BACKGROUND AND OBJECTIVES: Although anaplastic thyroid carcinoma (ATC) accounts for less than 2% of all thyroid malignancies, it contributes to 14-50% of deaths related to thyroid tumors. However, there is no definite treatment. The aim of the study is to review our experience of ATC at our own university clinic to look for clues for the management of ATC. SUBJECTS AND METHOD: The medical record of 15 patients with ATC treated in our clinic between 1997 and 2010 were retrospectively reviewed. RESULTS: Five (33.3%) patients underwent no curative treatment but biopsy or tracheostomy. Complete surgical resection was possible in only one patient. Six patients underwent debulking surgery with or without adjuvant treatment. One and two patients were treated with radiation therapy alone and concurrent chemoradiation therapy (CCRT), respectively. Despite various treatment regimens, there are surviving patients at the time of present evaluation. The mean survival was 253.1 days and median survival was 128 days. Only two patients had survived longer than a year. Each patient had been treated with complete surgical resection and CCRT with doxorubicin, respectively. In univariate analysis, there was no association between survival duration and various clinico-pathological parameters. However, old age (> or =65), history of pre-existing thyroid nodule, and radiation therapy was significantly associated with survival duration in multivariate analysis. CONCLUSION: Most ATC was unresponsive to ongoing treatment modalities in our clinic. However, we experienced that a certain treatment was effective in some patients. For the goal of forming a generally effective treatment regimen for ATC, we suggest a prospective multicenter study to be performed on the basis of present study.
Biopsy ; Doxorubicin ; Humans ; Medical Records ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Tracheostomy

Here, we describe two cases of cervical bronchogenic cysts mimicking thyroid cancer on ultrasound (US), introducing some sources of diagnostic error with the aim of improving the understanding of cervical bronchogenic cysts. In these cases, US demonstrated ill-defined nonhomogeneous hypoechoic nodules at the inferior pole of the thyroid gland, exhibiting several echogenic foci that mimicked microcalcification of papillary thyroid carcinoma. Although cervical bronchogenic cysts can be presented as highly suspicious thyroid nodules on US, recognition of this disease entity and comprehensive understanding of its presentation can allow an appropriate diagnostic process without unnecessary diagnostic surgery.

In the last few decades, the standard surgical treatment for primary hyperparathyroidism (PHPT) has shifted from bilateral neck exploration to focused/minimally invasive parathyroidectomy (FMIP). This shift was accelerated by the introduction of intraoperative parathyroid hormone (IOPTH) monitoring, which can provide intraoperative information regarding the localization and complete excision of the pathological parathyroid gland during FMIP. Since the first clinical application of the IOPTH assay in 1991, IOPTH monitoring has substantially improved to date to increase its performance and availability. In addition, the clinical applications of IOPTH changed with the needs of actual clinical practice, although the fundamental concept and technique remained unchanged. In this review, we discuss the role of IOPTH monitoring in the surgical management of PHPT based on the results of contemporary studies and summarized the major issues regarding IOPTH.

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.
Adenoma ; Adenoma, Oxyphilic ; Adipose Tissue ; Adult ; Female ; Humans ; Lipoma ; Parotid Gland ; Salivary Gland Neoplasms ; Salivary Glands ; Submandibular Gland*

As the prevalence of thyroid carcinoma is rapidly increasing, coexisting subtypes of thyroid carcinomas are often found. However, concurrent papillary and medullary carcinomas in the thyroid gland are extremely rare. We report the case of a 50-year-old man with co-occurrence of multiple papillary and medullary thyroid carcinomas; the latter were undetected at initial diagnosis. Sixty-three months after the initial operation performed because of papillary carcinoma diagnosis, a metastatic lymph node was detected in the left level IV region, which was revealed as medullary carcinoma. The histopathologic results from initial surgery were reviewed, and we found multiple coexisting medullary carcinomas that were not identified initially. The incidence of concurrent papillary and medullary thyroid carcinomas will continue to increase as rates of diagnosis of and surgery for thyroid carcinoma increase. Therefore, surgeons and pathologists should be aware of the possible coexistence of subtypes of thyroid carcinomas to avoid missing concurrent lesions.
Carcinoma, Medullary ; Carcinoma, Papillary ; Incidence ; Lymph Nodes ; Prevalence ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. MATERIALS AND METHODS: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. RESULTS: Inadvertent parathyroidectomy was identified in 7.4% of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size, coexisting Hashimoto's thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon's experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size > or =1 cm and surgeon's experience < or =5 years was statistically associated with permanent hypocalcemia on both univariate and multivariate analyses. CONCLUSION: Although inadvertent parathyroidectomy is not an uncommon complication of thyroid surgery, it appears to have only modest clinical implications. Permanent hypocalcemia was significantly associated with tumor size > or =1 cm and short surgical experience of surgeons, especially in the case of TT with CND. Therefore, we suggest that more accurate risk stratification should be made for routine CND, when it is performed by young surgeons.
Carcinoma ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Parathyroid Glands ; Parathyroidectomy ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyroiditis

