The concept of minimally invasive endocrine surgery is the newest and most interesting field of surgery. Endocrine surgery is well suited to minimally invasive technique because the nature of most endocrine operations involves a total or partial resection of a gland and reconstructive surgery is rarely necessary. The minimally invasive thyroid procedure can be classified into endoscopic technique with or without constant gas insufflation, video-assisted technique performed under direct and endoscopic vision, and minimally invasive open technique. The endoscopic technique can be subclassified into a neck approach, anterior chest approach, breast approach, and axillary approach. Each of these techniques has its own advantages in terms of cosmetic results, invasiveness, safety, and ease of use. With experience and more advanced devices, minimally invasive thyroid surgery can replace the traditional procedure for most patients. The advances in diseased parathyroid gland and removal make surgical removal for primary hyperparathyroidism simpler and faster. Various types of minimally invasive parathyroid surgery (endoscopic technique, video-assisted technique, radio-guidance technique, and focused parathyroidectomy) are now performed and have replaced traditional exploration for most patients. The adrenal surgery is well suited for laparoscopic removal due to their relatively small size and the low incidence of malignancy. Since its first description in 1992 by Gagner and associates, the laparoscopic adrenalectomy has become the gold standard for the treatment of most benign adrenal tumors and can give more benefits to the patients with advanced surgical skills and laparoscopic instruments.
Adrenalectomy ; Breast ; Humans ; Hyperparathyroidism, Primary ; Incidence ; Insufflation ; Neck ; Parathyroid Glands ; Surgical Procedures, Minimally Invasive* ; Thorax ; Thyroid Gland

Most patients with thyroid cancer have well differentiated tumors that usually respond to conventional therapy including total or near total thyroidectomy, radioiodine ablation and TSH suppression. About 10% of patients, however, have aggressive cancers as a consequence of de-differentiation. During de-differentiation, thyroid cancers not only show more mitosis, fibrosis, and altered cell structure, they also lose thyroid-specific functions (iodine uptake, TSH receptor expression, and thyroglobulin production). These poorly differentiated or undifferentiated tumors mostly fail to take up radioiodine and are responsible for most deaths from thyroid cancer. New therapies need to be developed for patients with these types of tumors. Among the most promising antineoplastic therapies for these poorly differentiated and undifferentiated thyroid cancers are the histone deacetylase inhibitors, the PPAR-gamma agonist and retinoic acids. These drugs have therapeutic effects for thyroid cancers in inhibiting growth and inducing apoptosis and redifferentiation, in vivo and in vitro studies. And, clinical trials in patients with refractory thyroid cancers have been initiated. Further laboratory investigation of these drugs is necessary to understand molecular mechanisms and demonstrate therapeutic efficacy for thyroid cancers.
Apoptosis ; Fibrosis ; Histone Deacetylase Inhibitors* ; Histone Deacetylases* ; Histones* ; Humans ; In Vitro Techniques ; Mitosis ; Receptors, Thyrotropin ; Therapeutic Uses ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Tretinoin*

