Absence of major salivary glands, especially those of occurring unilaterally or secondary to Wharton's duct stone, is a rare disorder, A case of unilateral submandibular gland absence occurring secondary to Wharton's duct stone was presented in a 51-year-old male. Using the ultrasonography (USG) and computerized tomography (CT), the absence of the submandibular gland was confirmed. The patient had long-term history of sialolithiasis of the right submandibular gland, so the right submandibular gland was suspected of having acquired a change due to sialolithiasis. The present case would be a second report demonstrating a case of unilateral submandibular gland absence occurring secondary to stones, suggesting that, without ligation of submandibular nerves, the obstruction of excretory duct of a submandibular gland could lead to a complete atrophy of the gland in human.
Atrophy ; Humans ; Ligation ; Male ; Middle Aged ; Salivary Ducts ; Salivary Gland Calculi ; Salivary Glands ; Submandibular Gland

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

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*

BACKGROUND AND OBJECTIVES: Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. SUBJECTS AND METHOD: A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. RESULTS: Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. CONCLUSION: The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Neck ; Neck Dissection ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

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

Pyostomatitis vegetans is a rare oral condition characterized by miliary pustules that primarily affect the labial gingiva as well as the buccal and labial mucosa. It is consistently associated with inflammatory bowel disease (IBD) and is a highly specific marker for IBD. Authors are reporting a 45 year-old female patient who developed pyostomatitis vegetans after she was diagnosed as having ulcerative colitis. Our experience indicates that there is an intimate relationship between pyostomatitis vegetans and inflammatory bowel disease (IBD). In a pyostomatitis vegetans patient whose IBD is in dormant state, the diagnosis of IBD can be missed. It is imperative, therefore, to suspect IBD in a patient with pyostomatitis vegetans who has no gastrointestinal symptoms and recommend thorough investigational study of the gatrointestinal system.
Colitis, Ulcerative* ; Diagnosis ; Female ; Gingiva ; Humans ; Inflammatory Bowel Diseases ; Middle Aged ; Mucous Membrane ; Oral Ulcer ; Ulcer*

BACKGROUND AND OBJECTIVES: Mucosal melanomas of head and neck are rare and show poor prognosis. Present study was undertaken to compare clinical features, treatment, recurrence and survival rates in the primary sites of head and neck mucosal melanoma. MATERIALS AND METHODS: From 1983 to 1992, 19 patients with malignant melanoma of the mucosal membrane of the head and neck were presented and treated at Kyungpook National University hospital. RESULTS: There were 12 males and 7 females with an average age of 50.7 years. Ten patients presented tumors in the oral cavity, six patients in nasal cavity and paranasal sinus, and three patients in laryngopharynx. The average duration of symptoms was 20.0 months in nasal sites and 3.7 months in oral sites. Seventeen patients were treated by surgery or combined surgery and radiotherapy (5 nasal melanomas, 9 oral melanomas, 3 laryngopharyngeal melanomas). Fifteen patients developed tumor recurrence, except for two patients with oral melanoma who were alive without disease. There were local recurrences in all five patients with nasal melanoma, and in two of seven patients with oral melanoma. However, there were regional recurrences or distant metastases without local recurrence in five of seven patients with oral melanoma, and in all three patients with laryngopharyngeal melanoma. 3YSR was 40.3%, with 50.0% in nasal melanomas and 24.0% in oral melanomas. 5-YSR was 17.2, with 16.7% in nasal melanomas and 12.0% in oral melanomas. CONCLUSION: The major factors in the failure of treatment were regional recurrence and distant metastasis in oral melanoma, but local recurrence in nasal melanoma. Patients with nasal melanoma showed higher survival rates than those with oral melanom, although there was no statistical difference in the survival rates.
Female ; Gyeongsangbuk-do ; Head ; Humans ; Hypopharynx ; Male ; Melanoma* ; Membranes ; Mouth ; Mucous Membrane ; Nasal Cavity ; Neck* ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Recurrence ; Survival Rate

