A Case of Aneurysmal Bone Cyst in the Skull Base / 대한이비인후과학회지

Aneurysmal bone cyst is relatively rare, benign tumor in the adolescent. An aneurymal bone cyst in the skull base is much more rare. This lesion is frequently accompanied with other conditions such as fibrous dysplasia, osteosarcoma, and chondroblastoma. The differential diagnosis is important;however it is difficult to make a correct diagnosis. The diagnosis is usually made from CT and pathological findings such as multi-lobulated, thin-walled cyst filled with blood. The treatment of choice is complete excision, if possible. We experienced a case of aneurysmal bone cyst arising from petrous bone, which was treated with transtemporal approach with partial excision. The patient remains free of symptom for 24 months with some tumor remaining in the clival area.

A Clinical Analysis in Minor Salivary Gland Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Minor salivary gland tumors vary in their primary sites, histopathology and biological behavior. Therefore, various factors are considered in selecting the treatment modality and predicting the prognosis. Generally, it is reported that the prognosis of malignant tumors of minor salivary glands are worse than that of such lesions of major salivary glands. We performed this study to find out the clinical features and determine the prognostic factors of minor salivary gland tumors. MATERIALS AND METHODS: We analyzed retrospectively, 83 cases of minor salivary gland tumor and the 10 year survival rates using the Kaplan-Meier method. RESULTS: We found 16 benign tumors and 67 malignant tumors. Among the patients, 43 were males and 40 were females. The most common age group was the sixties, with the mean age of 50. The most common site of benign tumor was the palate, whereas malignant tumors were most commonly found in the maxillary sinus, palate, and floor of mouth, etc. Histopathologically, 14 patients with benign tumor had pleomorphic adenoma, and 39 patients with malignant tumor had adenoid cystic carcinoma. According to the criteria set by the AJCC on staging, the most common stage found for the subjects were the stage IV. Overall, the 5 year and 10 year survival rates were 56.1% and 46.9%, respectively. Histopathologic type had no effect on 10 year survival rates. The clinical stage had a significant impact on survival. CONCLUSION: In minor salivary gland tumor, the most significant prognostic factor was its clinical stage. Considering the frequent local recurrence and distant metastasis, long term follow ups will be needed.

Tracheal Shaving in the Thyroid Papillary Carcinoma with Airway Invasion / 대한이비인후과학회지

OBJECTIVES: We analyzed the outcome of trachea shaving in 20 patients with locally invasive thyroid papillary carcinoma. MATERIALS AND METHODS: From Jan. 1992 to Jun. 1994, we treated surgically 205 patients with papillary thyroid carcinoma, of whom 41 revealed upper airway invasion and 20 were treated with the shaving method. The others were treated with window resection, circumferential resection, and total laryngopharyngectomy with free jejunal graft. Twenty patients who underwent the shaving procedure were followed up for 28 to 59 months (mean of 49.5 months) and were examined for the incidence of recurrence by way of physical examinations, elevated serum thyroglobulin, despite of the TSH suppression therapy, iodine whole body scan, and the endoscopic examination. RESULTS: The rate of recurrence was 5% (one patient), and it was detected by the iodine whole body scan. The site of recurrence was the pyriform sinus and paraglottic space, so we performed partial laryngopharyngectomy. CONCLUSION: In thyroid papillary carcinoma invading the upper airway, the extent of resection should be determined individually according to the extent of tumor invasion. If the adventitia of the trachea is only the invasion site, and a grossly complete resection is performed, the 'shaving' method may be sufficient. However, the window resection or the circumferential resection should be performed in more invasive cases. Our data suggest that the surgical method of resection may be determined individually, and surgeons who have flexible attitudes may have good results.

A Clinical Analysis in Adenoid Cystic Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND: Adenoid cystic carcinoma of the head and neck is relatively rare and is characterized by slow evolution, multiple recurrences, protracted clinical course, and distant metastases. OBJECTIVES: We performed this study for the purpose of determining the effect of age and sex distribution, site, treatment modality, distant metastasis and stage on survival in adenoid cystic carcinoma of the head and neck. MATERIALS AND METHOD: This article presents the age and sex distribution, primary sites, treatment modalities according to different clinical stages, recurrence patterns, and 5 year survival rates in each cases by analyzing 55 patients of adenoid cystic carcinoma of the head and neck treated from 1985 to 1995 at Korea Cancer Center Hospital. RESULTS: In 55 cases of adenoid cystic carcinomas, 27 were male and 28 were female. By age, 6th decades were most common. According to the primary site, major salivary gland origin were 20 cases and minor were 35 cases. 12 cases were stage 1, 18 cases were 2, 10 cases were 3, and 15 cases were 4. According to the treatment modality, 12 patients received surgery only, 31 patients received surgery and postoperative radiation therapy, and 9 patients received radiation therapy only. Among the 4 patients with distant metastases at diagnosis, 3 received chemotherapy. Local recurrence was identified in 12 cases, distant metastasis only was in 7 cases, and both were in 6 cases. Lung was the most common metastatic site. Overall 5 year survival rates were 77.1%. Age, sex, primary site, and treatment modality had no effect on 5 year survival rates. The clinical stage and distant metastasis had a significant impact on survival. CONCLUSION: In adenoid cystic carcinoma of the head and neck, the most significant prognostic factors are clinical stage and distant metastasis. But, considering the slow growing features of tumor, long term follow up will be needed for the more accurate evaluation.

Follicular Carcinoma of the Thyroid Gland / 대한이비인후과학회지

BACKGROUND: Follicular carcinoma of the thyroid is less common than papillary carcinoma and so with a few clinical data. OBJECTIVES: We performed this study for the purpose of getting further understanding and more supporting idea for diagnosis and treatment of follicular carcinoma. MATERIALS AND METHODS: Four hundred thirty patients with thyroid tumors were treated from 1991 to 1995. Twenty two patients were histopathologically proved as follicular carcinoma. All but one without treatment were reviewed retrospectively. RESULTS: Of the 430 patients, 382(88.8%) were malignant and 48(11.2%) were benign. In malignant tumors, 317(83.0%) were papillary carcinoma and 22(5.8%) were follicular carcinoma. Fine-needle aspiration cytology(FNAC) was performed in 17/21 which revealed malignancy only in 7 patients. Total thyroidectomies were performed in 18 patinets;12 patients had completion thyroidectomies. Cervical lymph node metastases presented in 3 patients and distant metastases were detected in 6 patients. According to the AMES risk group, 9 patients were in low and 12 patients were in high risk group. CONCLUSION: Follicular carcinoma of the thyroid reveals higher rate of distant metastases and lower accuracy of fine-needle aspiration cytology and frozen section biopsy. Therefore, the more aggressive treatment should be considered in high risk group after confirmation of distant metastases through careful evaluation.