측경부 종물로 발현된 잠복 갑상선유두암종의 임상양상

이정열 ( Jung Yeol Lee ),박재홍 ( Jae Hong Park ),목지오 ( Ji Oh Mok ),고은석 ( Eun Seok Koh ),홍현숙 ( Hyun Suk Hong ),박정미 ( Jung Mi Park ),고윤우 ( Yoon Woo Koh ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Background and Objectives: Neck metastasis associated with occult papillary thyroid carcinomas rarely present as a lateral neck mass. This study investigates the incidence, presentation, evaluation, pathologic features, and process for definite treatment of occult papillary thyroid carcinoma presenting with a lateral neck mass. Materials and Methods: Fifty-nine patients with papillary thyroid carcinoma combined with neck metastasis were enrolled in this study. All patients underwent total thyroidectomy with lateral compartment neck dissection. The occult group consisted of 11 patients. The non-occult group comprised 48 patients. Results: Mean age in occult group was younger than non-occult group and male was dominant in occult group. We could find the abnormality of thyroid gland only in 3 of 11 (27.3%) by CT and 3 of 3 (100%) by ultrasonograpy. Fine needle aspiration biopsy (FNAB) was found to be helpful in 6 of 10 (60%). All of four false negative results consisted of cystic lesions. Mean primary tumor size was significantly smaller in occult than in non-occult group. No significant difference was observed in the other variables. Conclusion: Sole presentation as a lateral neck mass, especially in young & male should be considered in the differential diagnosis of occult papillary thyroid carcinoma. FNAB may be a initial diagnostic tool of choice. However, in case of cystic lesion, there are possibility of misleading interpretation of cytology. Although ultrasonography can be a good modality to evaluate occult papillary thyroid carcinoma, various radiologic study could not find primary thyroid focus.

Preoperative BRAF Mutation is Predictive of Occult Contralateral Carcinoma in Patients with Unilateral Papillary Thyroid Microcarcinoma

Zhou, Yi-Li,Zhang, Wei,Gao, Er-Li,Dai, Xuan-Xuan,Yang, Han,Zhang, Xiao-Hua,Wang, Ou-Chen Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.4

Background and Objective: The optimal resection extent for clinically unilateral papillary thyroid microcarcinoma (PTMC) remains controversial. The objective was to investigate risk factors associated with occult contralateral carcinoma, and put emphasis on the predictive value of preoperative BRAF mutation. Materials and Methods: 100 clinically unilateral PTMC patients all newly diagnosed, previously untreated were analyzed in a prospective cohort study. We assessed the T1799A BRAF mutation status in FNAB specimens obtained from all PTMC patients before undergoing total thyroidectomy (TT) and central lymph node dissection (CLND) for PTMC. Univariate and multivariate analyses were used to reveal the incidence of contralateral occult cancer, difference of risk factors and predictive value, with respect to the following variables: preoperative BRAF mutation status, age, gender, tumor size, multifocality of primary tumor, capsular invasion, presence of Hashimoto thyroiditis and central lymph node metastasis. Results: 20 of 100 patients (20%) had occult contralateral lobe carcinoma. On multi-variate analysis, preoperative BRAF mutation (p = 0.030, OR = 3.439) and multifocality of the primary tumor (p = 0.004, OR = 9.570) were independent predictive factors for occult contralateral PTMC presence. However, there were no significant differences between the presence of occult contralateral carcinomas and age, gender, tumor size, capsular invasion, Hashimoto thyroiditis and central lymph node metastasis. Conclusions: Total thyroidectomy, including the contralateral lobe, should be considered for the treatment of unilateral PTMC if preoperative BRAF mutation is positive and/or if the observed lesion presents as a multifocal tumor in the unilateral lobe.

Papillary Thyroglossal Duct Cyst Carcinoma with Synchronous Occult Papillary Thyroid Microcarcinoma

박민호,윤정한,제갈영종,이지신 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.4

This is a case report on papillary thyroglossal duct cyst (TGDC) carcinoma along with synchronous occult papillary thyroid microcarcinoma. A 46-year-old woman visited our hospital because she had an anterior midline neck mass below her hyoid bone. Preoperative ultrasound-guided fine-needle aspiration cytology revealed signs of papillary TGDC carcinoma. We performed a Sistrunk operation and a total thyroidectomy. Histopathological examination of the specimen revealed papillary carcinoma arising in the TGDC and papillary microcarcinoma of the thyroid gland without extrathyroidal extension. Surgeons should be aware of TGDC carcinoma during surgical planning and postoperative treatment and should differentiate this carcinoma from an anterior midline neck mass.

종격동 종괴로 발현된 잠재성 갑상선암

형우진(Woo Jin Hyung),정웅윤(Woung Yoon Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1

We have experienced a case of occult papillary thyroid carcinoma presenting as an anterior mediastinal mass in a 40-year-old man. The CT scan revealed a huge mass behind the manubrium of the sternum but the ultrasound examination failed to detect any lesion and developmental defect in the thyroid. Excision of the mediastinal mass and total thyroidectomy were carried out. Histologically, the mediastinal mass turned out to be papillary carcinoma without any portion of the normal thyroid tissue or normal lymph node tissue and the thyroid gland showed a tiny papillary carcinoma with the diameter of 0.3cm. Although a mediastinal mass as the sole presentation of the thyroid carcinoma is very rare, we suggest that a mediastinal mass should be added to the list of possible metastatic thyroid carcinoma.

