-term recurrence in patients with low-risk DTC after thyroid lobectomy. TSH suppression should be conducted more selectively.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery

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.

Evaluation of Surgical Completeness in Endoscopic Total Thyroidectomy with Central Neck Dissection via a Unilateral Axillo-Breast Approach Compared with Bilateral Axillo-Breast and Open Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate surgical completeness in endoscopic total thyroidectomy with central neck dissection via unilateral axillo-breast approach (UABA) compared with bilateral axillo-breast (BABA) and open approach (OA) by means of the radioactive iodine uptake (RAIU) ratio and thyroglobulin (Tg) of remnant thyroid. SUBJECTS AND METHOD: From July 2010 to March 2013, 82 patients who had underwent total thyroidectomy with central neck dissection and postoperative radioactive iodine (RAI) ablation for papillary thyroid carcinoma were enrolled. Of these patients, 27 patients underwent UABA, 24 patients BABA, and 31 patients OA. Clinicopathologic data, surgical outcome, stimulated Tg and RAIU ratio on the first postoperative RAI ablation scan were compared among 3 groups. RESULTS: Patients in the endoscopic surgery groups (UABA, BABA) were younger than those in the OA groups. Invasiveness such as operation time, postoperative pain, and drain amount in UABA was less than that in BABA and severer than that in OA. Other variables regarding clinicopathologic and surgical data were not significantly different. Stimulated Tg and RAIU ratio did not show significant differences among 3 groups (p=0.659 and p=0.664). CONCLUSION: The completeness of UABA was comparable with that of BABA and OA. The UABA may be a safe option for patients who need endoscopic thyroidectomy for papillary thyroid carcinoma.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

Comparative Study of Unilateral Axillo-Breast Approach with Gas Insufflation Versus Gasless Transaxillary Approach for Endoscopic Thyroidectomy in a Single Institute / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been various approaches introduced for endoscopic thyroidectomy. This study evaluates and compares the surgical outcomes of two such approaches: the unilateral axillo-breast approach (UABA) with gas and the gasless transaxillary approach (TA). SUBJECTS AND METHOD: We retrospectively analyzed 279 patients who underwent endoscopic thyroidectomy via UABA with gas or gasless TA from March 2008 to August 2012. Studied variables were clinicopathologic data, surgical outcomes, complications, and cosmetic satisfactions. RESULTS: Of the 279 patients, 195 (69.9%) underwent UABA with gas and 84 (30.1%) underwent gasless TA. All of the variables related to clinicopathologic characteristics showed no significant differences between the two groups. The mean operation time was significantly shorter in the UABA with gas group (131.76±44.37 min) than in the gasless TA group (191.01±55.90 min) (p<0.001). The mean postoperative pain Visual Analogue Scale scores in the UABA with gas group were 2.61±0.96 and 1.85±0.79, respectively, and those in the gasless TA group were 3.12±1.02 and 2.17±0.76, respectively, at 1 and 3 days after surgery. Incidences of postoperative complications were similar except for the higher rate of seroma in the gasless TA group. Cosmetic satisfaction scores of UABA with gas were higher than those of the gasless TA. CONCLUSION: UABA with gas may be a good option for endoscopic thyroidectomy because this approach is less invasive than the gasless TA is.

Clinical Features and Outcomes of Papillary Thyroid Carcinoma in Patients Aged under 20 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid carcinoma rarely occurs in children and adolescents, whose clinical features are diverse, and treatment outcomes are still controversial. The aim of this study was to evaluate the clinical features and the treatment outcomes of papillary thyroid carcinoma (PTC) patients younger than 20 years old. SUBJECTS AND METHOD: This is a retrospective study for patients younger than 20 years old, who were diagnosed as PTC from January 1992 to February 2009. Clinical features, size, pathologic type, extrathyroidal extension, recurrence, multiplicity, extent of surgery, and lymph node metastasis were retrospectively evaluated. RESULTS: Forty patients, of 6 malse and 34 females, were enrolled, with their mean age being 16 years old. The initial operations were total thyroidectomy for 9 patients, unilateral lobectomy for 15 patients, and total thyroidectomy and lateral neck dissection for 16 patients. Cervical lymph node metastases were diagnosed in 25 patients. Extrathyroidal extensions were observed in 30 patients. Postoperative radioactive iodine therapy was performed in 35 patients. During the follow-up period, 8 patients had recurred. All patients were alive at the last follow-up. CONCLUSION: PTC in children and adolescents aged under 20 is a rare disease and tends to present as an advanced disease with low mortality compared to adult PTC. Recurrence had no effect on survival. Aggressive treatment with total thyroidectomy, central neck dissection, and radioiodine therapy may prevent recurrence.