OBJECTIVES: Numerous studies have reported the effects of subclinical hyperthyroidism on the cardiovascular system, osteoporosis, and metabolic syndrome. However, there are few studies examining the relationships between subclinical hyperthyroidism and thyroid cancer. The aim of this study was to investigate the relationships between preoperative subclinical hyperthyroidism and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC) in terms of thyroid-stimulating hormone (TSH) levels and TSH receptor antibody (TRAb) values. METHODS: Between January 2001 and December 2007, 462 patients were eligible for analysis in our study; we compared the clinicopathological characteristics of 39 preoperative subclinical hyperthyroidism patients with those of 423 euthyroid patients. RESULTS: There were no statistical differences between the 2 groups with respect to age, male to female ratio, primary tumor size, extrathyroidal extension (ETE), multifocality, lymph node metastasis, TNM and AMES stages, recurrence, and survival, despite significant difference in TSH concentrations between the 2 groups. In the evaluation for TRAb, primary tumor size was significantly larger in patients with normal TRAb than in patients with elevated TRAb. When the patients were subdivided into 4 categories according to TRAb values (<5.0%; 5.0%-10.0%; 10.1%-15.0%; >15.0%), tumor size and ETE were significantly different. However, we could not find linear relationships in the increase or decrease of TRAb values. CONCLUSION: The results of our study suggest that subclinical hyperthyroidism is not independently associated with tumor aggressiveness and prognosis in PTC in spite of reduced TSH levels and increased TRAb values as compared with euthyroid patients.
Carcinoma, Papillary ; Cardiovascular System ; Female ; Humans ; Hyperthyroidism* ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Osteoporosis ; Prognosis ; Receptors, Thyrotropin ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms* ; Thyrotropin

OBJECTIVES: Somatostatin inhibits lymph production and reduces lymph flow into the lymphatic duct. We hypothesized that octreotide, a long-acting somatostatin analog, would reduce drainage after neck dissection (ND) by reducing the overall lymphatic flow in the neck as well as thoracic duct flow. METHODS: From 2012 to 2014, total 123 patients who had undergone left-sided comprehensive ND, were divided into an octreotide group (49 patients) and a control group (74 patients). Seventeen patients from the octreotide group and 17 from the control group were individually matched by age (±10 years), sex, body mass index (±1 kg/m2), type of cancer, surgeon, and the extent of surgery. These 34 patients were finally included in the study. RESULTS: The total fluid drainage volume (540.9 mL vs. 707.9 mL) and drainage volume during the period of octreotide use (the first 5 postoperative days) (461.1 mL vs. 676.4 mL) were significantly lower in the octreotide group. The duration of drain placement (6.3 days vs. 9.4 days) was also shorter in the octreotide group. In the octreotide group, the mean triglyceride concentration in the drainage fluid was significantly lower than that in the control group (43.1 mg/dL vs. 88.8 mg/dL). There was no complication associated with the use of octreotide. CONCLUSION: Our study has shown that postoperative octreotide injections reduce postoperative drainage and the duration of drain placement. Further studies with larger patient populations are warranted to confirm these results and to evaluate the clinical benefits for patients.
Body Mass Index ; Case-Control Studies* ; Chyle ; Drainage* ; Humans ; Neck Dissection* ; Neck* ; Octreotide* ; Prospective Studies* ; Somatostatin ; Thoracic Duct ; Triglycerides

Low-grade cribriform cystadenocarcinoma (LGCCC) is a rare salivary gland tumor that was recently defined as a variant of cystadenocarcinoma by the 2005 World Health Orgazniation (WHO) classification system. We report cytologic findings of an unusual case of LGCCC with many psammoma bodies. A 90-year-old man presented a palpable mass on his left parotid gland. Fine-needle aspiration (FNA) cytology showed tumor cells that were arranged in clusters and dispersed individually. The tumor cells showed mild atypia and had clear or dense cytoplasm with some vacuoles. Numerous psammoma bodies were noted. After surgical resection, the histologic examination revealed a mixed solid and cystic mass showing intraductal growth with focal stromal invasion. The S-100 protein expressed in the tumor cells, but smooth muscle actin and p63 were positive only in myoepithelial cells. Although LGCCCs resemble other salivary gland tumors, differentiating LGCCC during preoperative FNA is important to avoid unnecessary overtreatment.
Actins ; Aged, 80 and over ; Biopsy, Fine-Needle* ; Cystadenocarcinoma* ; Cytoplasm ; Humans ; Muscle, Smooth ; Parotid Gland ; S100 Proteins ; Salivary Glands* ; Vacuoles ; World Health

BACKGROUND AND OBJECTIVES: Occult multifocal diseases are often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). There has been considerable debate with regard to whether multifocal diseases actually behave more aggressively compared with unifocal diseases, particularly PTMC. The present study aimed at evaluating the clinical impact of occult multifocal diseases on the recurrence of PTMC treated with hemithyroidectomy. SUBJECTS AND METHOD: We compared the clinicopathological characteristics and 5-year outcomes for 319 patients with unifocal PTMC patients and 29 patients with occult multifocal PTMC, all of whom were treated with hemithyroidectomy between January 2004 and December 2010. RESULTS: The incidence of occult multifocal disease was 8.4%, with a mean size of 0.28 cm. Although microscopic extrathyroidal extension (ETE) was more frequent in patients with occult multifocal PTMC as compared with that of unifocal diseases (41.4% vs. 23.2%, p=0.030), multifocality was not associated with age, primary tumor size, and concurrent Hashimoto's thyroiditis. With respect to recurrence, there was no difference between the unifocal and multifocal groups during the mean 55.8-month follow-up period (4.4% vs. 10.3%, p=0.160). In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and presence of occult multifocal diseases in patients with PTMC treated with hemithyroidectomy. CONCLUSION: Although presence of occult multifocal diseases was associated with microscopic ETE, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, multifocality identified after hemithyroidectomy would not be an absolute indication for the completion of thyroidectomy in patients with PTMC.
Follow-Up Studies ; Humans ; Incidence ; Multivariate Analysis ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis