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Tc-99m Sestamibi Scintigraphy를 이용한 부갑상선과 갑상선 결절의 감별진단
서승원<SUP>1<,SUP>,주재균<SUP>1<,SUP>,윤정한<SUP>1<,SUP>,제갈영종<SUP>1<,SUP>,범희승<SUP>2<,SUP>,Seung Won Seo,M,D,<SUP>1<,SUP>,Jae Kyun Joo,M,D,<SUP>1<,SUP>,Jung Han Yoon,M,D,<SUP>1<,SUP>,Young Jong Jaegal,M,D,<SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1
Purpose: Differentiation of parathyroid and thyroid nodule is often difficult even with aids of ultrasonography and computed tomography. Tc-9m sestamibi (MIBI) scintigraphy is useful in the detection of hyperfuntioning parathyroid nodules. However, its role in the differentiation between parathyroid and thyroid nodules including malignancies is not well studied. Therefore, the purpose of this study is to evlauate the role of Tc-99m MIBI imaing in the differentiation of parathyroid adenoma from thyroid malignancy. Methods: Six patients (4 women, 2 men, mean age 43 years) with parathyroid adenoma and 4 patients (2 women, 2 men, mean age 56 years) with thyroid papillary cancer were enrolled. Ten and 180 minutes after injection of 740 MBq Tc-99m MIBI, pinhole image of the anterior neck was obtained. Nodule-to-thyroid ratio (N:T) was measured from same sized region of interests over nodule and normal thyroid bed. Retention Index (RI) was calculated as N:T 10 minus N:T 180 divided by N:T 10. Results: Patients with parathyroid adenoma showed similar N:T 10 as those with thyroid cancer (1.09 / 0.35, 1.24/ 0.36, respectively, P>0.05 ). However, RI of parathyroid patients was higher than thyroid cancer patients (0.64 / 0.29, 0.12/ 0.20, respectively, P<0.05). Conclusion: Parathyroid adenoma showed higher retention rate of Tc-99m MIBI than thyroid cancer. Therefore, differntiation of parathyroid and thyroid nodule could be possible using Tc-99m MIBI scintigraphy. (Korean J Endocrine Surg 2002;2:15-18)
이주희<SUP>1<,SUP>,이규언<SUP>1,2<,SUP>,박경식<SUP>1,2<,SUP>,구도훈<SUP>1,2<,SUP>,오승근<SUP>1<,SUP>,윤여규<SUP>1,2<,SUP>,Ju Hee Lee,M,D,<SUP>1<,SUP>,Kyu Eun Lee,M,D,<SUP>1,2<,SUP>,Kyung Sik Park,M,D,<SUP>1,2<,SUP>,Do 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3
<B>Purpose:</B> Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor and the clinical course is variable. Many prognostic factors for MTC have been studied, but the significance of some of these factors remains con</B>troversial. This study aimed to evaluate the prognosis of recurrent disease in patients suffering with MTC. <P><B>Methods: </B>Fifty three patients who were operated for MTC from 1987 to 2006 in Seoul National University Hospital (SNUH) was retrospectively analyzed. Their medical records were reviewed for the demographic data, the laboratory data and the clinical course, the treatment and the long-term outcome. The median duration of follow-up was 66.5 months. Forty-two patients who were operated on primarily in this hospital were analyzed for their recurrence free survival. <P><B>Results:</B> The mean age atdiagnosis was 41.8 years. There were 28 femaleand 25 male patients. Eleven patients (22.9%) had multifocal disease. There were 32 sporadic MTC patients, 15 MEN2A patients, 3 familial medullary thyroid carcinoma (FMTC) patients and 1 MEN 2B patient. The 10- and 15-year overall survival rates were 91.9% and 76.5%, respectively; the 5- and 10-year recurrence-free survival rates were 70.6% and 45.5%, respectively. By univariate statistical analysis, the stage (stage I/II vs. III/IV, P= 0.025), extrathyroidal extension (P=0.039), cervical lymph node metastasis (P=0.044), and the postoperative calcitonin level (≥25 pg/ml) (P=0.003) were the significant factors that influenced recurrence. <P><B>Conclusion:</B> The overall prognosis of MTC is favorable. The significantfactors for a poor prognosis were the presence of lymph node metastasis, TNM stage III and IV, positive extrathyroidal extension at the first diagnosis and a high postoperative calcitonin level.<B> (Korean J Endocrine Surg 2008;8:183-188)</B>
갑상선 결절에 동반된 거대석회화에 대한 임상적인 고찰: 미세석회화와 비교분석
왕서걸<SUP>1<.SUP>,백선미<SUP>2.4<.SUP>,임양수<SUP>1<.SUP>,정민희<SUP>3<.SUP>,봉진구<SUP>5<.SUP>,Hsu Chieh Wang,M.D.<SUP>1<.SUP>,Sun Mi Paik,M.D.<SUP>2,4<.SUP>,Yang Soo Lim,M.D.<SUP>1<.SUP>,Min Hee Jeong,M.D.<SUP>3< 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.4
