PLAG1, SOX10, and Myb Expression in Benign and Malignant Salivary Gland Neoplasms

BACKGROUND: Recent findings in molecular pathology suggest that genetic translocation and/or overexpression of oncoproteins is important in salivary gland tumorigenesis and diagnosis. We investigated PLAG1, SOX10, and Myb protein expression in various salivary gland neoplasm tissues. METHODS: A total of 113 cases of surgically resected salivary gland neoplasms at the National Cancer Center from January 2007 to March 2017 were identified. Immunohistochemical staining of PLAG1, SOX10, and Myb in tissue samples was performed using tissue microarrays. RESULTS: Among the 113 cases, 82 (72.6%) were benign and 31 (27.4%) were malignant. PLAG1 showed nuclear staining and normal parotid gland was not stained. Among 48 cases of pleomorphic adenoma, 29 (60.4%) were positive for PLAG1. All other benign and malignant salivary gland neoplasms were PLAG1-negative. SOX10 showed nuclear staining. In normal salivary gland tissues SOX10 was expressed in cells of acinus and intercalated ducts. In benign tumors, SOX10 expression was observed in all pleomorphic adenoma (48/48), and basal cell adenoma (3/3), but not in other benign tumors. SOX10 positivity was observed in nine of 31 (29.0%) malignant tumors. Myb showed nuclear staining but was not detected in normal parotid glands. Four of 31 (12.9%) malignant tumors showed Myb positivity: three adenoid cystic carcinomas (AdCC) and one myoepithelial carcinoma with focal AdCC-like histology. CONCLUSIONS: PLAG1 expression is specific to pleomorphic adenoma. SOX10 expression is helpful to rule out excretory duct origin tumor, but its diagnostic value is relatively low. Myb is useful for diagnosing AdCC when histology is unclear in the surgical specimen.

Right Paraesophageal Lymph Node Metastasis in Papillary Thyroid Cancer and Prophylactic Dissection: A Retrospective Study / 대한내분비외과학회지

PURPOSE: The purpose of this study is to determine the status of nodal disease, including the right paraesophageal node, in papillary thyroid carcinoma (PTC). METHODS: A total of 116 patients with PTC underwent total thyroidectomy and prophylactic central node dissection, including right paraesophageal lymph nodes (RPE LNs). Metastases to RPELNs were analyzed by site and clinicopathologic variables. Recurrence rate and post-operative complications were also evaluated by comparing the right paraesophageal lymph node dissection (RPE LND) with the non-RPE LND group. RESULTS: Central node metastases were detected in 57 (49.1%) patients; paratracheal and pre-tracheal lymph node metastases, total RPE LN metastases, and metastases only in RPE LN occurred in 50 (43.1%), 18 (15.5%), and 5 (4.3%) patients, respectively. Age, tumor size, tumor longitudinal location, extrathyroidal extension, and multicentricity were insignificant in RPE LN metastasis (P>.05). Although there was no significant statistical difference, tumors with lymphatic invasion and larger tumors (>1 cm) had more frequent RPE LN metastases. RPE LN metastases were frequent in deeply located tumors instead of superficially located tumors (P=0.015). Compared with the non-RPE LND group, the incidence of post-operative complications (transient hypocalcemia and vocal cord palsy) was not significantly different and there was no recurrence in both groups during the follow up period. CONCLUSION: The metastatic rate of the right paraesophageal lymph nodes was 15.5%; 83.3% of these were macrometastatic. Prophylactic RPE dissection compared with the non-RPE LND group, however, did not show a survival difference for 5 years.

Preoperative Serum Thyroglobulin as a Useful Predictive Marker to Differentiate Follicular Thyroid Cancer from Benign Nodules in Indeterminate Nodules

Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.

Evaluation of Xerostomia Following Intensity Modulated Radiotherapy (IMRT) for Head and Neck Cancer Patients / 대한방사선종양학회지

