PURPOSE: Obesity is a known risk factor for several cancers, including breast, colon, esophagus, kidney, uterus, and thyroid. Recent studies have reported that higher body mass index (BMI) is also associated with more advanced stage. The aim of this study was to investigate the clinicopathological relevance between BMI and papillary thyroid carcinoma (PTC). METHODS: A total of 798 patients surgically treated for PTC from January 2006 to June 2010 were included in this study. Medical records and pathologic reports were reviewed retrospectively. According to BMI, patients were divided into four groups: underweight (3.1%), normal (57.3%), overweight (31.6%), and obese (8.0%). Clinicopathological factors were analyzed and compared between normal and other groups. RESULTS: According to the results, 709 patients were women (89.0%) and mean age was 48.5 years; mean follow-up period was 1,721+/-464.2 days. In comparison between the normal and underweight groups, there was significantly more extra-thyroidal invasion [Odds ratio (OR) 3.923, P=0.006] in the underweight group. In the obese group, tumor size was significantly larger (OR 1.794, P=0.007). However, there was no significant difference between the normal and overweight group. CONCLUSION: In the obese group, tumor size was the only clinical significant factor between high BMI and PTC. Interestingly, more extra-thyroidal invasion was seen in the underweight group. To confirm this result, further studies with long-term follow-up and more patients are required.
Body Mass Index* ; Breast ; Colon ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Kidney ; Medical Records ; Obesity ; Overweight ; Retrospective Studies ; Risk Factors ; Thinness ; Thyroid Gland ; Thyroid Neoplasms* ; Uterus

Parathyroid carcinoma is a rare malignancy presenting hyperparathyroidism. At times, diagnosis and localization are difficult. The optimum treatment for parathyroid carcinoma is en bloc resection when malignancy is highly suspicious or diagnosed. However, even after the adequate surgical treatment, persistent or recurrent disease is well encountered. Here we report a case with recurred parathyroid carcinoma presenting discrepancy between image findings and operative findings.
Diagnosis ; Hyperparathyroidism ; Parathyroid Neoplasms* ; Recurrence* ; Ultrasonography

We report here on a case of a neurogenic tumor of the neck with an uncertain origin on the preoperative evaluation. A 67-year-old woman with a palpable mass in the left side of the neck was referred to our hospital. The mass had slowly grown over 7 years and her dyspnea had gradually become more severe over the recent 6 months. Computerized tomography and magnetic resonance imaging showed an 8 cm sized solid mass that abutted the trachea and the esophagus without invasion, but the origin of the mass was not clearly identified. During surgical exploration, we identified that the tumor was located in the esophageal muscle layer. Immunohistochemical staining revealed that the tumor cells were positive for S-100 protein, which confirmed a diagnosis of schwannoma.
Aged ; Diagnosis ; Diagnosis, Differential* ; Dyspnea ; Esophagus ; Female ; Humans ; Magnetic Resonance Imaging ; Neck ; Neurilemmoma ; S100 Proteins ; Thyroid Gland ; Trachea

Granular cell tumor (GCT) of the thyroid is rare and histogenesis of the carcinoma still remains poorly understood. Here in this study, we report a case of perithyroidal granular cell tumor in a 44-year-old woman, diagnosed as medullary carcinoma upon the interoperative frozen diagnosis. The tumor was comprised of white, solid mass with infiltrating margin in isthmus. Microscopically, the tumor revealed abundant eosinophilic cytoplasm, elongated nucleus and eosinophilic amyloid-like materials. It was composed of diffuse sheets of polygonal cells with abundant eosinophilic cytoplasm and cytologically bland nucleus on permanent section. On immunohistochemical staining, S-100 and CD68 are diffusely positive. Determining the progression and the behavior of the tumor is critical for providing long-term management and preventing aggressive treatment.
Adult ; Carcinoma, Medullary ; Carcinoma, Papillary ; Cytoplasm ; Diagnosis ; Eosinophils ; Female ; Granular Cell Tumor* ; Humans ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: Incidental resection of parathyroid gland is not uncommon during thyroid surgery and may occur even in experienced thyroid surgeons. The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. METHODS: A retrospective review of patients who underwent thyroid surgery between January and December 2008 was carried out. Pathologic reports were reviewed for the presence of parathyroid tissue in resected thyroid specimen. Two groups of patients were studied: a group with incidental parathyroidectomy (Group A) and without incidental parathyroidectomy (Group B). RESULTS: Three hundred and thirty-four thyroid surgery were performed: 194 total thyroidectomies, 18 near- or subtotal thyroidectomies, 44 lobectomies, 23 endoscopic total thyroidectomies, 55 endoscopic lobectomies. Of these, 265 patients (79.3%) were preformed for malignant disease. Incidental parathyroidectomy occurred in 30.5% (102/334) of thyroid surgery. Risk factors for incidental parathyroidectomy included malignant pathology (P<0.001), operation method (P<0.001), lymph node dissection (P<0.001), and extrathyroidal invasion (P=0.001). Biochemical hypocalcemia was defined as a serum calcium levels less than 8.4 mg/dL. Symptomatic hypocalcemia was defined as patient had tingled sense or spasm of muscle and need to add more calcium replacement. In group A, 86 patients (93.5%) had a biochemical hypocalcemia (P=0.001). Symptomatic hypocalcemia developed in 35.3% (36/102) of group A, compared to 20.7% (48/232) in group B (P=0.005). CONCLUSION: Malignant pathology, total thyroidectomy, lymph node dissection, and extrathyroidal invasion were associated with a significantly higher risk of incidental parathyroidectomy during thyroid surgery. Incidental parathyroidectomy resulted in biochemical and symptomatic postoperative hypocalcemia. This study suggests that incidental parathyroidectomy may be a potential complication; therefore, parathyroid glands should be identified and preserved with more meticulous inspection during thyroid surgery.
Calcium ; Humans ; Hypocalcemia ; Incidence ; Lymph Node Excision ; Methods ; Parathyroid Glands ; Parathyroidectomy* ; Pathology ; Retrospective Studies ; Risk Factors* ; Spasm ; Surgeons ; Thyroid Gland* ; Thyroidectomy