Purpose: The clinical value of macrocalcifications as an indicator that predicts malignancy of thyroid nodules is controversial. The purpose of this study was to investigate additional ultrasonographic findings accompanying macrocalcifications for predicting malignancies in thyroid nodules. Methods: Between January 2005 and April 2008, 315 patients who had thyroid nodules with FNAB resulting in suspicious malignancies underwent thyroidectomy at the Wallace Memorial Baptist Hospital. Three hundred fifteen nodules, which were confirmed to be papillary thyroid carcinoma, and 192 nodules, which were confirmed to be benign, were reviewed retrospectively. We analyzed the malignancy rates according to calcification patterns and US findings of the associated solid nodules. Results: Among the 165 papillary thyroid carcinomas with microcalcifications, 161 accompanied solid nodules, and 4 were found with microcalcifications, but without solid nodules. Of the 161 papillary thyroid carcinomas with microcalcifications and solid nodules, 85.7% showed signs suggestive of malignancy. The remaining 14.3%, where only microcalcifications were present, showed indications of predicting malignancy. When solid nodules were found with macrocalcifications, there were indicators of predicting malignancy (100%). Also, for situations in which benign nodules were accompanied by solid nodules, 29% had signs of predicting malignancy. For situations in which benign nodules did not accompany solid nodules, 21% showed suspicious signs of predicting malignancy, but were all confirmed as benign. Conclusion: For nodules that accompany microcalcifications, there can be indicators that predict malignant conditions separate from other opinions that accompany microcalcifications. However, for macrocalcifications, it would be more effective to set up future treatment plans based on ultrasonographic features of solid nodules accompanying calcifications rather than the calcification itself. (Korean J Endocrine Surg 2008;8:260-265)
갑상선질환에서 Sonic Hedgehog 단백질 발현의 임상적 의의
유근수,이옥준<SUP>1<,SUP>,김원재<SUP>2<,SUP>,박성수,김동주,박진우,최재운,장이찬,OrloH,Clark<SUP>3<,SUP>,Kuhn-Soo Ryu,M,D,Ok-Jun Lee,M,D,<SUP>1<,SUP>,Wun-Jae Kim,M,D,<SUP>2<,SUP>,Sung Su Park,M,D,Dong-Ju Kim,M,D,Jin- Woo Park 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.4
Purpose: The Hedgehog (Hh) signaling pathway is important in embryonic development including cell differentiation and proliferation. Recently, activation of this pathway has been implicated in several forms of solid cancers. We investigated sonic hedgehog (Shh) protein expression and its relation to differentiation and clinicopathologic characteristics in thyroid cancer cell lines and tissues. Methods: We used five thyroid cancer cell lines: TPC-1, FTC-133, FTC-236, FTC-238, and XTC-1. We made tissue microarray slides using 80 thyroid surgical specimen: 40 benign and 40 malignant lesions. Immunohistochemical staining was performed using anti-Shh antibody. mRNA expression of NIS, thyroglobulin, and CD97 were evaluated by RT-PCR. Cyclopamine was used as a Shh signal inhibitor. Results: Shh expression was more prominent in TPC-1, FTC-133, and XTC-1 cell lines than the others. Cyclopamine downregulated CD97 and upregulated thyroglobulin mRNA expression, but did not induce mRNA expression of NIS. Thyroid tissues showed varied expression of Shh in both benign and malignant diseases. Shh expression was detected in 38 of 50 (76%) normal, in 18 of 25 (72%) non-neoplastic benign, in nine of 15 (60%) benign tumors, and in 31 of 40 (77%) malignant tumors. Shh over-expression was significantly less frequent in papillary thyroid carcinomas than in normal or benign thyroid tissues. In addition, Shh protein expression did not relate to clinicopathologic characteristics in papillary thyroid carcinomas. Conclusion: Thyroid tissues and cell lines vary in expression of Shh. Cyclopamine can induce redifferentiation in thyroid cancer cell lines. Shh protein expression, however, is unrelated to clinicopathologic characteristics in papillary thyroid carcinomas. (Korean J Endocrine Surg 2011;11:234-241)
윤지영,정종길<SUP>1<.SUP>,정웅길<SUP>2<.SUP>,박미옥<SUP>3<.SUP>,Ji Young Yun,Jong Gill Jeong,M.D.<SUP>1<.SUP>,Ung Gill Jeong,M.D.<SUP>2 <.SUP>and Mi-Ok Park,M.D.<SUP>3<.SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2
Glucagonomas are rare pancreatic tumors of islet ahpha-2 cells. Less than 430 cases have been reported worldwide and 210 cases are malignant tumors. In generally, the tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema of the skin, weight loss, non-insulin-dependent diabetes mellitus, anemia, cheliosis, stomatitis, and an increased thrombotic tendency. Since pancreatic glucagonomas are predominantly located in the tail and findings of radiographic or sonographic examination can remain unspecific, patients often present already metastasis when diagnosis is first established, and can be difficult to differentiate from the other pancreatic tumors. We report the case of a 59-year-old woman with an malignant glucagonoma of the pancreas infiltrating already the spleen and presenting metastatic lesion in perirenal lymph nodes, and that the tumor was not assocated with the characteristic skin rash. The pateint with a past history of a diabetes mellitus and hypertension for 9 years was admitted with cramp-like left lower abdominal pain, watery diarrhea, and nausea. A solid tumor of tail of the pancreas revealed by ultrasonography and abdominal computed tomography and distal pancreatectomy, radical nephrectomy, and splenectomy were performed. Immunohistochemial examination of the tumor did show glucagon-reactive tissue and electron microscopy revealed many secretory granules, 180 to 300 nm in diameter in granulated cells. After pancreatic tumor resection, the patient had normalization of plasma glucagon and blood sugar. (Korean J Endocrine Surg 2002;2:120-123)