PURPOSE: This study was done to evaluate xerostomia following intensity modulated radiotherapy for patients with head and neck cancer, and to analyze the correlation between the dosimetric parameters and xerostomia parameters. MATERIALS AND MEHTODS: From February till October 2003, 13 patients with 3 months of follow-up were evaluated for xerostomia after being treated for head and neck cancer with IMRT. Their median age was 57 years (range: 43~77). Xerostomia were assessed with a 4-question xerostomia questionnaire score (XQS) and a test for salivary flow rates (unstimulated and stimulated). The patients were also given a validated LENT SOMA scale (LSC) questionnaire. The evaluations were completed before radiation therapy (pre-RT) and at 1 and, 3 months after radiation therapy (RT). We evaluated xerostomia at pre-RT, 1 and, 3 months after RT. The association between the xerostomia parameters (XQS and LSC) and salivary flow rates (unstimulated and stimulated: USFR and SSFR) was assessed at 1 and 3 months after RT. RESULTS: All 13 patients showed no significant changes in XQS, LSC and Salivary Flow rates. As a result, we couldn`t find out about xerostomia development. Based on the total mean parotid dose, 3,500 cGy, we divided these patients into two groups. The 8 patients ( or =3,500 cGy), there was a significant increase in USFR and, SSFR at 3 months after RT, and for the XQS and, LSC at 1 and 3 months after RT. The correlation between XQS and, LSC, and USFR and, SSFR in all patients (13) was significant at 3 months after RT. The correlation had a tendency to the decrease for USFR and, SSFR in proportion to the increase of XQS and, LSC. CONCLUSION: Based on the results of this study, IMRT seem to be an effective treatment to significantly decrease the xerostomia. XQS and, LSC seem to be a effective tool for predicting the xerostomia. A total parotid gland mean dose of <3,500 cGy should be a planning goal if substantial sparing of the gland function is desired. Furthermore, patients should be enrolled in a study to define a more accurate threshold dose for the parotid gland.

A Case of Submental Lymphadenitis by Toxoplasmosis / 대한이비인후과학회지

Toxoplasma gondii, an intracellular coccidian protozoan and a widespread parasite affecting various animals and humans, is one of the common causes of cervical lymphadenitis in human. Cervical lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host, but still more rare in Korea than in other countries, including United States and Europe. In Korea, number of travelers to and from other countries and inclusion of meat as a part of daily diet are increasing, possibly increasing the incidence of toxoplasma lymphadenitis, which should be considered by differential diagnosis of lymphadenitis. We present a case of toxoplasma lymphadenitis in submental lymph nodes in an immunocompetent host.

A Study of Microvessel Density, P53, Ki67, and DNA Flowcytometry in Cervical Lymph Node Metastasis of Squamous Cell Cancer in Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Lymph node metastasis is believed to be the single most important prognostic factor in the head and neck squamous cell cancer. To identify potential biological parameters for predicting cervical lymph node metastasis, we evaluated the relationship between cervical nodal status and several parameters, such as microvessel density, p53, Ki67, and DNA ploidy, and compared it with the conventional clinical parameters including histologic grade of the tumors. MATERIALS AND METHOD: This study group included 26 specimens from the primary sites of patients who were diagnosed with squamous cell cancers of the head and neck. Immunohistochemstry and DNA flowcytometry were performed at almost the same sections of the primary sites. To quantify angiogenesis, the microvessel density was determined by counting the number of the vascular endothelial cells positively stained with CD-31 under the magnification filed power of 200 by two investigators; the cell number was determined by taking the average of the highest values of three counts made by each investigator. Immunohistochemical staining with Ki67 and p53 were also done to evaluate the cellular proliferation of tumors and the overexpression of mutated tumor suppressor gene. DNA flowcytometry was performed to evaluate the ploidy and proliferation index. These results were compared and analyzed with clinical parameters. RESULTS: All of the parameters failed to show a significant relationship to nodal status in this study. However, the microvessel density of the laryngeal cancers showed a statistically significant relationship with the cervical nodal metastasis (p=0.045). CONCLUSION: The microvessel density may have a correlation to the lymph nodal metastasis in the head and neck squamous cell cancer and may be regarded as an additional prognostic factor for planning treatment.

A Case of Chondrodysplasia Punctata Combined with Unilateral Choanal Atresia / 대한이비인후과학회지

Chondrodysplasia punctata is a rare congenital disease. It is classified into four main types according to the clinical features and heredity: autosomal dominant (Conradi-Hunermann's) type, autosomal recessive (rhizomelic) type, X-linked dominant type and X-linked recessive type. Among the four, rhizomelic chondrodysplasia punctata (RCDP) is the most lethal form of the disease, and most patients die in the neonatal period. Diagnosis of the RCDP relies on its characteristic features and radiological finding. The characteristic features are craniofacial dysmorphism (flat face, flat nasal bridge, anteverted nostril, telecanthus), cataracts, rhizomelic limb shortening, ichthyosis, and mental retardation. Radiologic findings include rhizomelic symmetrical shortening of upper or lower extremity, coronal cleft of vertebral body, metaphysical spraying and stippled calcification. This case shows typical abnormality in the face and extremity and also radiologic abnormality, uniquely combined with unilateral choanal atresia.

