BACKGROUND: Fibroadenoma is a common benign breast tumor that has a rare malignancy rate. However, various studies reported that it is associated with a certain increase in breast cancers. CASES: We report three cases of malignancy arising from a breast fibroadenoma. They were 32, 36 and 52 years old and presented with a lump of recent onset. Any one of mammography, ultrasonography and cytologic examination could diagnose malignancy exactly. But cytological examination demonstrated atypical cells with fibroadenoma in two cases. Wide excision was performed in two cases and localization & excisional biopsy was performed in an occult case. Pathologic report of the cases revealed them as DCIS in a fibroadenoma. CONCLUSION: Possibility of malignancy cannot be excluded in fibroadenomas especially in case with calcifications within the mass in the radiological study or with atypical cells presented in the cytology. Cytology and ultrasonogram should be used to evaluate fibroadenomas. If there are any suspicion of malignancy, excisional biopsy should be performed to confirm the benign state.
Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Fibroadenoma* ; Humans ; Mammography ; Middle Aged ; Ultrasonography

PURPOSE: Fine needle aspiration cytology (FNA) and frozen section (FS) have been extremely valuable tools in the evaluation of thyroid nodules. However, in follicular carcinomas, it is often difficult to distinguish between a benign and a malignant lesion. The aims of this study were to evaluate the characteristic clinicopathologic findings and sensitivities of FNA and FS examination in the diagnosis of follicular carcinomas and to delineate the influence of preoperative and intraoperative clinicopathologic findings and the prognostic factors on the extent of surgery. METHODS: The cases of 33 patients who had undergone thyroid surgery and who had been histologically diagnosed as having follicular thyroid carcinomas were reviewed for age, sex, laboratory findings, FNA findings, frozen-section results, extent of surgery, completion thyroidectomy, and coexistent pathology. RESULTS: There were 28 women and 10 men (2.3:1 ratio) whose ages ranged from 14 to 75 years with a mean of 40.8 years. The mean follow-up was 27.2 months. The most prominent sign was an asymptomatic palpable anterior neck mass, which was present in 29 (87.8%) cases. Fine needle aspiration cytology was performed in 31 patients, revealing a follicular neoplasm in 16 patients (sensitivity=51.6%), an adenomatous goiter in 6 (19.4%), a papillary carcinoma in 5 (16.1%), and an anaplastic carcinoma in 1 (3.2%); the specimens were inadequate in 3 patients (9.7%). Among the 32 patients having an intraoperative frozen sections, only 7 patients (sensitivity=21.2%) were correctly diagnosed as having cancer. The diagnoses were deferred (reported as a follicular neoplasm) in 21 patients (65.6%) and were changed from benign at frozen section to malignant on final diagnosis in 4 patients (12.6%). Among the 21 patients diagnosed as having a follicular neoplasm on frozen section, 10 patients (47.6%) were treated with a subtotal thyroidectomy, 6 patients (28.6%) with a total thyroidectomy taking into consideration the gross findings at operation and prognostic factors such as AGES and AMES to reduce the incidence of a completion thyroidectomy.Only 5 patients (23.8%) underwent a lobectomy followed by a reoperation (a completion thyroidectomy). CONCLUSION: Fine needle aspiration cytology and frozen section results are not good indicators in making the decision regarding the extent of the thyroidectomy. A definitive decision to avoid a completion thyroidectomy should be made during the initial operation based on gross findings, frozen-section results, and prognostic factor such as age, tumor grade, tumor size, and the presence of extracapsular spread or distant metastasis.
Adenocarcinoma, Follicular ; Biopsy, Fine-Needle* ; Carcinoma ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections* ; Goiter ; Humans ; Incidence ; Male ; Neck ; Neoplasm Metastasis ; Pathology ; Reoperation ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy

BACKGROUND: A fibroadenoma is a common benign breast tumor with little potential for malignancy. There are, however, increasing numbers of reports that it is associated with a certain increase in breast cancer. METHODS: We reviewed the medical records of 4 patient's who were diagnosed as intraductal carcinoma within a fibroadenoma. RESULTS: The patient's age were relatively young (32, 36, 52, and 36 years), and the tumor presented as a lump of recent onset in 3 patients and as an abnormal mammography in one patient. None of the patients could be diagnosed as having malignancy by using mammography, ultrasonography, or cytologic examination. However, a radiologic study showed microcalcifications in the masses in two patients, and cytological examination demonstrated atypical cells in three patients. Breast-conservation surgery was performed in two patients; a wide excision was used in one and a localization & excision in the other. Pathologic features were ductal carcinomas in situ within fibroadenomas in all. Estrogen and progesteron receptors were all positive. CONCLUSION: Possibility of malignancy should be excluded in patients with a fibroadenoma, especially when microcalcifications are observed within the mass or atypical cells are suspected based on cytologic examination. Fine needle aspiration cytology, ultrasonography and even excisional biopsy should be performed to evaluate the possibility of malignancy in these patients.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Fibroadenoma* ; Humans ; Mammography ; Medical Records ; Ultrasonography