Analysis of Treatment Results after Thyroid Lobectomy with Prophylactic Ipsilateral Central Neck Lymph Node Dissection for Low-Risk Papillary Thyroid Carcinoma: A Single Institute Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical options for low-risk papillary thyroid carcinoma (PTC) have been in debate. The purpose of this study was to analyze the treatment results of lobectomy and prophylactic ipsilateral central lymph node dissection (cND) for low-risk PTC. SUBJECTS AND METHOD: We retrospectively analyzed 906 patients who were diagnosed as PTC pre- or post-operatively and underwent lobectomy and/or prophylactic ipsilateral cND from 2001 to 2010. Studied variables were clinicopathologic data, complications, sites of recurrence, overall survival, and recurrence free survival rates. RESULTS: Fifty two (5.7%) patients showed recurrence during follow-up. Of the 52 recurrent cases, 32 (61.5%) cases recurred in a remnant thyroid only, 11 (21.2%) cases in a lymph node (LN) only, and 9 (17.3%) cases in a remnant thyroid and the LN. One (0.1%) patient showed permanent vocal cord palsy. Overall survival rate at 10 years was 99.6%. Overall recurrence free survival rates at 5 and 10 years were 97.1% and 81.0%, respectively. Risk factors for recurrences were old age (>45), contralateral nodule(s) at initial surgery, large tumor, no prophylactic cND, and pathological LN metastasis. CONCLUSION: Lobectomy with prophylactic ipsilateral cND may be a good option for low risk PTC patients due to excellent overall survival rates, recurrence rates, and minimal complication rates.

A Case of Pancreatitis Associated with Hyperfunctioning Intrathyroidal Parathyroid Adenoma / 대한이비인후과학회지

Both intrathyroidal parathyroid adenoma and acute pancreatitis from hyperparathyroidism are rare disorders. We report a case of acute pancreatitis from hyperfunctioning intrathyroidal parathyroid adenoma in a 40-year-old man with severe abdominal pain. Serum chemistry values show-ed high amylase, lipase, calcium and intact parathyroid hormone level, and abdominal CT revealed acute pancreatitis. A 7 mm lesion was detected inside the left upper pole of thyroid on neck ultrasonography and confirmed to be a parathyroid lesion based on fine needle aspiration cytology. After exploratory parathyroidectomy, symptoms subsided. In patients who present with acute pancreatitis, hyperparathyroidism should also be considered if risk factors such as alcohol ingestion, gallstone, previous endoscopic retrograde cholangiopancreatography, and abdominal trauma do not exist. Exploratory parathyroidectomy should be performed in a case of acute pancreatitis from primary hyperparathyroidism.

Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism

BACKGROUND: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. METHODS: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. RESULTS: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. CONCLUSION: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

A Case of Parathyroid Carcinoma Presenting as Brown Tumors / 대한이비인후과학회지

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.

