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Insular Component가 공존한 고분화 갑상선암
정웅윤(Woong Yoon Chung),심정연(Jeong Yun Shim),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1
We have experienced 5 cases of unusual well differentiated thyroid carcinoma with insular component during the past 5 years. 4 cases were presented with cervical masses but I case (patient 2.) was initiallty with lung and brain metastasis. The tumors from 4 cases showed invasive growths but that of 1 cases(patient 1.) showed intrathyroidal. Total thyroidectomy and cervical lymphnode dissection(CCND or RND) was performed in 4 cases but only RND was performed in spite of mediastinal metastasis of the tumor in patient 5 under the patient's choice. During the follow-up period, we also performed radical nephrectomy and metastatectomy for the kidney and iliac bone metastasis respectively, in patint 2. Microcsopically, the tumors showed the insular growth patterns, focally(less than 50%) in 3 cases and predominantly(more than 75%) in 2 cases. And the insular componentas were combined with papillary carcinoma in 2 cases and follicular carcinoma in 3 cases. Cervical lymphnode metastases were confirmed in 4 cases. Patient 2 died of disease with metastases to lung, brain, bone and kidney, 52 months after initial therapy. Patient 1, 3 and 4 are alive and have no recurrence and distant metastasis. Patient 5 is also alive with the mediastinal metastasis. In our experience, the well differentiated thyroid carcinomas with insular component showed characteristic histologic features, aggressive behavior in initial presentation and unfavorable prognosis regardless of the percentage of the insular component.
정웅윤(Woong Yoon Chung),장항석(Hang Seok Chang),김은경(Eun Kyung Kim),박정수(Cheong Soo Park) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2
Objective: The clinical significance of mass screening for thyroid carcinoma remains unclear. This study was carried out to clarify the value of mass screening for thyroid carcinoma. Materials and Methods: From December 1997 through July 1998, a total of 1,401 subjects who were enrolled to receive breast screening or follow-up examination for breast cancer were included in this study. Thyroid glands were examined by 10 MHz ultrasonography by one experienced radiologist. The patients with thyroid nodules were classified into 2 groups according to their potential risk of malignancy by ultrasonographic findings(high-risk : hypoechogenicity, microcalcification, irregular margin, taller than wider shape). High-risk patients were advised to undergo fine-needle aspiration biopsy and thyroidectomy. The characteristics of the thyroid cancers detected by ultrasonographic mass screening were compared by those of clinical thyroid cancer excluding male patients during the same period. Results: Thyroid nodules were detected in 353(25.2%) of the subjects and 259(73.4%) were listed in the low-risk group and 94(26.6%) in high-risk group. Among 94 patients in the high-risk group, 43 underwent thyroidectomy and 37 turned out to have thyroid carcinomas. Thus, the detection rates for carcinoma were 2.6% of all subject, 10.5% of the detected nodules, 36.4% of the high risk women and 86.0% of the operated cases. The tumor size was significantly smaller in the mass-screening group than in the clinical cancer group(p<0.05). However, there was no statistical differences between two groups in the prevalences of neck node involvement and extracapsular invasion and the patients distributions by AMES score, MACIS score and TNM stage. Conclusion: Ultrasonogrpahic mass screening may be useful for the early detection of thyroid carcinoma in women who are scheduled to have breast examination.
이상와루(Pyriform Sinus Fistula)에 대한 내시경적 경화요법의 3예
박윤아(Yoon Ah Park),서진학(Jin Hak Seo),조상현(Sang Hyun Cho),정웅윤(Woong Yoon Chung),최은창(Eun Chang Choi),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2
Pyriform sinus fistula is a rare anomaly arising from 3rd or 4th branchial apparatus and has been recognized as one cause of acute suppurative thyroiditis or acute deep neck infection. Pyriform sinus fistula must be considered when a clinician is encountered recurrent left lower neck abscess and a history of repeated incision and drainage. The confirmation of the diagnosis is made when the fistula tract is identified on a barium swallow study and when the internal orifice of the fistula is found at the apex of pyriform sinus on laryngoscopic examination. A complete excision of the fistula tract has been proposed as a treatment of choice. However, in some cases it is very difficult to resect the tract completely because of severe inflammation and repeated drainage procedure. We present three cases of pyriform sinus fistula which are successfully treated by laryngomicroscopic chemocauterization using synthetic fibrin and AgNO₃.