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which is first described by Carcangiu in 1984. It is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and the prognosis of the insular thyroid carcinoma. MATERIALS AND METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and mean age was 44 years. Three of four patients complained anterior neck mass and one patient complained low back pain and paresthesia of right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology could diagnose follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extra- thyroidal invasion, vascular invasion and multicentricity was noted in two cases. All four patients showed recurrence or distant metastasis in follow up period of 10~31 months and 2 of them died of distant metastasis. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinoma.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Low Back Pain ; Neck ; Neoplasm Metastasis ; Paresthesia ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Thigh ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

A case of huge cystosarcoma phyllodes is presented. A 45-year-old female visited our clinic because she had had a mass in the right breast for two and a half years. She had performed breast mass excisions at the same site on 2 different occasions, 5 and 3 years ago. The tumors consisted of benign phyllodes, and there had been necrosis with a foul odor in half of the mass surface. A total mastectomy was performed due to the large size (30x22 cm), the recurrent nature and a fear of malignancy. The tumor was somewhat incompletely well-encapsulated and was adherent to the pectoralis major. Pathologic findings revealed that the tumor was made up of malignant cystosarcoma phyllodes.
Breast ; Female ; Humans ; Mastectomy, Simple ; Middle Aged ; Necrosis ; Odors ; Phyllodes Tumor*

No abstract available.
Typhlitis*

PURPOSE: To describe the two-phase spiral CT findings of acute cholecystitis. MATERIALS AND METHODS: CTscans of nine patients with surgically-proven acute cholecystitis were retrospectively reviewed for wallthickening, enhancement pattern of the wall, attenuation of the liver adjacent to the gallbladder, gallstones,gallbladder distention, gas collection within the gallbladder, pericholecystic fluid and infiltration ofpericholecystic fat. RESULT: In all cases, wall thickening of the gallbladder was seen, though this was moredistinct on delayed images, Using high-low-high attenuation, one layer was seen in five cases, nd three layers infour. On arterial images, eight cases showed transient focal increased attenuation of the liver adjacent to thegall bladder;four of these showed curvilinear attenuation and four showed subsegmental attenuation. One caseshowed curvilinear decreased attenuation between increased attenuation of the liver and the gallbladder, andduring surgery, severe adhesion between the liver and gallbladder was confirmed. Additional CT findings wereinfiltration of pericholecystic fat (n=9), gallstones (n=7), gallbladder distension (n=6), pericholecystic fluid(n=3), and gas collection within the gallbladder (n=2). CONCLUSION: In patients with acute cholecystisis,two-phase spiral CT revealed wall thickening in one or three layers ; on delayed images this was more distint. Inmany cases, arterial images showed transient focal increased attenuation of the liver adjacent to the gallbladder.
Cholecystitis, Acute* ; Gallbladder ; Gallstones ; Humans ; Liver ; Retrospective Studies ; Tomography, Spiral Computed*

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Low Back Pain ; Neck ; Neoplasm Metastasis ; Paresthesia ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Thigh ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Low Back Pain ; Neck ; Neoplasm Metastasis ; Paresthesia ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Thigh ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Graves' disease can be treated with antithyroid medication, radioiodine, or a thyroidectomy. Antithyroid medication is less likely to achieve a permanent remission than radioiodine or thyroidectomy. Radioiodine is preferred in the United States and antithyroid medication is used more often in Europe. However a thyroidectomy is less preferred as a primary therapy and is used only in the cases of recurrence or no response to medication. METHODS: We studied 152 patients with Graves' disease who had been treated at Samsung Medical Center. Fifty seven patients of them were surgically managed after antithyroid medication, and the rest of them were managed medically. Patient's age, sex, symptoms, thyroid fuction, autoantibody, treatment method and recurrence were retrospectively analyzed. RESULTS: Women had Graves' disease more frequently than men a thyroidectomy was performed more often in women and relatively young patients. The symptoms of Graves' disease were neck mass, palpitation, eye symptoms, weight loss and etc. The response to treatment was much higher in the thyroidectomy group than in the medically treated group. And more patients in surgically treatmented group had their thyroid function normalized. A subtotal thyroidectomy was performed in all patient and a mean of 7.4 g of thyroid tissue was remained. Hypothyroidism was noted in 7 patients (12.3%), permanent hypocalcemia in 1 (1.8%), vocal cord paralysis in 1 (1.8%) and transient hoarseness, transient hypocalcemia in the others. Recurrences were noted in 4 patients. There was no correlation between recurrence and remnant thyroid mass. However, preoperative TBII (thyrotropine binding inhibiting immunoglobulin) values were higher in recurrence group and immediate and late postoperative values were also higher than in the recovered group. CONCLUSION: A thyroidectomy is the treatment of choice in Graves' disease. However, further investigation will be needed to predict thyroid the function after a thyroidectomy for Graves' disease
Europe ; Female ; Graves Disease* ; Hoarseness ; Humans ; Hypocalcemia ; Hypothyroidism ; Male ; Neck ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroidectomy ; United States ; Vocal Cord Paralysis ; Weight Loss