Clinical Characteristics of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC) and has been adopted as a histologic variant. Due to the limited number of cases and the heterogeneity of the tumor's clinical behavior, there is no consensus for DSV's optimal treatment and post-operative follow-up. The purpose of this study is to evaluate the clinical manifestation, recurrence and prognosis of 10 patients with DSV. SUBJECTS AND METHOD: We retrospectively reviewed ten consecutive patients in whom DSV was first observed between 2000 and 2012. All patients are presently under active follow-up at Korea Cancer Center Hospital. Patients underwent a total thyroidectomy with central compartment and laterocervical lymph node dissection only when this involvement was documented by pre-surgery ultrasound examination with fine needle aspiration biopsy. RESULTS: The mean observation interval was 41.6 months. The ratio of male to female was 1 : 9, and the age of incidence was 34.2+/-11.4. The average size of mass was measured 2.9+/-1.9 cm. Upon the diagnosis, eight cases had central and lateral neck lymph nodal metastasis, which was confirmed during the operation. There was no distant metastasis, but one case was confirmed with lung metastasis during the follow-up period. There was no mortality during the follow-up periods in all ten cases. CONCLUSION: DSV of PTC has high risk characteristics of large tumor size, extrathyroidal extension, and multiple lymph nodes metastasis. We may expect comparable outcome with classical PTC by proper surgical treatment and postoperative radioactiveiodine ablation.

A Case of Asymptomatic Multiple Endocrine Neoplasia Type 1 Detected Incidentally on Health Screening / 대한이비인후과학회지

Multiple endocrine neoplasia type 1 (MEN 1) is characterized by the coexistence of primary hyperparathyroidism, enteropancreatic tumors, and anterior pituitary adenoma. Also adrenal adenoma, lipoma, carcinoid tumors could exist simultaneously on the atypical clinical course of MEN 1. Among these diseases, primary hyperparathyroidism is the most common manisfestation of MEN 1 syndrome. However, it sometimes presents no clinical symptoms and is incidentally detected on medical checkup. A 48-year-old woman, while undergoing a regular medical check-up, was diagnosed with primary hyperparathyroidism. Further studies showed concurrence of pancreatic tumor and adrenal tumor, but there was no pituitary lesion. The patient underwent parathyroidectomy with auto-implantation of parathyroid tissue, pylorus preserving pancreatico-duodenectomy and partial adrenalectomy. The pathological test confirmed it to be parathyroid hyperplasia, well-differentiated pancreatic endocrine carcinoma and adrenal cortical adenoma. We report this atypical and asymptomatic case of MEN 1 with a review of the relevant literature.

Follicular Variant of Papillary Thyroid Carcinoma: Clinical Manifestation and Prognosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite relatively high incidences of follicular variant of papillary thyroid carcinoma (FV-PTC), there is a continuous debate regarding the clinical behavior, treatment outcome, prognostic variables and survival of this disease. We performed this study for the purpose of getting further understanding and more supporting ideas for the treatment of FV-PTC. SUBJECTS AND METHOD: A clinicopathologic analysis of 116 patients who underwent a thyroidectomy with a final diagnosis of FV-PTC divided the patients into three groups: the FV-PTC only group (group A, n=78), the FV-PTC group who developed classical papillary thyroid carcinoma (C-PTC) (group B, n=38) and the C-PTC only (group C, n=320, 2003, Korea Cancer Center Hospital). The three groups were compared with respect to the following various clinicopathological characteristics: age at diagnosis, tumor size, stage of tumor, capsular invasion, age, metastasis, extent, size score, multifocality of tumor, LN metastasis, treatment, and recurrence. RESULTS: The mean tumor sizes, disease stage, and type of initial surgery were similar in three groups. However, the prevalence of nodal disease and capsular invasion were significantly higher in the groups B and C compared to the patients of group A. The 8-year disease-free survival rate was 93.7% in the patients with FV-PTC only, 90.4% in the patients with C-PTC only and 88.2% in the patients with FV-PTC group, who developed C-PTC (p>0.05). CONCLUSION: The clinical behavior and prognosis of PTC and FV-PTC groups did not differ significantly. In treating FV-PTC, we find that it is desirable to choose a similar strategy as that used to treat C-PTC.

