갑상선과 후두에 발생한 다발성 원발암 1례

손영익,권중근,추광철 대한기관식도과학회 1997 大韓氣管食道科學會誌 Vol.3 No.1

Multiple primary tumors in the head and neck are not uncommon, however those in the thyroid and the larynx are known to be very rare. In most cases of multiple primary tumors involving the thyroid and the larynx, lesions are observed usually simultaneously and thyroid tumors are found incidentally during the laryngeal tumor surgery. In rare cases, thyroid tumors are found metachronously after radiation therapy of laryngeal cancer. The authors recently experienced a case of multiple primary tumor involving the thyroid and the larynx, in which thyroid papillary carcinoma was the index tumor and the laryngeal squamous carcinoma was the meatachronous second tumor. Both tumors showed aggressive local extension and regional nodal meatastasis with tumor collision in the same node. The patient died of recurrent or of residual squamous carcinoma shortly after main surgical treatment index thyroid cancer.

소아에서의 갑상선 종양

양성환(Sung Hwan Yang),김갑태(Gab Tae Kim),오성수(Sung Su Oh),정을삼(Eul Sam Chung) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.1

Objectives: We'd like to give help in diagnosis and treatment of children's thyoid tumor through our clinical experiences and reference consideration. Materials and Methods: The authors report their experiences with 33 cases of thyroid tumor in patients younger than 16 years of age who were treated at Presbyterian Medical Center from 1979 to 1995. Results: 1) Girls were more predominant than boys by a ratio of 5.6:1. The peak incidence was in the 15 years old of age. 2) The final diagnosis in the 33 patients were thyroid carcinoma in 12 cases, nodular goiter in 6 cases, adenoma in 6 cases, Graves disease in 4 cases, Hasimoto's disease in 4 cases and cyst in 1 case. 3) All of 12 patients with thyroid cancer had nodular tumor. 4) In 5 of 6 patients with palpable cervical lymphadenopathy, the final diagnosis was thyroid carcinoma. 5) Delayed diagnosis arose in 6 of 12 thyroid carcinomas which were treated for long periods as benign disease. 6) The surgical procedures were total thyroidectomy in 3 cases, subtotal thyroidectomy in 13 cases and thyroid lobectomy in 17 cases. 7) 11 of 12 patients with thyroid carcinoma had subtotal or total thyroidectomy with lymphnode dissection and only one had lobectomy. 8) The overall rate of postoperative complication was 3%(1 of 33 patient). 9) Postoperative 131I therapy was done in 7 case because of recurrence and distant metastasis in six and severe local invasion in one. 10) In thyroid cancer, the metastatic rate of lymph node at initial surgery was 81%(9/11) and rate of recurrence was 50%(6/12). 11) Patients with thyroid carcinoma were followed up for a mean of 12 years but only one died as a result of thyroid carcinoma 3.5 years later. Conclusion: The authors suggest that thyroid tumors in childhood should receive the benifit of joint management by endocrine pediatrician and experianced surgeons with an agreed protocol of diagnosis and management. We, also, recommend aggressive surgical and 131I treatment as the most effective regimen for children with thyroid carcinoma.

갑상선 질환(종양)에서 Cyclooxygenase-2의 발현에 대한 연구

이국종,박희붕,김지훈,정용식,주희재<SUP>1<,SUP>,소의영,Kug Jong Lee,M,D,Hee Boong Park,M,D,Ji Hoon Kim,M,D,Yong Sik Jeong,M,D,Hee Jae Joo,M,D,<SUP>1<,SUP> and Euy Young Soh,M,D 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: Thyroid tumor is one of the most common endocrine tumors, and yet little is known about its molecular process of development and progression. Cyclooxygenase (COX)- 2, the inducible form of the COX enzyme for prostaglandin synthesis, is up-regulated in gastrointestinal cancers and is a key mediator of epithelial cell growth. Regular intake of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) is associated with a decreased incidence of colorectal, esophageal, gastric, and lung cancer. We sought to determine the involvement of COX-2 in human thyroid cancer. Methods: COX-2 protein was assayed in thyroid tissue of 64 which were inflammatory disease and benign tumor and malignant tumor with or without metastasis patients by using immunohistochemistry and Western Blot analysis. Results: COX-2 protein was not expressed in normal thyroid tissue. But COX-2 protein was expressed strongly in inflammatory tissue. Expression of COX-2 was very high in both benign and malignant tumor. There is no difference in pathology and malignant potential or existence of metastasis. Conclusion: There was no correlation between clinicopathological characteristics of thyroid tumor and intensity of COX-2 protein expression. In addition, there was no difference of expression of COX-2 between inflammatory thyroid disease and thyroid tumor. This study indicates that COX-2 protein over expression may contribute to an early event of gastric cancer development, and it further suggests that selective inhibition of COX-2 may provide a chemopreventive effect against thyroid cancer. (Korean J Endocrine Surg 2002;2:90-96)

