유두상 갑상선암 발생에 대한 내인성 스테로이드의 영향

정웅윤,서진학,정봉철<SUP>1<.SUP>,박정수,Woung Youn Chung,Jin Hak Suh,Bong Chul Chung<SUP>1 <.SUP>and Cheong Soo Park 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.2

목적: 스테로이드 호르몬은 다양한 종양의 성장에 기여하는 것은 잘 알려져 있다. 여러 보고에서 외인성 안드로겐이 갑상선 호르몬과 갑상선 세포의 성장에 기여한다는 사실이 증명되었으나, 갑상선 암에서의 안드로겐의 역할은 아직 분명히 밝혀지지 않았으며, 최근의 연구에서는 갑상선 조직에서 에스트로겐 수용체의 존재에 관하여, 갑상선암의 에스트로겐 의존성의 가능성을 제안해왔으나, 에스트로겐 수용체 양성율과 종양의 생물학적 양상과의 관계에 대한 명확한 결론을 얻지는 못하였다. 이에 연구자들은 갑상선 암에서의 안드로겐과 에스트로겐의 역할을 규명하고자 본 연구를 시행하였다. 대상 및 방법: 유두상 갑상선암 환자의 수술전과 수술후의 소변 견본과 정상여성의 소변 견본에서 안드로겐, 코티코이드(corticoid), 에스트로겐 호르몬 프로파일의 변화를 gas chromatography/mass spectrometry/selected ion-monitoring (GC/ MS/SIM) system를 통해 분석하였다. 또한, 호르몬의 불균형 이나 산화대사가 갑상선 암과의 연관성이 있는지 간접적으로 측정하기 위하여 관계 있는 호르몬 농도비를 측정하였다. 결과: 수술전 측정된 11-DOKS/17-OHCS비가 17-OHCS 양의 감소로 인하여 의미 있게 증가하였다. Catechol 과 2-OH E1을 포함한 에스트로젠의 측정량이 다른 에스트로겐의 대사산물에 큰 변화 없이 수술전 유두상 갑상선암 환자에서 유의하게 증가하였다. 수술전 16-OH E1/2-OH E1 비는 수술후 측정치에 비해 통계적으로 유의하게 낮은 결과를 보였다. 결론: 이상의 결과로 부신피질 홀몬 결핍에 의한 안드로겐의 체내 변화는 유두상 갑상선암의 발생에 영향을 줄 것으로 생각되며, 또한 에스트로겐 대사과정 중에 2-hydroxylation 과정의 증가는 유두상 갑상선암과 연관성이 있을 것으로 사료된다. (Korean J Endocrine Surg 2001;1:259-266)

갑상선 우연암종의 임상병리적 특성

정웅윤(Woung Youn Chung),정재호(Jae Ho Cheong),장항석(Hang Seok Chang),박정수(Cheong Soo Park) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.1

Objectives: With the recent advances and increasing use of imaging techniques in examination of the neck, the incidence of incidentally discovered thyroid carcinoma has been increasing. This study was carried out to evaluate the clinicopathologic characteristics of incidental thyroid carcinomas and to find optimal therapeutic strategies for these lesions. Materials & Methods: From Jan. 1988 to Aug. 1998, 1,053 patients were operated on for thyroid cancer, of whom 127(12.1%) had incidentally discovered thyroid cancers which were identified during routine health checkups(n=40), diagnostic procedures for unrelated medical conditions(n=39) and mass screening for thyroid cancer(n=48). The preoperative diagnosis was obtained by ultrasound-guided FNAB and the extent of surgery was determined based on frozen section examinations, as well as prognostic factors and gross findings at the time of surgery. Results: There were 6 men and 121 women with a mean age of 45.9 years. Histopathological diagnosis included papillary carcinomas(n=1l9), follicular carcinomas(n=6), poorly differentiated carcinoma(n=l) and medullary carcinoma(n=1). Thirty patients(23.6%) had multifocallesions. The mean diameter of the tumors was 1.1 cm(0.2-3.4 cm). Capsular invasions were found in 53 patients(41.7%) and nodal metastases in 41(32.3%). The surgical procedures used were: 90 less-than total thyroidectomies and 37 total thyroidectomies with central neck node dissection. Lateral neck dissection was added in 5 patients. According to TNM staging, 79 patients(63.2%) were at stage I, 15(12.0%) at stage II, 31(24.8%) at stage III and 0(0.0%) at stage IV. By AMES scoring system, 102 patients(81.6%) were in the low-risk group and 23(18.4%) in the high-risk group. And by MACIS scoring system, 103(86.6%) of 119 papillary thyroid cancer patients were less than 6. Conclusions: The clinicopathological characteristics of incidentally discovered thyroid carcinomas are similar to ordinary thyroid carcinomas. The treatment of choice should be individualized based on the particular clinical situation encountered, as in ordinary thyroid carcinomas.

