Pattern and Treatment of Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node metastasis develops in approximately 30% to 80% of patients with papillary thyroid carcinoma. In papillary thyroid carcinoma, lymph node metastasis at presentation do not seem to adversely affect survival, but do increase the risk of loco-regional recurrence. The management of cervical metastasis in thyroid papillary carcinoma ranges from selective removal to a formal comprehensive neck dissection. In this study, we analyzed the pattern of cervical lymph node metastasis and the impact of prognostic variables in oder to plan how to manage the cervical lymph node metastasis in patients with papillary thyroid carcinoma. SUBJECTS AND METHOD: The clinical records and pathological reports of 114 patients who underwent surgery for thyroid papillary carcinoma at the Department of Otolaryngology-Head and Neck Surgery, Hanyang university from 1996 to 2002 were analyzed retrospectively. RESULTS: Cervical nodal metastasis was found in 57 (50.0%) patients. Occult metastasis was found in 26 (22.8%) patients. Cervical lymph node metastasis was most frequently noted in the level VI (38.6%). The size of primary tumor and extrathyroidal invasion were associated with cervical metastasis. CONCLUSION: Based on our results, it might be suggested that elective central neck dissection is needed for patients with papillary thyroid carcinoma which is larger than 35mm or has extrathyriodal extension.

Angiogenesis and Ki67 Expression in the Thyroid Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angiogenesis is the process of new blood vessel development from preexisting vessel. In many human solid tumor, the extent of angiogenesis is one of the most significant prognostic factors that can be used to predict the patient survival rate and metastasis. The aim of this study is to investigate the role of new blood vessel formation in the thyroid tumors. SUBJECTS AND METHOD: We analyzed the microvascular density and proliferation index in the 70 cases of thyroid tumors by double immunohistochemistry with anti-CD34 and anti-Ki67 antibody. The microvascular density and Ki67 index were compared with the clinical parameters such as sex, age, stage, tumor extension, cervical lymph node metastasis, and prognostic factors, which were obtained through the retrospective review of the medical records. RESULTS: The microvascular density and Ki67 index were higher in malignant tumors than in benign tumors. Higher microvascular density and Ki67 index were associated with tumor stage and increased risk of AMES, AGES and MACIS scores. CONCLUSION: The microvascular density and Ki67 index may serve as significant prognostic factors in the differentiated thyroid cancer.

One-Stage Vertebral Reconstruction Combined with Posterior Instrumentation by Posterolateral Approach for Spinal Metastasis

The authors present a series of 12 patients who underwent one-stage spondylectomy, vertebral reconstruction, posterior segmental stabilization for malignant metastatic disease. Major indication for this approach includes three column involvement or untolerable thoracotomy. This operative method involved the spondylectomy via a bilateral transpedicular or unilateral extracavitary approach, vertebral body reconstruction with methlymethacrylate (MMA), and posterior stabilization with sublaminar wiring in one stage. Postoperatively, all patients improved neurologically. Average neurologic improvement was 1.5 Frankel grade. Pain relief was obtained in all patients. Recovery of sphincter change was obtained 7(88%) of the 8 patients. One patient died postoperatively due to pneumonia. Spinal alignment was maintained in all. The major advantage of this approach is that circumferential decompression of the spine and stabilization can be obtained safely by one stage.

Surgical Treatment of Metastatic Spinal Tumor

The authors present a series of 35 patients who underwent operation for metastatic spinal tumor. Patients were operated via anterior, posterior or posterolateral and combined anterior-posterior approach. The anterior approach was used in cases where there was no involvement of the posterior column, tolerable of a thoracotomy and involvement of three or less adjacent vertebral bodies. The posterior or posterolateral approach was used in cases with involvement of the posterior column, disease at two seperated locations, intolerable of a thoracotomy and involvement of three columns. The combined anterior-posterior approach was used when it was not enough to obtain stabilization with anterior or posterior approach alone and expected greater than 1 year life expectancy. Twenty-five(89%) of the 28 patients improved neurologically following surgery. Average neurologic improvement was 1.3 Frankel grade. Pain relief was obtained in twenty-six(93%) of the 28 patients. Recovery of spincter change was obtained twelve(80%) of the 15 patients. Two patients died postoperatively due to DIC and pneumonia. Prior to operation, selective spinal angiography and embolization were performed in nine patients with metastases from renal carcinoma, thyroid cancer and hepatoma to reduce intraoperative bleeding. The authors believe that the choice of surgical approach has to be individualized for each patient depending on extent and location of the tumor, general condition of patient, goal of therapy and life expectancy.