Posttransplant lymphoproliferative disorder (PTLD)is recognized as a significant and morbid complication of organ transplantation. The majority of PTLD is of B cell origin and strongly associated with Epstein Barr virus (EBV). T cell origin is uncommon and has a poor prognosis. There are only a few cases of PTLD of T cell origin, associated with EBV. We have experienced a case of angiocentric T cell lymphoma in nasal cavity, associated with EBV in a renal transplanted recipient. The patient was 25 years old woman who received transplant from her brother in 1995. Angiocentric T cell lymphoma was developed 33 months after the transplantation. We detected EBV mRNA in the neoplastic cells by in situ hybridization. She was treated by radiotherapy and is in complete remission state at present.
Adult ; Female ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Kidney Transplantation* ; Lymphoma, T-Cell* ; Lymphoproliferative Disorders ; Nasal Cavity* ; Organ Transplantation ; Prognosis ; Radiotherapy ; RNA, Messenger ; Siblings ; Transplants

The number of patients diagnosed with Kaposi's sarcoma has grown steadily since it was first discovered in 1972 by Moric Kaposi, a Hungarian dermatologist. Kaposi's sarcoma can be classified into four subtypes according to clinical form, epidemiology, and prognosis: idiopathic, endemic or African, immunosuppresion related, and acquired immunodeficiency syndrome related or epidemic Kaposi's sarcoma. A single idiopathic Kaposi's sarcoma in the head and neck area is very rarely found in an immunocompetent person. We experienced a case of Kaposi's sarcoma of the oropharynx and hypopharynx. The patient was healthy 70-year-old man and had no signs of being human immunodeficiency virus positive or immunocompromised. The patient was treated with inductive chemotherapy using capecitabine (Xeloda(R))/cisplatin followed by radiotherapy to a total 54 Gy.
Acquired Immunodeficiency Syndrome ; Aged ; Deoxycytidine ; Fluorouracil ; Head ; Herpesvirus 8, Human ; HIV ; Humans ; Hypopharynx ; Neck ; Oropharynx ; Sarcoma, Kaposi ; Capecitabine

BACKGROUND AND OBJECTIVES: Extranodal non-Hodgkin's lymphoma (NHL) of the head and neck (H & N) accounts for 10-20% of all cases of NHL. Despite their frequency, the cause of these lymphomas is still poorly understood. Recently, the role of viral origin in NHLs, including Epstein-Barr virus (EBV), as the main cause of sinonasal lymphomas of T/NK cell phenotype and HTLV-1 as a cause of acute T-cell lymphoma/leukemia has been well documented. We investigated the clinicopathologic findings, immunophenotypic profile, and status of EBV and HTLV-1 DNA of patients with H & N lymphoma. MATERIALS AND METHODS: Twenty-seven patients with NHL of H & N region were studied. There were 15 males and 12 females with the median age of 50 years. All patients were reclassified according to the Working formulation (WF) and REAL classificaton. EBV genome DNA and HTLV-1 RNA were surveyed by PCR assay using formalin-fixed and paraffin-embedded tissue blocks. RESULTS: The tonsil was the most commonly involved site (44.4%), followed by nasal cavity (18.5%), nasopharynx (18.5%) and orbit (7.4%). Immunophenotyping revealed 19 cases of B cell lineage, 7 cases of T cell lineage and one case of null cell type. Most of B-cell lymphomas were diffuse large cell lymphomas (58%). Tonsillar lymphomas were all B-cell origin. Four of the five nasal cavity lymphomas and one nasopharyngeal lymphoma showed an angiocentric T/NK cell phenotype with strong association with EBV. EBV genome was detected in 15 of 26 H & N NHLs (57.7%). Seven of 19 B-cell lymphomas (36.8%) and all T/NK or null cell type lymphomas were positive for FBV DNA. However, there was no HTLV-1 positive cases found. CONCLUSIONS: It could be concluded that the high incidence of EBV of angiocentric T/NK-cell lymphomas of the nasal cavity may indicate a probable role of EBV in the development of these lymphomas.
B-Lymphocytes ; Cell Lineage ; DNA ; Female ; Genome ; Head* ; Herpesvirus 4, Human* ; Human T-lymphotropic virus 1* ; Humans ; Immunophenotyping ; Incidence ; Lymphocytes, Null ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; Male ; Nasal Cavity ; Nasopharynx ; Neck* ; Orbit ; Palatine Tonsil ; Phenotype ; Polymerase Chain Reaction ; RNA ; T-Lymphocytes