후방접근 안면신경탐색 이하선 절제술과 수술후 안면신경 기능

정웅윤(Woung Youn Chung),정준(Joon Jeong),박정수(Cheong Soo Park) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.2

We performed a retrospective study to evaluate the effect of posterior approach to facial nerve in parotid surgery, being the standard procedure in our hospital, on postoperative facial palsy and to access the safety of this procedure in preserving the function of facial nerve. A series of 176 parotid surgeries from 172 patients from January 1989 to December 1994 was analyzed, of which, 2 Schwannomas, 4 Kimura's diseases, 6 preoperative facial palsies, and 4 intentional nerve resections for malignancy were excluded. Factors such as pathology of tumor, extent of surgery, location of tumor, size of tumor, frequency of surgery were reviewed to determine if any factor contributed to the developement of facial palsy postoperatively. Of 160 parotidectomies, postoperative facial palsy was found in 58(36.3%), being temporary in 35(35. 6%), recovered within 12 months after surgery and permanent in 1(0.6%). Facial palsy occured in 47(35.7%) of 128 benign tumors, 42(89.5%) recovered completely within 6 months and in 11(34.4%) of 32 malignant tumors, 6(54.5%) within 6 months. Among the factors analyzed, postoperative facial palsy was found to be common in the tumors of deep lobe(p<0.02) and in total or neartotal parotidectomies(p<0.08). In our study, the factors of the location of tumor and extent of surgery would be contributable to developement of postoperative facial palsy and the surgical technique using posterior approach to the facial nerve may be a simple and safe surgical procedure for identification and preservation of facial nerve in parotid surgery.

갑상선 및 부갑상선 수술시 배액관 삽입술에 대한 검토

정웅윤(Woung youn Chung),박정수(Cheong soo Park) 대한두경부종양학회 1995 대한두경부 종양학회지 Vol.11 No.2

Traditionally, wound drainage after thyroid or parathyroid surgery has been widely used to prevent airway obstruction due to accumulation of hematoma or seroma within the paratracheal dead space. Recently, however, the routine use of drains after thyroid or parathyroid surgery has become a matter of controversy. To determine whether the rouine use of drains after thyroid or parathyroid surgery is warranted, a prospective study on the complications after various types of thyroid or parathyroid surgery without wound drains was conducted. Three hunded sixty-six consecutive patients underwent thyroid or parathyorid surgeries by one surgeon from January through December 1994 were included in this study. Of these, only 38 patients (10.4%) required the wound drains. Indications for drainage included the patients with a large dead space(n=9) or wet operative field at the conclusion of surgery(n=11), and patients with radical neck disection(n=18). In the remaining 328 patients(89.6%), the wounds were closed without drains after thyroid lobectomy and isthmusectomy(n=226), bilateral subtotal thyroidectomy(n=21), total or near-total thyroidectomy(n=62), isthmusectomy(n=9) and parathyroid surgery(n=l0). Histologic findings revealed benign tumors in 214(65.2%), carcinoma in 89(27.1%), Graves' disease in 15(4.7%), hyperparathyroidism in 7(2.1%) and parathyroid cyst in 3(0.9%). Among the 328 patients without drain used, wound related complications were seen in only 15 patients(4.6%); 12 patients with seroma and 3 patients with hematoma. All but one complications could be controlled by two or three aspirations, and the remaining one patient required re-exploration. There were no instances of laryngeal nerve palsy or wound infection. The mean length of hospital stay after surgery was 2.8 days with a range of 1 to 11 days. These results support the routine use of drains is not warranted in most thyroid or parathyroid surgeries.