A Study of the Natural Course and Radiologic Findings in the Bilateral Vocal Cord Palsy Originating from Acute Cerebral Lesions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bilateral vocal cord paralysis is a potentially life-threating problem, but it accompanies a relatively rare complication of acute cerebral lesions. We attempted to estimate the usefulness of radiologic studies as predictive factors of recovery from this condition. MATERIALS AND METHOD: Five patients who developed acute respiratory failure after acute ischemic stroke were included in the study and followed up. Radiologic studies (CT or MRI) were performed to localize the brain lesions. Bilateral vocal cord paralyses were confirmed by rigid or fiberoptic laryngoscopy. RESULTS: Recovery of vocal cord mobility was observed in three patients. Vocal cord paralysis was not resolved in two patients with lateral medullary infarction and large subcortical infarction. CONCLUSION: Bilateral vocal cord paralyses resulting from acute cerebral lesions have different prognoses according to their location and extent. Therefore, radiological studies may be useful for predicting the recovery of centrally originated bilateral vocal cord paralysis.

A Case of Acquired Transient Laryngomalacia Associated with Diabetic Ketoacidosis / 대한이비인후과학회지

Collapse of epiglottis during inspiration is an unusual cause of upper airway obstruction. It is usually classified as a congenital anomaly but several acquired cases have been reported to occur in patients who have lost pharyngeal airway support by head injury and coma. Recently, we experienced a case of laryngomalacia that was associated with diabetic ketoacidosis and compromised the airway. A tracheotomy was first needed to maintain the respiration, then conservative management including diabetes control was enough to restore the patient's condition. This case supports the neuromuscular dysfunction theory which purports laryngomalacia as its cause.

Four Cases of Bilateral Vocal Cord Paralysis by Ischemic Stroke

Bilateral vocal cord paralysis (VCP) is a rare, life-threatening complication of stroke. We described the clinical course and treatment of bilateral VCP by acute ischemic stroke. We confirmed 4 cases of VCP. Two cases had brain-stem lesions, one case showed bilateral cerebral lesions and the last one had brainstem and cerebral lesions. One of the 4 cases showed spontaneous improvement of unilateral vocal cord function after 2 months. Among the rest, one under-went laser cordotomy, one remained tracheostomized, one was lost. (J Korean Neurol Assoc 19(4):400~403, 2001)

A Case of Kartagener's syndrome combined with congenital nystagmus / 대한이비인후과학회지

Primary ciliary dyskinesia results in characteristic clinical symptoms, including chronic pansinusitis, recurrent infections of the respiratory tract, and infertility. Kartagener's syndrome is clinically distinguishable by the presence of situs inversus from this group of diseases. Other otolaryngological manifestations of primary ciliary dyskinesia which have been reported include otitis media with effusion, tympanosclerosis, keratosis obturans, and chronic cholesteatoma. Congenital nystagmus is another otological symptom characterized by ocular oscillation, which usually appears in the early infancy, and is often associated with visuosensory abnormalities. Recently, we experienced a 13 year-old boy with congenital nystagmus in addition to all other manifestations of Kartagener's syndrome. Although the clinical implication is not clear, it is possible that two diseases share the same developmental abnormality.

Dislocation of the Globe into the Nasal Cavity after Orbital Wall Fracture

No Abstract Available.

Management of Paranasal Sinusitis in the Patient with Transplantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently there has been a marked increase in the number and the success rate of organ transplantation with the development of surgical technique and the introduction of new immunosuppressants. However, clinically silent sinonasal infections in transplant recipients frequently cause problems which are sometimes fatal. As otolaryngologists, we must give attention to sinonasal infection in these immunocompromised patients who have received organ transplantation. MAERIALS AND METHODS: We reviewed 170 patients who have received organ transplantation for three years and analyzed the clinical course of patients with sinonasal infection around the transplantation period. They were managed according to the protocol of our hospital. RESULTS: There were 17 patients with sinonasal infection around transplantation. Four out of nine patients needed sinus operation before transplantation and six out of eight patients required operation after transplantation, and two of them had invasive fungal infection. Three out of four bone marrow transplant patients needed surgical management. CONCLUSION: Immune status of the transplant patients was the most important prognostic factor. Before organ transplantation, when the patient's immune status is relatively normal, thorough and aggressive physical examination including OMU-CT is mandatory. OMU-CT plays the major role in the diagnosis of sinusitis and the treatment planning. Prompt decision-making and aggressive management are also thought to improve patients' outcome, especially after transplantation. We also propose a protocol that can be used for management of sinonasal infection in transplantation patients.