HBV : Prevalence of Occult Hepatitis B Virus Infection in HBsAg-Negative Patients with Liver Cirrhosis or Hepatocellular Carcinoma

( Ji Yun Jung ),( Hyung Joon Kim ),( Sun Young Cho ),( Young Kwang Choo ),( Sung Soo La ),( Suk Bae Kim ),( Il Han Song ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Occult hepatitis B virus (HBV) infection is de- fined as the presence of HBV DNA in the liver tissue or the serum in subjects negative for hepatitis B surface antigen (HBsAg). The prevalence of occult HBV infection is depending on the virus endemicity, the assay sensitivity, and the population variability. This study was conducted to estimate the prevalence of occult HBV infection in HBsAg-negative patients with liver cirrhosis (LC) or hepatocellular carcinoma (HCC). Methods: Serum samples from 114 patients with HBsAg-negative LC or HCC were obtained. HBsAg, anti-HBs, and IgG an- ti-HBc were measured by radioimmunoassay and HBV DNA was determined by real-time polymerase chain reaction. The prevalence of occult HBV infection in these patients was compared to that of 94 age- and sex-matched healthy subjects negative for HBsAg. Results: The prevalence of occult HBV infection was 2.6% in HBsAg-negative patients with LC or HCC, while that of healthy subjects was 2.1%. In all cases with occult HBV infection, hepatitis B viral loads were less than 116 copies/mL except one with 144 copies/mL. Table 1 displayed below are clinical characteristics of the patients with occult HBV infection. Conclusions: The overall prevalence of occult HBV infection was 2.4% in which viral load was extremely low. No difference of the prevalence was observed among LC or HCC patients and healthy subjects in endemic area for HBV.

기획B형간염 바이러스의 잠재 감염 ; B형간염 바이러스 잠재 감염과 간세포암

이종준 ( Jong Joon Lee ),권오상 ( Oh Sang Kwon ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.3

Many studies have suggested that occult HBV infection has a substantial clinical relevance to hepatocellular carcinoma (HCC). Occult HBV infection is an important risk factor for the development of cirrhosis and HCC in patients without HBsAg. As a matter of fact, occult HBV infection is one of the most common causes of crytogenic HCC in endemic areas of HBV. However, there still are controversial issues about the association between occult HBV infection and HCC according to the underlying liver disease. In alcoholic cirrhosis, occult HBV infection may exert synergistic effect on the development of HCC. However, there is insufficient evidence to relate occult HBV infection to hepatocarcinogenesis in non-alcoholic fatty liver disease. In cryptogenic HCC, occult HBV infection may play a direct role in the development of HCC. In order to elucidate the assocciation between occult HBV infection and HCC, underlying liver disease must be specified and larger number of cases must be included in future studies. (Korean J Gastroenterol 2013;62:160-164)

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma

Park, Seog Yun,Jung, Yuh-S,Ryu, Chang Hwan,Lee, Chang Yoon,Lee, You Jin,Lee, Eun Kyung,Kim, Seok-Ki,Kim, Tae Sung,Kim, Tae Hyun,Jang, Jeyun,Park, Daeyoon,Dong, Seung Myung,Kang, Jae-Goo,Lee, Jin Soo,R Society for Endocrinology 2015 Endocrine-related cancer Vol.22 No.4

<P>We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11–8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68–15.08) and extrathyroidal extensions (OR, 3.03; 95% CI, 1.03–8.95) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients.</P>

후두 및 하인두 편평세포암종의 경부 잠재전이율

최은창(Eun Chang Choi),김동영(Dong Young Kim),고윤우(Yoon Woo Koh),홍정표(Jung Pyoe Hong),이세영(Sei Young Lee),홍원표(Won Pyo Hong) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Background and Objectives: Occult neck metastasis rate of laryngeal and hypopharyngeal cancer varies widely depending upon authors. Materials and Methods: Sixty four cases, previously untreated, of N0 laryngeal and hypopharyngeal squamous cell carcinoma patients who underwent surgery as an initial treatment from 1992 to 1997 were evaluated. All had unilateral or bilateral elective neck dissection at the time of surgery for the primary. Occult neck metastasis rate was evaluated with pathologic examination of neck dissection specimen. Results: Occult neck metastasis rate by primary site was as follows. Supraglottis ipsilateral 32%(8/25) contralateral 15%(3/20), glottis ipsilateral 17%(5/30), contralateral 0%(0/22), hypopharynx ipsilateral 78%(7/9), contralateral 25%(2/8). Conclusion: Supraglottic and hypopharyngeal cancer may need elective neck treatment bilaterally. Occult neck metastasis of glottic cancer to opposite site was minimal.

기관지 내시경에 의해 진단된 기관과 식도를 침범한 갑상선 잠재성 유두암 1예

조덕수,안병이,이덕수,한동호,김상영,김귀완 예수병원 1998 예수병원학술지 Vol.19 No.-

Is elective neck dissection needed in squamous cell carcinoma of maxilla?

Jung-Hyun Park,Woong Nam,Hyung Jun Kim,In-Ho Cha 대한구강악안면외과학회 2017 대한구강악안면외과학회지 Vol.43 No.3

Objectives: To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients. Materials and Methods: Sixty-seven patients with maxillary SCC and cN0 neck were analyzed retrospectively, including 35 patients with maxillary gingiva and 32 patients with maxillary sinus. Results: Of 67 patients, 10 patients (14.9%) had occult cervical metastasis. The incidence of occult cervical metastasis of maxillary gingival SCC was higher than that of maxillary sinus SCC (17.1% and 12.5%, respectively). The 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. The success rate of treatment for regional recurrence was high at 71.4%, whereas that for local or locoregional recurrence was low (33.3% and 0%, respectively). Conclusion: The incidence of occult cervical metastasis of maxillary SCC was not high enough to recommend END. For survival of cN0 patients, local control of the primary tumor is more important than modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible irrespective of the site or T stage. The key enabler of early detection is patient education with periodic follow-up.