OK-432 경화요법으로 치유된 Plunging Ranula

정웅윤(Woung Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.1

The incidence of plunging ranula has been reported as about 10% of all ranula cases. Treatment consists of wide surgical excision or marsupialization. However, it seldom provides a satisfactory result and various modalities of treatment have been proposed in addition to surgical extirpation. We reported our experience using intralesional OK-432 sclerotherapy for a case of plunging ranula in 20 year-old male patient. The OK-432 solution was prepared by dissolving 0.1 KE in 2ml of physiologic saline and was instilled in the same amount of the aspirated cystic fluid. Following two instillations, the lesion completely disappeared. The side effects were mild fever for 3 days and a mild local induration for several days. At present, 9 months after instillation, no recurrence was observed. OK-432 sclerotherapy appears to be simple, safe and effective method for the treatment of plunging ranula.

유두상 갑상선암에서 예후인자와 DNA배수성의 상관관계

정웅윤(Woung Youn Chung),이종훈(Jong Hoon Lee),박정수(Cheong Soo Park) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.2

Regardless of the prognostic factors in papillary thyroid cancer, such as sex, age, size of tumor, extent of disease, and distant metastasis, the prognosis of papillary thyroid cancer is sometimes difficult to predict from clinical and microscopic analysis alone and additional prognostic indicators are needed. Recent studies of thyroid cancer have indicated that DNA aneuploidy may be correlated to the biological behavior of malignancy and inversely correlated to the prognosis, but it still remains contraversal. We performed this study to assess DNA ploidy patterns in relation with the previously known prognostic factors in AMES scoring system and lateral neck node metastasis in papillary thyroid cancer. A series of 132 patients with papillary thyroid cancer and 80 patients with benign thyroid tumor(27 follicular adenomas and 53 adenomatous goiters) as a control group from October 1993 to Feburary 1995 were analyzed and their nuclear DNA content was measured with flow cytometry using fresh tissue specimens. DNA aneuploidy was found in 8(6.1%) in papillary cancer and 8(10%) in benign tumor. S-phase traction(SFP) and proliferative index(PI) were higher in thyroid cancers, being 2.18 ± 4.24%, 6.34 ± 4.94% in the papillary thyroid cancers and 1.97 ± 2.93%, 4.44 ± 3.80% in the benign tumors, respectively. However there was no significant difference of values between two groups(p>0.05). Among variable prognostic factors studied(age, sex, size of tun or, extent of disease, distant metastasis in AMES scoring system and lateral neck node metastasis), DNA aneuploidy was found to be common in distant metastasis(p 0.035), but there was no significant difference between the high risk and low risk group according to the AMES scoring system(p<0.08). In our study, DNA aneuploidy was not valuable in determining the presence of malignancy and did not correlate to the AMES scoring system. However, follow-up study of more cases will be needed for accurate information about the DNA ploidy as a independent prognostic factor.

갑상선 결절의 Ki67과 p27 발현도에 대한 분석

박정수(Cheong Soo Park),정웅윤(Woung Youn Chung),장항석(Hang Seok Chang),이미경(Mi Kyung Lee) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Objective: The expression of Ki67, a proliferation marker, and p27, a cyclin dependent kinases(CDKs) inhibitor, has been studied in various human neoplasms. This study was carried out to determine whether these markers are useful in distinguishing benign from malignant lesions of the thyroid or predicting biologic behavior of malignant lesions. Material and Methods: Using immunohistochemical techniques with monoclonal antibodies to Ki67 and p27, we analyzed the expression of Ki67 and p27 in various thyroid disorders(25 follicular adenomas, 47 follicular carcinomas, 16 papillary carcinomas, 20 adenomatous goiters and 40 normal thyroid tissues). The labeling indices(LIs) were determined by counting cells expressing these markers in 1000 cells per immunostained slide. Results: Neoplastic thyroid diseases showed higher expression of Ki67 and lower expression of p27 than non-neoplastic diseases(p LI=55.4±5.7) and follicular carcinomas( LI=23.2±10.2). There was, however, no significant correlation between the degree of Ki67 and p27labeling indices and types of carcinoma or clinical aggressiveness of diseases. Conclusion: The degree of Ki67 and p27 expression was useful in distinguishing between benign from malignant thyroid lesions, particulary between follicular adenoma and follicular carcinoma, but was not directly proportional to the tumor aggressiveness.

