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)

측경부 낭성 종괴로 발현된 갑상선 유두상 미세암종

이동욱 충북대학교 의과대학 충북대학교 의학연구소 2003 忠北醫大學術誌 Vol.13 No.1

갑상선암은 모든 악성종양의 약 1%를 차지하며 약 80%이상이 유두상 암종이다. 갑상선암 은 경부림프절 전이율이 높지만 매우 완만한 임상경과를 가지며, 경부림프절 전이가 환자의 이환율이나 사망률에 미치는 영향은 높지 않다. 유두상 미세암종(papillary microcarcinoma)는 WHO에서 유두상 갑상선 암과 같은 조직학 적 소견을 보이나 직경이 약 1cm 미만인 경우로 정의하였으며 주로 부검이나 다른 갑상선 질환으로 절제된 갑상선의 병리조직학적 분석을 통해 우연히 발견되는 경우가 많다. 유두상 미세암종은 갑상선 호르몬으로 인한 증상이나 갑상선 부위에 만져지는 종물 없이 무증상으로 발현된 측경부 종괴를 주소로 환자들이 내원한다. 저자는 무증상의 측경부 낭성 종괴를 주소로 방문한 63세 남자환자에서 병리조직검사상 갑 상선 유두상 미세암종으로 판명되어 갑상선 전절제술(total thyroidectomy)을 시행하여 원발 부위를 발견하고 치료한 증례가 있어 문헌 고찰과 함께 보고하는 바이다. Thyroid cancer is known to represent 1 percent of all malignancies. It may run an indolent course over many years and has a variable prognosis, irrespective of the presence of cervical lymph node metastasis. Papillary microcarcinoma are a specific subgroup of papillary thyroid cancer. Papillary microcarcinoma is defined according to the World Health Organization (WHO) as a tumour focus of 1.0 cm or less in diameter. These tumours are a common incidental finding at autopsy and in thyroid glands excised for other pathology. The presence of cervical node metastasis is a well recognized presentation of papillary microcarcinoma without palpable mass in thyroid glands. I report a case of papillary microcarcinoma of thyroid gland with contralateral solitary cystic metastatic neck mass.

유두상 갑상선암 수술 후 발생한 유미루

박종대,홍석준 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: Most of postoperative chylous fistula in the neck occur after lateral neck lymph node dissection. However we experienced chylous fistulas in the central neck as well as lateral neck after surgery for papillary thyroid carcinoma. Herein we reviewed our experience of chylous fistula and tried to make guideline for the decision of optimal treatment in the early period of chylous fistula. Methods: We retrospectively reviewed our thyroidectomy cases for the papillary thyroid carcinoma with central neck node dissection (n: 1220) and left neck node dissection (n: 149) over a period of 6years. In 17 patients, a chylous fistula was occurred, 8 in the lateral neck, 9 in the central neck. The treatment method, daily output, and the hospital course of the chylous fistula were analysed. Results: The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.7% and 5.4% respectively. All 9 central neck fistulas were successfully treated with conservative treatment . 6 lateral neck fistulas were also treated successfully with conservative treatment including medium chain triglyceride treatment and compression dressing. In 2 lateral neck fistulas, operative management was required, one due to poor response to conservative management and metabolic derrangement, another one due to large amount of daily output in the early post operative days. The maximal daily output of conservative management group and operative management group were below 250 cc/day and over 1,800 cc/day respectively. Conclusion: The chylous fistula in the neck could be occurred not only after lateral neck dissection but also after central neck dissection, although the clinical course of central neck fistula was relatively benign. Most of chylous fistulas could be treated conservatively. However, in the early high output fistula (over 1,800 cc/day) cases, prompt operative management should be considered for the prevention of metabolic derrangement and shortening the hospital course. (Korean J Endocrine Surg 2002;2:109-115)

후두암의 경부 전이로 오인된 측경부 미입 갑상샘에서 발생한 유두상 암종 1예

최전하,김춘동,김은주,김승우 대한갑상선학회 2015 International Journal of Thyroidology Vol.8 No.2

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.

유두상 갑상선 암에서 측경부 림프절 전이패턴 및 5구역 전이 예측

김태령,이영돈,박흥규,정유승,구소령,Taeryung Kim,Youngdon Lee,Ph,D,Heungkyu Park,Ph,D,Yooseung Chung,Ph,D,and<SUP> <,SUP>Soryung Ku 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3

유두상 암종과 병발하며 갑상선과 동측 기관주위 림프절에 발생한 결핵 1예

사대진,최전하,김윤정,김승우 대한갑상선학회 2013 International Journal of Thyroidology Vol.6 No.2

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.