Endoscopic Maxillary Sinus Surgery Using the Microdebrider

In the treatment of chronic maxillary sinusitis, endoscopic sinus surgery, unlike the more radical Caldwell-Luc (C-L) operation, enables the preservation of mucosa. However, although a middle meatal antrostomy is superior in function and patency to an inferior meatal antrostomy, at times it is very difficult to remove diseased mucosa located at the antero-inferior or antero-medial side of the maxillary sinus : to prevent recurrence, the C-L procedure is often chosen. In an effort to decrease the failure rate of endoscopic maxillary sinus surgery, we applied the microdebrider technique, a new approach of puncture and shaving. To evaluate the effectiveness of the microdebrider technique, we retrospectively reviewed the medical records of 33 patients (43 sinuses) who have been treated by this method. We analyzed the clinical courses of these patients during recovery and evaluated endoscopic findings made during follow-up examinations. Nasal symptoms were alleviated in every case except for two. Three cases required revision ESS or a C-L procedure at the puncture and shaving site. The maxillary sinuses of most patients (80%) were normalized, but five sinuses demonstrated polypoid or thickened mucosa. The ostiums of 36 maxillary sinuses remained patent but nine sinuses became stenotic. Complications, which included facial pain and facial paresthesia, were rare and disappeared shortly. We consider this new technique to be an effective method of eradicating maxillary sinus disease that is not otherwise accessible through the MMA window.

Hypercholesterolemia and Abnormal Liver Function in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Abnormalities in serum cholesterol and liver enzymes are frequently encountered during preoperative evaluation for patients with obstructive sleep apnea (OSA). Obesity is known to be one of the possible causes and aggravating factors of OSA, and it is also known to be associated with hyperlipidemia, glucose intolerance and fatty liver. We tried to elucidate whether OSA itself, without the effects of obesity, can induce abnormalities in liver function and lipid metabolism. MATERIALS AND METHODS: The levels of fasting serum cholesterol, glucose and alanine aminotransferase (ALT) were checked in 215 adults who had received polysomnographic sleep study. The relationship between the apnea-hypopnea index (AHI) and these variables was evaluated using the general linear model analysis. RESULTS: A statistically significant correlation was found between AHI and cholesterol level. However, ALT was found to be more dependent on sex and obesity, than AHI. CONCLUSION: The study showed that, without the influence of obesity, age and sex, OSA itself had a meaningful correlation with hypercholesterolemia. This relationship could offer as one of the possible explanations for the increased cardiovascular risk in patients with OSA.

Correlation between Nasal Obstruction and Parameters in Acoustic Rhinometry

Several attempts have been made to correlate nasal obstruction and acoustic rhinometric parameters, so far failed to find any significant correlation. We evaluated the correlation between the sense of nasal obstruction and parameters measured with acoustic rhinometry, and searched any secondary variables calculated from primary parameters, to explain the sense of nasal obstruction objectively on 114 patients (72 men and 42 women) with nasal obstruction. The sense of nasal obstruction was measured with visual analogue scale. Nasal volume, minimal cross-sectional area, and equivalent resistance were measured by acoustic rhinometry. As secondary variables, we introduced the concept of decongestion rate which representing the amount of change in the parameters after application of nasal decongestant. Weak correlations were found between the sense of nasal obstruction and total minimal cross-sectional area. Significant correlations were found between the sense of nasal obstruction and decongestion rate of total nasal volume, and particularly in the wider cavity. Stronger correlations than in total population were found in male patients. The decongestion rate may have potential implication in explaining the sense of nasal obstruction.

A Case of Synovial Sarcoma Arising in the Hypopharynx / 대한이비인후과학회지

Synovial sarcomas are rarely occurring, highly malignant tumors of mesenchymal origin. Most cases are confined to the extremities. Fewer than 100 cases of synovial sarcoma have been reported in the head and neck area. We experienced a 24-year-old male patient who first complained of globus sensation. Initial suspension laryngoscopic biopsy specimen of the primary lesion was consistent with hypopharyngeal synovial sarcoma. Surgical excision through lateral pharyngotomy approach and postoperative radiotherapy were performed. We report this rare case with a literature review.