Analysis of Fine Needle Aspiration Cytology and Ultrasonography of Metastatic Tumors to the Thyroid

조은윤,오영륜,Cho, Eun-Yoon,Oh, Young-Lyun The Korean Society for Cytopathology 2007 대한세포병리학회지 Vol.18 No.2

Cytologic diagnosis of the metastatic tumors to the thyroid is important in the management of the patients. There have been rare reports analyzing fine-needle aspiration (FNA) cytology of metastatic tumors to the thyroid. This study examines comprehensive cytologic findings of metastatic tumors to the thyroid with radiologic findings. The FNA cytology slides obtained from 12 cases with metastatic tumors of the thyroid; lung cancer (n=5), tongue and tonsil cancer (n=3), esophageal cancer (n=2), and breast cancer (n=2) were reviewed. Radiological study showed single mass with heterogeneous texture or multiple masses without calcification. Metastatic tumor was easily considered in a differential diagnosis of FNA cytology because they had peculiar cytological features which were not seen in primary thyroid tumor. The smear background varied from predominantly necrotic, bloody, and inflammatory to colloid. The aspirates exhibited a mixture of benign follicular cells and malignant cells in 6 cases. The characteristic cytoplasmic features of the tumor cells, such as keratin, mucin and melanin, were found in 9 cases. Although some cases mimic primary thyroid neoplasm, a careful examination of the cytological characteristics may help cytopathologists to recognize a metastatic tumor in the thyroid by FNA, and may help the clinicians to establish a proper treatment plan.

갑상선 종양에서 Galectin-3 발현의 임상적 의의

김진환,한동혁,오소정,노영수,안회영,신형식,조성진 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.8

Background and Objectives:Galectin-3 is a beta-galactoside binding protein, of which the major function is not fully elucidatedin malignant tumor. However, galectin-3 is expressed in epithelial cells and contributes to the progression of cancer. Althoughgalectin-3 is expressed in a variety of tissues and plays important roles in malignant transformation or tumor progression,the study on its expression related to clinicopathological parameters in thyroid tumor is rare. So, the present study aims to findout the clinical significance of galectin-3 in thyroid tumor. Subjects and Method:We assessed mRNA and protein expressionsof the galectin-3 gene by means of the RT-PCR method and immunohistochemical staining in 100 cases of thyroid tumors (50papillary carcinomas, 10 follicular carcinomas, 20 follicular adenomas, 20 nodular hyperplasia). The expression of galectin-3 iscompared with the clinical prognostic factors of thyroid papillary cancer. Results:Using RT-PCR, galectin-3 mRNA was detectedin 41 (82%) in papillary carcinoma, 6 (60%) in follicular carcinoma, 8 (40%) in follicular adenoma and 9 (45%) in nodularhyperplasia cases. Using immunohistochemical staining, galectin-3 protein expressions were detected in 46 (92%), 7(70%), 3 (15%) and 1 (5%). The expressions of the galectin-3 mRNA and protein were significantly recognized in thyroid papillarycarcinoma. However, the galectin-3 mRNA and protein over-expression is not significantly correlated with the clinicalprognostic factors of thyroid papillary carcinoma. Conclusion:These results suggest that galectin-3 expression may be associatedwith thyroid papillary carcinoma development. (Korean J Otolaryngol 2006;49:812-6)

갑상선 수질암과 갑상선 유두암의 충돌종양: 5예 증례보고

정호철,김제룡,안병현,이진선,장일성,김진만1,Ho Chul Jeong,Je Ryong Kim,Byong Hyon Ahn,Jin Sun Lee,Eil Sung Chang,Jin Man Kim1 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.1

Medullary thyroid carcinoma and papillary thyroid carcinoma are different subtypes of thyroid carcinoma. The concomitant occurrence of medullary thyroid carcinoma and papil-lary thyroid carcinoma as a collision tumor is rare. We describe five cases of medullary and papillary thyroid carcinoma as a collision tumor. Four women and one man underwent thyroidectomy for treatment of thyroid cancer. Collision tumor was then detected by histopathologic finding. Genetic testing, point mutation of the BRAF gene or mutation of the RET gene was performed in three cases. However, only one case had point mutation of the BRAF gene. Exact diagnosis of this uncommon event is important because the strategies for treatment of papillary thyroid carcinoma and medullary thyroid carcinoma are different.