Clinical Menifestation and Anaylsis of Thyroid Follicular Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid carcinoma. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of thyroid follicular carcinoma. SUBJECTS AND METHOD: Over a 12-year period, 126 patients surgically treated for FTC with an average follow-up of 57.5 months were retrospectively studied. RESULTS: Eighteen (14.3%) patients had distant metastasis at presentation and completion thyroidectomy was performed for 58 patients (46%) after partial thyroidectomy. This implies how difficult it is to diagnosis this type of cancer at the preoperative or intra-operative stage of treatment. Fine-needle aspiration cytology has been shown to be an ineffective method for the diagnosis of FTC. Five patients developed recurrent distant metastasis 6 month after their initial treatment and 3 patients died of persistent distant metastatic disease. The 10-year overall survival rate were 97.6%, and 10-year disease free survival rate was 82.5%. The patients with minimally invasive follicular carcinoma (n=92) and low risk group according to AMES classification, stage IV in TNM classification had more favorable prognosis. But the results showed no statistically significant difference. CONCLUSION: Several staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma, analysis of prognostic factor (recurrence, local invasion, distant metastasis, age, tumor size) is important in identifying low risk patients for a more conservative treatment.

The Clinical Importance of Minimal Extrathyroid Extension on Tumor Recurrence in Patients with Papillary Thyroid Carcinoma

BACKGROUND: We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC). METHODS: We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/without subsequent 131I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE. RESULTS: Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6-142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log-rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log-rank test). CONCLUSION: These findings suggest that METE might not be a prognostic factor to predict tumor recurrence in patients with PTC, including PTMC.

Nonrecurrent Inferior Laryngeal Nerve Related to Thyroid Surgery : Review of Ten Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nonrecurrent inferior laryngeal nerve (NRILN) is a rare anomaly of the recurrent inferior laryngeal nerve (RILN), associated with abnormal development of the aortic arch that can be associated with an increased risk of vocal fold paralysis. This study will describe preoperative diagnosis and intraoperative findings. SUBJECTS AND METHOD: We describe 10 cases (0.53%) of the NRILN observed during 1890 surgical procedure between January 2006 and December 2008. RESULTS: The NRILN was observed on the right side in all cases. Although the NRILN was preserved, immediately after the surgery, vocal fold paralysis was present in one patient who completely recovered one month later. CONCLUSION: Injury due to RILN that results in vocal fold paralysis is one of the serious complications in thyroid and parathyroid surgery. If the RILN is not found in the classic position during surgery, this can be a possibility of the presence of the NRILN

Clinical Assessment and Management of Papillary Thyroid Carcinoma with Coexistent Hashimoto's Thyroiditis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The frequency of co-occurence of Hashimoto's thyroiditis and papillary thyroid carcinoma has been variously reported to range from 0.3% to 38%, and the association of these two diseases is still controversial. The aim of our study is to determine the relationship between these two entities, and in this paper, we compare the clinical characteristics of patients with and without histopathological evidence of Hashimoto's thyroiditis. SUBJECTS AND METHOD: Among 366 patients treated for thyroid nodules (including benign nodules and thyroid cancers) during the period of July 2004-June 2005, 278 patients (male versus female=1 : 7.9) with papillary thyroid carcinoma were included in this study. RESULTS: Hashimoto's thyroiditis co-occurred with papillary thyroid carcinoma in 68 of 278 patients (24.5%), compared with 0 of 21 patients (0%) with other thyroid malignancies. The age at presentation (median, 43.9 years), tumor size (median, 1.31 cm), methods of diagnostic evaluation, and the extent of surgery had not influenced by the presence of Hashimoto's thyroiditis. However, TNM stage, AMES stage, MACIS score were slightly lower and the proportion of female patients (1 : 67) was higher in patients with Hashimoto's thyroiditis. CONCLUSION: These results suggest that patients who have papillary thyroid carcinoma may have more favorable prognosis in the co-ocurring Hashimoto's thyroiditis. Further studies are required to confirm the long-term prognostic association between these two diseases.

Primary Cutaneous Actinomycosis of the Nasolabial Fold / 대한이비인후과학회지

Actinomycosis is a chronic and suppurative infection caused by an endogenous Gram-positive bacterium. The usual sites of infection are the head and neck, thorax, and abdomen. Primary cutaneous actinomycosis is very rare and usually associated with external trauma and local ischemia. We report on the case of a primary cutaneous actinomycosis of the nasolabial fold in a 70-year-old woman. The patient had a well-defined subcutaneous nodule on the nasolabial fold without any other lesion. The patient was treated successfully with surgical resection and combined antibiotic therapy. There has been no recurrence during the 3 months period of follow-up.