A Case of Thyroid Insular Carcinoma with Multiple Bone Metastases Presenting as Pyriform Sinus Mass / 대한이비인후과학회지

Thyroid insular carcinoma (TIC, poorly differentiated thyroid carcinoma) is derived from thyroid follicular cells and known to show pathophysiologic behaviors intermediate between well-differentiated and undifferentiated types of thyroid carcinoma. The estimated incidence of TIC is from 0.4% to 5% of all thyroid cancers and is rare in Asians. Moreover, the multiple bone metastases in TIC have been rarely reported so far. Clinically, there are two pathways that thyroid cancer is presented, either as a parapharyngeal or retropharyngeal mass. For the first pathway, the mass is located on the thyroid upper pole and it grows toward the anatomical defect of posterior aspect of inferior pharyngeal constrictor. The second pathway involves a pharynx directly compressed by the mass from outside to inside of inferior pharyngeal constrictor. A 66-year-old man who had a thyroid mass revealed important clinical findings: a right pyriform sinus mass from laryngoscopy and multiple bone metastases from radiology. We performed subtotal thyroidectomy with central neck dissection. The mass was confirmed as TIC from follicular thyroid carcinoma. The patient received radiation and radioactive iodine therapy, and bcause of a remnant thyroid mass, he was observed closely. We herein report a rare, unique case of TIC with a review of literatures.

Two Cases of Immunoglobulin G4-Related Sclerosing Disease in Submandibular Triangle / 대한이비인후과학회지

Immunoglobulin G4-related sclerosing disease (IgG4-RD) is histologically a chronic inflammatory disorder characterized by infiltration of lymphoplasmacytes, sclerosis, and an elevated serum level of IgG4 and IgG4 positive plasmocytes. IgG4-RD is associated with autoimmune pancreatitis, sclerosing cholangitis, sialalithiasis, retroperitoneal diseases, inflammatory arotitis and Mikulicz's disease, typically including the lacrimal glands, salivary glands, pancreas, thyroid gland, lungs and kidneys. It is important to distinguish IgG4-RD from neoplastic disease as it responses well to steroid. Because consensus for nomenclature of IgG4-RD is recently made, reports of IgG4-RD in the Head and Neck area are still rare. In the first case, a 68-year-old man presented with a recurring submandibular gland mass from 7 years ago; he underwent submandibular gland resection and was diagnosed as IgG4-RD. In the second case, a 69-year-old mass presented with a relapsing right neck mass on level Ib. He underwent an exsional biopsy and was diagnosed with the same disease entity. We experienced two cases of IgG4-RD, and so report them with a brief literature review.

Papillary Thyroid Cancer from Lateral Aberrant Thyroid Masquerading as Cervical Metastasis from Larynx Cancer: A Case Report

The aberrant or ectopic thyroid in lateral neck is a rare developmental anomaly. Furthermore, the primary thyroid carcinoma arising in ectopic thyroid is extremely rare, only a few cases have been reported so far in English literature. We report a 64-year-old male with left transglottic cancer and primary papillary carcinoma from lateral aberrant thyroid in left lateral neck. Preoperatively, we diagnosed as transglottic cancer with ipsilateral neck metastasis. The patient underwent total laryngectomy, left selective neck dissection and left thyroidectomy. Finally, the patient was diagnosed as left transglottic cancer and papillary carcinoma from lateral aberrant thyroid. Surgeons should take into account a primary ectopic thyroid carcinoma arising in lateral neck may co-exist with another type of head and neck tumor.

A Case of Anisakiasis Invading the Oropharynx / 대한이비인후과학회지

Anisakiasis is one of the fish-transmitted infections that result from the accidental ingestion of third-stage larva belonging to the family Anisakidae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary; however, there have been very few reports of anisakiasis involving the oral cavity and oropharynx. A 46-year-old woman complained of sore throat shortly after eating raw flatfishes. The oropharyngeal examination revealed two living tubular spinning objects in the submucosal layer of left posterior pillar. It was removed with biopsy forceps. We report a very rare and unique case of anisakiasis in oropharynx confirmed by pathologic findings. To best of our knowledge, this is the first case report involving oropharyngeal anisakiasis in Korea.

Co-existence of Papillary Thyroid Cancer with Tuberculosis Involving the Thyroid and Ipsilateral Paratracheal Lymph Node: A Case Report / 대한갑상선학회지

There are relatively rare cases concerning about concurrent papillary thyroid cancer and thyroid tuberculosis with cervical tuberculous lymphadenitis in English literature so far. Cervical lymphadenitis (scrofula) is a common manifestation of extra-pulmonary invasion of the tuberculosis. A cervical tuberculous lymphadenitis could be confused with metastatic lymph node from the thyroid cancer. A 49-year-old woman with multiple right thyroid nodules of Bethesda category VI referred our department for surgery. We performed the right thyroid lobectomy with anterior compartment neck dissection. The histopathology revealed concurrent papillary thyroid carcinoma and thyroid tuberculosis with cervical tuberculous lymphadenitis. We report a unique case of concurrent papillary thyroid cancer and tuberculosis involving the thyroid gland and ipsilateral paratracheal lymph node with literature review. To our best knowledge, such case has not been reported earlier.

A Case of Bilateral Peripheral Tapia's Syndrome Subsequent to Coronary Artery Bypass Graft / 대한이비인후과학회지

The Tapia's syndrome means symptom complex that result from unilateral vago-hypoglossal nerve paralysis. This syndrome is rare disease entity, bilateral attack is extremely rare. Only three cases have been reported in English literature. A-66-year-old man received the coronary artery bypass graft in our hospital. After the operation, he complained of severe dyspnea, voice change and drooling. The laryngoscopic findings showed the bilateral vocal cord palsy. He could not move the tongue toward any directions. We diagnosed as bilateral Tapia's syndrome. Usually, unilateral Tapia's syndrome is related to the complications of anesthesia and position of the patient's head during surgery. Otherwise, our case may be associated with the complications of operation and anesthesia. The patient's recovered three months later, but the right vocal cord palsy is persistent. We report the very unique disease entity with literature review.

A Case of Contemporaneous Occurrence of Thyroglossal Duct Cyst and Lingual Thyroid without the Orthotopic Thyroid Gland / 대한이비인후과학회지

Thyroglossal duct cyst (TGDC) and lingual thyroid (LT) are two relatively common anomalies of thyroid gland development. Each may occur without the orthotopic thyroid gland, although the co-existence of these three anomalies is very rare. The thyroidal function may be abnormal in both anomalies, and careful evaluation of thyroid function is essential for the management of these lesions. A 71-year-old woman was admitted to our department for removal of midline neck mass. She underwent the classical Sistrunk's operation, but after the surgery, her hypothyroidism became aggravated. We report, along with a literature review, an extremely rare case of co-existence of TGDC and LT in the absence of orthotopic thyroid gland.