PURPOSE: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.
Carcinoma, Papillary* ; Diagnosis ; Gangwon-do ; Humans ; Lymph Node Excision ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

PURPOSE: Ultrasound (US) elastography is a newly developed imaging technique for assessing tissue stiffness by measuring the degree of the tissue's deformation in response to the application of an external force. This technique has recently been applied for making the diagnosis of nodular thyroid disease. The purpose of this study was to evaluate the diagnostic utility of US elastography for differentiating benign thyroid nodules from malignant thyroid nodules. METHODS: A total of 63 consecutive patients with thyroid nodules and who were referred for surgical treatment were examined in this study. Seventy-five nodules in these patients were examined by US B-mode, color Doppler US and US elastography. The final diagnosis was obtained from the histologic findings. The tissue stiffness on ultrasound elastography was scored from 1 (elasticity in the whole nodule) to 5 (no elasticity in the nodule and in the posterior shadowing). RESULTS: On US elastography, 18 of 32 benign nodules (56.3%) had a score of 1 to 3, whereas 23 of 43 malignant nodules (62.8%) had a score of 4 to 5. With applying a US elastography score of 4-5 as an indicator for malignancy, the sensitivity, specificity, positive predictive value and negative predictive value of US elastography were 65.9%, 52.9%, 62.8% and 56.3%, respectively. Of the 14 follicular tumors, 12 were follicular adenoma and four were follicular carcinoma. The sensitivity and specificity of US elastography for diagnosing follicular carcinoma were 50.0% and 81% (56=69), respectively. The positive and negative predictive values were 55.2% (16=29) and 60.0%, respectively. The accuracy of the technique was 57.1%. The findings of US elastography were not significantly correlated with the histopathologic findings. CONCLUSION: This study has shown that US elastography may be not useful for differentiating between benign and malignant thyroid nodules. Further studies are needed to confirm the usefulness of US elastography for making the differential diagnosis of thyroid nodules.
Adenoma ; Diagnosis ; Diagnosis, Differential* ; Elasticity ; Elasticity Imaging Techniques* ; Humans ; Sensitivity and Specificity ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

The incidence of PTMC (papillary thyroid microcarcinoma) has rapidly increased recently due to the application of ultrasonography to the thyroid. The good prognosis of PTMC is well known with a mortality rate of less than 1%. However, there is controversy about the surgical extent of thyroidectomy for PTMC patients between surgeons and endocrinologists due to differences in understanding the clinical properties of PTMC, while having a difference in basic concepts in the treatment and follow up strategy for PTMC patients. Total thyroidectomy is recommended for PTMC patients because there is no major difference in the rate of lymph node metastasis, extrathyroidal extension, multiplicity between the PTMC and PTC over 1 cm in size and although rare, occasional distant metastasis and mortality cases could be developed. However, there is no evidence of benefit of total thyroidectomy for the survival rate of PTMC patients. The microscopic lymph node metastasis and extrathyroidal extension are not prognostic factors for the survival or recurrence in PTMC. The clinical lateral neck lymph node metastasis and multiplicity has been proposed as valuable prognostic factors in micropapillary carcinoma and these factors could be assessed accurately by ultrasonography preoperatively. A decision on the proper extent of thyroidectomy could be possible in most PTMC patients. This article summarizes available data and concludes that routine total thyroidectomy for PTMC patients is not rational.
Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Mortality ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Surgeons ; Survival Rate ; Thyroid Gland* ; Thyroidectomy* ; Ultrasonography

Anaplastic thyroid carcinoma (ATC) is a rare disease that shows very aggressive behavior. Most ATCs arise from pre-existing thyroid carcinomas. However, anaplastic transformation occurring in metastatic cervical nodes is extremely rare. We report herein on 3 cases of anaplastic transformation of metastatic lateral cervical lymph nodes from primary papillary thyroid carcinoma (PTC), which happened long after the initial surgical treatment. All the patients died of disease within 4 months in spite of aggressive treatment for the lesions. Our experience supports that appropriate lymph node dissection is mandatory at the time of initial surgery even for differentiated thyroid carcinomas.
Humans ; Lymph Node Excision ; Lymph Nodes* ; Rare Diseases ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms*

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.
Abscess ; Adolescent ; Barium ; Fistula* ; Humans ; Inflammation ; Laryngoscopy ; Male ; Neck ; Pyriform Sinus* ; Soft Tissue Infections* ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Suppurative ; Tomography, X-Ray Computed