유두상 갑상선 암종에서 경부 림프절 전이의 양상 및 치료

태경,전성하,이현창,김경래,이형석,박용수,안유헌,김태화 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.12

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.

하시모토 갑상선염과 동반된 갑상선 유두상 암종의 임상적 의의

심윤상,이용식,이국행,이병철,정연우,이지웅,이가희,이윤용,이승숙 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.6

Background and Objectives:The frequency of co-ocurence of Hashimotos thyroiditis and papillary thyroid carcinoma has ben variously reported to range from 0.3% to 38%, and the asociation of these two diseases is still controversial. The aim of cs of patients with and without histopathological evidence of Hashimotos thyroiditis. Subjects and Method:Among 366 patients treated for thyroid nodules (including benign nodules and thyroid cancers) during the period of July 2004 - June 2005, 278 patients (male versus female= 1 : 7.9) with papillary thyroid carcinoma were included in this study. Results:Hashimotos thyroiditis co-ocurred with papillary thyroid carcinoma in 68 of (24.5%), compared with 0 of 21 patients (0% ) with other thyroid malignancies. The age at presentation (median, 43.9 years), tumor size (median, 1.31 cm), methods of diag-nostic evaluation, and the extent of surgery had not influenced by the presence of Hashimotos thyroiditis. However, TNM stage, AMES stage, MACIS score were slightly lower and the proportion of female patients (1:67) was higher in patients with Conclusion:These results sugest that patients who have papillary thyroid carcinoma may have more favorable prognosis in the co-ocurring Hashimotos thyroiditis. Further studies are required to confirm the long-term prognostic association betwen these two diseases. (Korean J Otolaryngol 2007 ;50 :537-41)

유두상 갑상선 암의 척추전이 1예

양석민(Suk Min Yang),장재원(Jae Won Chang),신유섭(Yoo Seob Shin),김철호(Chul-Ho Kim) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Thyroid cancer is known as its relatively high cure rate after surgical treatment and spinal metastasis of thyroid cancer is extremely rare as the prevalence is only 2-13%. Spinal metastasis is usually asymptomatic and discov-ered incidentally in most cases. A 66-year-old man was diagnosed as thyroid papillary cancer with spinal metas-tasis. We treated the patient by surgery, adjuvant radiotheraphy and radioactive iodine therapy. C6 corpectomy was followed for the residual spinal metastasis by the department of neurosurgery. The patient had no functional complication by the surgical process. At 24 months after surgery, there was no sign of recurrence and the patient led social life without any discomfort. We present this case with a review of the related literatures.

인간의 갑상선 결절성 과증식증과 유두상 암종에서의 Endothelial Nitric Oxide의 발현

김영모(Young Mo Kim),조정일(Jung Il Cho),김용재(Yong Jai Kim),양태용(Tae Yong Yang),김대형(Dae Hyung Kim),박창신(Chang Sin Park),한창준(Chang Jun Han) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2

Background and Objectives: Nitric oxide (NO) is generated in mammalian tissue by the conversion of L-arginine to L-citrulline. This reaction is catalyzed by nitric oxide synthase (NOS). NO is an important bioactive agent and a signalling molecule that mediates a variety of biologic actions such as vasodilation, neurotransmission, host defense, and iron metabolism but increased NO production may also contribute to the pathogenesis of a various of disorders, including cancer. Before now, the role of NO in thyroid gland is still investigated and it was supposed that NO mediate the angiogenesis in tumor growth. Others journal and works identified the expression of iNOS that involve by neutrophil and eNOS that involve in part in the vascular remodeling and to understand the role of NO in human thyroid gland. But authors revealed only eNOS in thyroid neoplasm. iNOS was identifed by inflammation in fault. Materials and Methods: Western blot analysis was performed, using a polyclonal antibody against eNOS (Rabbit polyclonal IgG). Using the same antibody, the distribution of eNOS was examined in 15 formalin-fixed paraffin embedded samples by immunohistochemistry. By NADPH consumption rate, NOS activity was estimated at nodular hyperplasia. Results: Western blot analysis exhibited that eNOS was significantly elevated in thyroid papillary carcinoma, compared to that in nodular hyperplasia and normal tissue. Immunohistochemistry showed that the immunoreacitivity was present more significantly in thyroid follicular epithelial cell layer than vascular endothelial cell. NOS activity increased in nodular hyperplasia. Conclusions: Thyroid papillary cancer without neutrophil invasion expressed only eNOS. The endothelial localization of eNOS may play an important role in pathogenensis of human thyroid nodular hyperplasia and the follicular localization of thyroid papillary carcinomas.