세포검사 결과 여포성 종양으로 진단된 갑상선 결절에서 암의 위험성과 수술 후 소견
김은숙<SUP>1<,SUP>,남궁일성,공경엽<SUP>2<,SUP>,홍석준<SUP>3<,SUP>,김원배,송영기,Eun Sook Kim,M,D,<SUP>1<,SUP>,Il Sung Nam-Goong,M,D,Gyeongyub Gong,M,D,<SUP>2<,SUP>,Suck Joon Hong,M,D,<SUP>3<,SUP>,Won Bae Kim,M,D,and You 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2
Purpose: To assess the prevalence and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. Methods: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Results: Two hundreds and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12∼76). About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 Hürthle cell carcinomas, and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy such as male gender, large tumor size (>4 cm), or age of patients (>45 years), were not associated with increased risk. Diagnosis of Hürthle cell neoplasia on FNA was also not associated with increased risk. Only the extreme age of the patients (below 20 or above 60 years) was associated with increased risk for malignancy. Conclusion: By our hands, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics such as male gender, age, and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery without any further work up. (Korean J Endocrine Surg 2002;2:105-108)
수술 전 혈청 갑상선 자극 호르몬(TSH)수치와 갑상선 유두암과의 상관관계
송금종,한선욱,이진형<SUP>1<,SUP>,우희두<SUP>2<,SUP>,김성용,김재우<SUP>3<,SUP>,박래경<SUP>1<,SUP>,백무준,김창호,Geum Jong Song,M,D,Sun Wook Han,M,D,Jin-Hyung Lee,M,D,<SUP>1<,SUP>,Hee-Doo Woo,M,D,<SUP>2<,SUP>,Sung Yong Kim,M,D,Ph 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.3
Purpose: Recent research has shown that there is a relationship between the level of preoperative serum TSH and a papillary thyroid carcinoma. Therefore, this study examined the correlation between the serum TSH and papillary thyroid carcinoma. Methods: The preoperative serum TSH level of papillary thyroid carcinoma and nodular hyperplasia of 418 patients from 2009 Jan. to 2011 Dec. was examined. The patients were divided into 3 groups, nodular hyperplasia, less than 1 cm micropapillary carcinoma and more than 1 cm papillary carcinoma, and their TSH levels were compared. Results: Nodular hyperplasia and total papillary carcinoma was found in 98 (23.0%) and 322 (77.0%) patients, respectively. After dividing the patients according to the size of the mass, there were 224 (53.6%) patients with a mass less than 1 cm in size and 98 (23.4%) patients with a mass more than 1 cm in size. The preoperative serum TSH level of the 3 groups showed a significant difference, which was 1.180±1.168 ՌIU/ml in the nodular hyperplasia group, 1.670±1.224 ՌIU/ml in the micropapillary carcinoma group and 2.279±2.837 ՌIU/ml in the papillary carcinoma group (P<0.001). On the other hand, there were no significant correlations between the preoperative serum TSH level and gender, age, metastasis to lymph node, number of masses and extrathyroidal extensions. Conclusion: The larger size of the papillary thyroid carcinoma, the higher the preoperative high serum TSH level. Therefore, the stimulation of TSH can affect the progression of papillary thyroid carcinoma but more study will be needed.
갑상샘의 미만성 경화아형 유두상암의 1예 보고: 초음파와 컴퓨터 단층촬영 영상
김흥철,남궁숙,홍명선,황임경,김한준<SUP>1<.SUP>,최영희<SUP>2<.SUP>,Heung Cheol Kim,M.D.,Sook Namkung,M.D.,Myong Son Hong,M.D.,Im Kyung Hwang,M.D.,Han Joon Kim,M.D.<SUP>1<.SUP> and Young Hee Choi,M.D.<SUP>2<.SUP> 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1
We report here on a case of diffuse sclerosing papillary carcinoma (DSPC), which is a subtype of papillary carcinoma of thyroid, in a 27-year-old female. The ultrasound images showed diffuse enlargement of the thyroid lobes and this was associated with underlying diffuse scattered microcalcifications and a heterogeneous hypoechoic background parenchyma that was without any masses. The CT image showeddiffuse scattered dot-like hyperdensities with bilateral multiple metastastic lymph nodes. Because making the cytological diagnosis of DSPC is still challenging, the radiological findings that show this disease's characteristic features may be important clues for making the correct diagnosis. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:43-47)</B>