We report here on a case of diffuse sclerosing papillary carcinoma (DSPC), which is a subtype of papillary carcinoma of thyroid, in a 27-year-old female. The ultrasound images showed diffuse enlargement of the thyroid lobes and this was associated with underlying diffuse scattered microcalcifications and a heterogeneous hypoechoic background parenchyma that was without any masses. The CT image showeddiffuse scattered dot-like hyperdensities with bilateral multiple metastastic lymph nodes. Because making the cytological diagnosis of DSPC is still challenging, the radiological findings that show this disease's characteristic features may be important clues for making the correct diagnosis.
Adult ; Carcinoma, Papillary* ; Diagnosis ; Female ; Humans ; Lymph Nodes ; Thyroid Gland* ; Ultrasonography*

PURPOSE: Subacute thyroiditis (SAT) is an uncommon, self-lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. METHODS: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. RESULTS: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. CONCLUSION: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign.
Biopsy ; Biopsy, Fine-Needle ; Blood Sedimentation ; Female ; Hoarseness ; Humans ; Male ; Prodromal Symptoms ; Retrospective Studies ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis, Subacute*

PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.
Anesthesia, General ; Diagnosis ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Paresthesia ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy*

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Ultrasonography*

PURPOSE: Papillary thyroid microcarcinomas (PTMCs) have the same histological features as papillary thyroid cancer, but they are 1.0 cm or less in diameter. They can metastasize to the regional lymph nodes and distant sites, but its ability to cause significant morbidity and mortality has been questioned. Because of this reason, the extent of thyroid tumor resection remains an issue of controversy. This study is aimed at identifying the statistically significant factors that are associated with recurrence and we also wanted to devise an appropriate surgical treatment plan for PTMC patients. METHODS: The retrospective review (350 cases, 1990.1~2004. 11) was obtained from Seoul National University Hospital (SNUH). The mean age at the time of diagnosis was 46.5± 11.0 (yrs) (range: 12~75). The mean overall length of follow- up was 37.70± 36.03 months (range: 1~169). The PTMCs were treated with total and subtotal thyroidectomy or lobectomy. The invasiveness and lymph node metastasis (LNM) from 350 PTMCs were analyzed according to the size, multiplicity, bilaterality of the tumor and the perithyroidal invasion. Fishers exact test and the exact logistic regression test were used for the stratified analysis. RESULTS: 350 of the 2187 papillary carcinoma were PTMCs. There were 296 females (84.6%) and 54 males (15.4%) in the study. Invasion into the perithyroidal tissue was common (128/336, 38.1%). There were 68 patients with LNM among the 312 total patients (21.7%). The group with either perithyroidal invasion or LNM showed a significantly higher recurrence rate than those group having neither one (4.8% vs. 10.9%, 4.5% vs. 19.1%, respectively). Even for tumor smaller than 1 cm, a larger-sized tumor resulted in a poorer prognosis. CONCLUSION: PTMC is an early stage carcinoma with the capability of tissue invasion, lymph node metastasis and multiplicity. Based on this study, total thyroidectomy is recommended for significant portion of the PTMCs. Furthermore, more careful imaging studies (such as neck ultrasonography or neck CT scan) are needed to detect contralateral lesions or neck lymph node metastasis.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Logistic Models ; Lymph Nodes ; Male ; Mortality ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

PURPOSE: Recent studies suggest that immunization with autologous dendritic cells (DCs) results in a protective immunity and a rejection of established tumors for various human malignancies. It has been reported that a dense infiltration of DCs correlates with a favorable prognosis for several types of cancer. The purpose of this study is to determine whether DCs are generated from peripheral blood monocytes by using cytokines such as granulocyte macrophage-colony stimulating factor (GM-CSF), TNF-α, Flt-3 ligand and IL-4 and to determine if cytotoxic CD8⁺T cells are activated against medullary thyroid carcinoma (MTC) tissue by the DCs. METHODS: Peripheral bloods were obtained from two patients with MTC. Mononuclear cells were cultured in the presence of GM-CSF, Flt-3 ligand, TNF-α and IL-4 for 14 days to establish DCs. At day 16, the differentiated cells were analyzed morphologically using electron microscopy. The immunophenotypic features of DCs such as expression of CD1a, CD83, and CD86 were anlayzed by immunofluorescent microscopy. At day 15, DCs were incubated with either thyroid cancer tissue or normal thyroid tissue for an additional 7 days. RESULTS: The generated DCs showed the classic morphology of DCs including multiple processes and a profuse cytoplasm. Activated cytotoxic T lymphocytes (CTLs) were observed with prominent pseudopods. The CTLs activated by DCs bound to the MTC were observed by scanning electron microscopy. However, normal tissues were free from CTL binding. CONCLUSION: We could generate DCs from peripheral blood mononuclear cells. Furthermore, these DCs activate CTLs that are able to attach to MTC tissue. These results suggest that DCs can be used as an adjuvant for immunotherapy of MTC. This study represents the basis for the development of new therapeutic strategies not only for MTC but also for other malignancies.
Cytokines ; Cytoplasm ; Dendritic Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocytes ; Humans ; Immunization ; Immunotherapy ; Interleukin-4 ; Microscopy ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Monocytes ; Prognosis ; T-Lymphocytes, Cytotoxic* ; Thyroid Gland* ; Thyroid Neoplasms*

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An ectopic hyperfunctioning parathyroid gland is a wellknown cause of failure of an initial surgical procedure for primary hyperparathyroidism. Primary hyperparathyroidism, which is usually asymptomatic, occasionally presents with a hyper-parathyroid crisis. Techniques for preoperative localization are of great importance to prevent or minimize negative exploration and the possible need for future additional exploratory surgery. Surgical resection is the only way of managing mediastinal parathyroid adenoma. Without removal of the involved parathyroid glands, severe hypercalcemia will progress to multisystem organ failure affecting the gastrointestinal, cardiac, renal and cerebral functions, with the mortality rate approaching 100%. We describe a patient with hyperparathyroidism that was caused by a large posterior mediastinal parathyroid adenoma.
Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Mediastinum* ; Mortality ; Parathyroid Glands ; Parathyroid Neoplasms*