갑상선의 $H\"{u}rthle$씨 세포 종양

정웅윤,김석주,박정수,Chung Woong-Youn,Kim Suk-Ju,Park Cheong-Soo 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

H$\"{u}$rthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the H$\"{u}$rthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the H$\"{u}$rthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of H$\"{u}$rthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were $121.7{\pm}35.3$ and $114.3{\pm}31.7$, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the H$\"{u}$rthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate H$\"{u}$rthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

갑상선의 Hürthle씨 세포 종양

정웅윤(Woong Youn Chung),김석주(Suk Ju Kim),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

Hürthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the Hürthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the Hürthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of Hürthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were 121.7±35.3 and 114.3±31.7, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the Hürthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate Hürthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

The Expression of Tumor-Associated Macrophages in Papillary Thyroid Carcinoma

김승환,조선욱,민혜숙,김강민,염계정,김은영,이규언,윤여규,박도준,박영주 대한내분비학회 2013 Endocrinology and metabolism Vol.28 No.3

Background: Tumor-associated macrophages (TAMs) play a tumorigenic role related to advanced staging and poor prognosis in many human cancers including thyroid cancers. Yet, a functional role of TAMs in papillary thyroid carcinoma (PTC) has not been established. The aim of this study was to investigate TAM expression in human PTC with lymph node (LN) metastasis. Methods: Thirty-six patients who underwent surgery after being diagnosed with PTC with LN metastasis were included. Primary tumor tissues were immunohistochemically stained with an anti-CD68 antibody and clinical characteristics according to TAM density were evaluated. Results: The TAM densities (CD68+ cells) varied from 5% to 70%, in all tumor areas, while few cells were stained in adjacent normal tissues. TAMs were identified as CD68+ cells with thin, elongated cytoplasmic extensions that formed a canopy structure over tumor cells. Comparing clinicopathologic characteristics between tumors with low (<25%) and high (25% to 70%) TAM densities, primary tumors were larger in the high density group than in the low density group (2.0±0.1 vs. 1.5±0.1; P=0.009). Conclusion: TAMs were identified in primary PTC tumors with LN metastasis and higher TAM densities were related to larger tumor sizes, suggesting a tumorigenic role of TAMs in human PTCs.

여포상 갑상선암종의 종양맥관형성도

정웅윤(Woong Youn Chung),이미경(Mi Kyung Lee),장항석(Hang Suk Chang),박정수(Cheong Soo Park) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

Objectives: We performed an immunohistochemical study to examine the place of neovascularization in the tumorigenic process of follicular thyroid carcinoma and to determine whether tumor angiogenic activity in follicular carcinoma plays a role in tumor aggression. Materials & Methods: We studied 63 follicular thyroid carcinomas and compared with 22 follicular adenomas. The areas of capsular invasion, vascular invasion and cellular atypism of the tumor were confimed on H & E stains. The paraffin embedded tissues were stained by the use of monoclonal antibodies against Ag CD34. Microvesseles were counted in the area of highest vascular density at 200 times magnification. The microvessel densities(MVD) were analized in relation to histologic type and location of the tumors. Results: There were 59 minimal invasive types and 4 widely invasive types of carcinoma. In the histologic specimens of carcinomas, capsular invasion was identified in all the cases, vascular invasion in 46 and cellular atypism in 24. Mean values of the MVDs of the minimal invasive carcinomas, the widely invasive carcinomas and the adenomas were 263.8±69.2, 256.l±49.3 and 241.5±159.4, respectively and there was no significant difference between each group. In follicular carcinomas, there was a regional difference of the MVDs. The areas of tumor showing cellular atypism and adjacent to or penetrating the capsule, in which represents the tumorigenic process of carcinoma, had a higher rate of vascularization, than other areas of the tumor(p<0.05). However, these features were not noted in the follicular adenomas. Conclusion: Although there was no significant difference of the MVD between follicular carcinomas and adenomas, there was a regional difference of the MVD within the carcinomas and the values were significantly higher in the more malignant areas, as indicated by cellular atypism and capsular invasion. Therefore, tumor angiogenic activity measured by MVD may play a role in tumor aggression in follicular thyroid carcinoma.