이하선에 발생한 소관 선종

신동우,정웅윤,심정연,박정수,Shin Dong-Woo,Chung Woung-Youn,Shim Jeong-Yun,Park Cheong-Soo 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

Parotid canalicular adenoma is a benign neoplasm that is predominantly composed of branching and interconnecting cords of single or double rows of columnar epithelium in a very loose stroma. There has been considerable confusion in the literature concerning the terminology of canalicular adenoma. However, thesedays it has been newly-recognized as a discrete entity of the monomorphic adenoma group. Canalicular adenoma has a remarkable predilection for occurrence in the minor salivary glands such as the upper lip, in contrast with basal cell adenoma that occurs predominantly in major salivary glands such as the parotid gland. We have experienced a case of canalicular adenoma of the parotid gland in a 65-year-old woman. The patient had a palpable mass on the preauricular area for the last 15 years and recently noticed a mild pain and discomfort on the mass. Neck ultrasonography showed a low echogenic mass of 1.0cm in diameter in the right parotid gland and a neck CT scan showed a well-enhanced rectangular-shaped mass. A superficial parotidectomy was performed for the lesion and the final pathologic diagnosis turned out to be 'multifocal canalicular adenoma'.

이하선 심부엽에 발생한 거대 혼합종(Giant Pleomorphic Adenoma) 1예

박정수(Cheong Soo Park),정웅윤(Woung Youn Chung),장항석(Hang Seok Chang),윤종호(Jong Ho Yoon) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.1

Pleomorphic adenoma is the most common tumor in the parotid gland and a parotidectomy with preservation of the facial nerve is a widely accepted treatment. With the advanced imaging methods such as CT scan or MRI and the developed surgical technique, the incidence of complications in parotid surgery declined considerably. However, when the tumor forms a huge mass after a prolonged period, surgeons tend to hesitate surgical treatment regarding the possibility of facial nerve injury and incomplete resection due to a malignant transformation of the tumor. And this is more likely when the huge tumor arised in the deep lobe of the parotid gland. We present a case of 39-year old man with a giant pleomorphic adenoma arising in the deep lobe of the parotid gland who was treated successfully by total parotidectomy without any complications. The size and weight of the tumor were 20x15x15cm and 1,100gm, respectively. In our experience, because pleomorphic adenoma is well encapsulated and not invasive to the adjacent tissue, even a giant pleomorphic adenoma arising in the deep lobe of the parotid gland can be treated by careful surgical resection with the preservation of the facial nerve.

유두상 갑상선암에서 nm23, Bcl2, Bax 발현도의 임상적 의의

박정수(Cheong Soo Park),백소야(So Ya Baik),이해경(Hae Kyung Lee),정웅윤(Woung Youn Chung) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2

Objective: The nm23 gene has been identified as a potential metastasis suppressor gene in various human neoplasms. Both Bcl-2, which promotes cell survival, and Bax, which promotes cell death, have been considered as major factors in controlling the apoptotic pathway. This study was carried out to determine whether these markers are useful in distinguishing potential intrinsic differences in tumor virulence of papillary thyroid cancers. Material and Method: The expressions of nm23, Bcl-2 and Bax have been evaluated using immunohistochemical techniques in 100 pure papillary thyroid cancers and 20 metastatic lymphnodes. The intensity of immnunoreactivity was graded on arbitrary four point scale(grade 0 or 1 : negative reactivity, grade 2 or 3 positive reactivity). The immunoreactivities were analyzed in relation to TNM atage, AMES score, local recurrence and distant metastasis, and that of metastatic LNs was compared with the tumors. Results: The expression of Bcl-2 and bax did not show any statistical differences by TNM stage, AMES score, recurrence, distant metastasis and also between the tumor and metastatic LN. However, the nm23 showed higher expression of Ki67 in distant metastasis than in control group and in metastatic LNs than in the tumors(p