소포 변이 유두 갑상선암(Follicular Variant Papillary Thyroid Carcinoma)
이승철(Seung Chul Lee),윤종호(Jong Ho Yoon),윤지섭(Ji-Sup Yun),남기현(Kee-Hyun Nam),임치영(Chi-Young Lim),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5
Purpose: The follicular variant of papillary thyroid carcinoma (FVPTC) is difficult to diagnose and there is continuous debate regarding the optimal extent of surgery. Methods: One hundred sixty three patients (17 male, 146 female; mean age 43.3 years), who underwent a thyroidectomy with a final diagnosis of FVPTC were divided into the total thyroidectomy group (Group Ⅰ, n=74) and the lessthan total thyroidectomy group (Group Ⅱ, n=89). The two groups were compared with respect to the various clinicopathological characteristics. The mean follow up duration was 64.9 months (13∼247 months). Results: Group Ⅰ showed a significantly higher sensitivity than Group Ⅱ for the diagnosis. The age of the patients in Group Ⅰ was significantly older than those in Group Ⅱ. The frequency of multifocality, capsular invasion, and the incidence of a cervical lymph node metastasis were significantly higher in Group Ⅰ. Therefore, Group Ⅰ had a higher proportion of stage Ⅲ and Ⅳ. The percentage of high risk patients according to the AMES (Age, distant Metastasis, Extent of primary tumor, and tumor Size) category and MACIS (distant Metastasis, Age, Completeness of primary surgical resection, extrathyroidal Invasion, and tumor Size) score was significantly higher in Group Ⅰ. However, there was a similar rate of locoregional recurrence, distant metastasis, and survival in the two groups. Conclusion: When a diagnosis of FVPTC is made preoperatively or intraoperatively, definitive thyroid cancer surgery can be applied using the corresponding extent of surgery for an ordinary papillary thyroid carcinoma. However, if no definitive diagnosis is made, then a less-than total thyroidectomy is recommended as the initial surgery, and a complete thyroidectomy is reserved only for high-risk patients.
장항석(Hang Seok Chang),윤종호(Jong Ho Yoon),정웅윤(Woong Youn Chung),이미경(Mi Kyung Lee),박정수(Cheong Soo Park) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2
The clinical and pathological features of 35 cases of anaplastic thyroid cancer were studied. These tumors occurred in 12 men and 23 women ranging in age from 19 to 83 years(mean age; 61.7 years). A rapidly enlarging thyroid mass was the most common presentation. The duration of the presence of mass varied from 20 days to 12 months with an average of 2.7 months. Systemic metastasis at the time of initial examination was found in 14 patients(40.0%) and the lung was the most common site of involvement. The overall rate of distant metastasis was about 65.7%. The tumors were subdivided morphologically into giant cell type of 10 cases, spindle cell type of 7 cases, epidermoid cell type of 1 cases, and mixed giant cell and spindle cell type of 5 cases. The mean survival period of 6 among 35 patients who had biopsy alone was 1.4 months. The 22 patients underwent the incomplete combined treatment modalities (palliative surgery with or without chemotherpy or radiation therapy) survived for a mean period of 3.0 months, among them, 7 patients who had surgery combined with chemotherapy and radiation therapy showed mean survival period of 3.7 months. The mean survival of 7 patients who had complete combined treatment modality(curative surgery combined with chemotherapy and hyperfractionated radiation therapy) was 6.6 months, only one patient survived for 21 months and one patient has been alive for 1 month after operation, and the others survived for a mean period of 4.8 months. So far, as of July 31, 1998, 34 patients among 35 were died(one has been survived for 1 month) despite the various treatment modalities, and the main cause of death were failure of local control and systemic metastasis. None of the various treatment modalities gave consistently favourable results. However, a combination of surgery, radiation therapy and chemotherapy seemed to have a slight positive effect on survival. Furthermore, the aggressive treatment modalities will be indicated only in the early diagnosed and minimal cases.
내시경 갑상선 절제술 후에 발생한 갑상선 선종성 과형성증의 연조직 착상 1예
이용상(Yong-Sang Lee),윤지섭(Ji-Sup Yoon),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 2007 대한두경부 종양학회지 Vol.23 No.1
Soft tissue implantation of thyroid tissue is a very rare event. Needle tract implantation of thyroid carcinoma after fine-needle aspiration(FNA) biopsy has been occasionally reported, but implantation of benign thyroid tumor tissue is extremely rare. Rupture of thyroid tissues during surgery or trauma may cause the thyroid tissue to be implanted and result in multiple palpable nodules in soft tissue of the neck. Several reports have shown the possibility of implantation of normal or hyperplastic thyroid tissues in soft tissue. We herein report a case of implantation of adenomatous hyperplastic tissue in the neck along the trochar and previous operation site after endoscopic thyroid surgery, which was successfully treated by complete excision.
한윤대,이용상,윤지섭,정종주,남기현,장항석,정웅윤,박정수,Yoon Dae Han,M,D,Yong Sang Lee,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3
It is well known that the thyroid gland is resistant to infection due to its anatomic and physiological characteristics. Thyroid abscess in an adult is extremely rare. It is more commonly found in children than in adults. The treatment goal of this disease is to eliminate the source of infection by incision and drainage, or by a thyroidectomy and administration of antibiotics, depending on the clinical findings.We report a case of thyroid abscess found in a 29-year-old woman. The patient presented with a painful mass in the left thyroid for 6 days duration. The patient had a history of subacute thyroiditis that was treated with steroidsand thyroid hormone. Computed tomography showed a large, fluid contained, cystic predominant mass in the left thyroid. Aspiration of the cystic fluid confirmed the presence of the thyroid abscess. Under local anesthesia, an incision and drainage was performed. The patient improved dramatically after surgery and the patient was discharged 8 days later. (Korean J Endocrine Surg 2007;7:161-163)