Although the utility of FDG-PET scan is usually limited to the follow up of a recurrence follow the resection of primary malignant tumors. Its usefulness may be widen to the diagnosis in some malignant neoplasms; that use mostly glucose their energy sources. Thyroid cancers use glucose for their metabolic activities and incidental focal thyroid uptake shown on FDG-PET scans may be representative of a primary tumor. Therefore, increased focal thyroid uptake shown on whole body FDG-PET scans should not be overlooked even when it is not marked, and prompt further investigation should be done to rule out a possible cancer. We present a case of thyroid cancer, incidentally detected with a PET scan in a 60-year-old-man. We also present a review of the literatures regarding the usefulness of PET scan in thyroid cancer.
Diagnosis ; Follow-Up Studies ; Glucose ; Positron-Emission Tomography* ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: We performed this study to identify the patterns of lateral neck node involvement and to define the appropriate method of neck node dissection in papillary thyroid carcinoma. MATERIAL AND METHODS: One hundred seventy one patients who had undergone radical neck dissection for lateral cervical lymph node metastasis of papillary thyroid cancer from January 1986 to December 1995 were analyzed retrospectively. Total operations were 178 cases and total radical neck dissections were 206 cases (bilateral in 28 cases, unilateral in 150 cases). Of these 206 cases, group I (170 cases, 82.5%) who had undergone comprehensive radical neck dissection or modified radical neck dissection and group II (36 cases, 17.5%) who had undergone jugular neck dissection were studied. RESULTS: In group I, the most prevalent site of lymph node metastases was level III, followed by level II, IV, V and I. The 158 cases of group I in which nodes in the posterior triangle of the neck were not palpable preoperatively, were divided into five groups, 0, 1, 2, 3 and 4 or more, according to the number of clinically positive internal jugular nodes. The incidence of microscopically positive nodes in level V was significantly lower in the groups of one or less palpable internal jugular nodes (p=0.0007). In the 60 of 158 cases with the evaluable CT scans of the neck, the incidence of microscopically positive nodes in level V was significantly lower in the groups of two or less positive nodes on CT scan (p=0.0001). And, there were no significant differences in the incidence of recurrence, sites of recurrence, distant metastases, mortality between Group I and Group II. CONCLUSION: The modified radical neck dissection might be justified in most papillary thyroid cancer patients with clinically positive lateral neck nodes. However, in patients with only one or less palpable node and two or less positive nodes on CT scan along the jugular lymphatic chains but negative in level V, it appears to be beneficial to perform a jugular neck dissection in reducing cosmetic disfigurement and preserving function.
Humans ; Incidence ; Lymph Nodes ; Mortality ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Tomography, X-Ray Computed

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult

No abstract available in English.
Estrogens ; Humans* ; Steroids* ; Thyroid Gland* ; Thyroid Neoplasms*

Parathyroid cysts are uncommon lesions of the neck and superior mediastinum, rarely large enough to be of clinical significance. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodule. They can be classified as either functioning or non-functioning depending on whether or not they are associated with hypercalcemia. Non-functioning or "true" cysts are those associated with normocalcemia (85%), whereas functioning or "pseudocysts" are those associated with hypercalcemia (15%). The presence of a high content of intact parathyroid hormone (iPTH) in the cystic fluid on fine-needle aspiration (FNA), in conjunction with elevated serum levels of calcium and iPTH is diagnostic of a functional parathyroid cyst, which usually requires surgical removal. We report herein two cases of such a functional parathyroid cyst and present a review of the literature.
Biopsy, Fine-Needle ; Calcium ; Hypercalcemia ; Mediastinum ; Neck ; Parathyroid Hormone ; Thyroid Nodule

Recently, the rearrangement of RET proto-oncogene has been reported to be the most common genetic change in papillary thyroid carcinoma (PTC). However, its prevalence has been reported variably and its relation to clinical outcome has been controversial. The characteristic nuclear features of PTC usually render the diagnosis, but problem arises with equivocal cytologic features that are present focally. Although there remains some controversy, CK19 has been reported to be a useful ancillary tool for diagnosis of PTC. To evaluate the expression rate of RET/PTC rearrangement and CK19 in PTCs in a Korean population, we studied 115 papillary thyroid carcinomas in 3 mm-core tissue microarray based immunohistochemical analysis. The prevalence of Ret protein expression was 62.6% and the CK19 immunoreactivity was 80.9%. There was no statistically significant asso-ciation between the Ret positivity and CK19 immunoreactivity, although the percent agreement of the two was relatively high. The clinicopathological variables did not correlate with the expression of Ret. In conclusion, the prevalence of Ret protein expression and its clinicopathological implications in a Korean population are not much different from those reported in previous studies. However, its detection via immunohistochemistry can be a useful diagnostic tool for diagnosing papillary thyroid carcinoma in conjunction with CK19.
Adenocarcinoma, Papillary/*metabolism ; Adult ; Carcinoma/pathology ; Cell Line, Tumor ; Cytoplasm/metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Keratin/*biosynthesis ; Korea ; Lymphatic Metastasis ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Oncogene Proteins/*biosynthesis ; Receptor Protein-Tyrosine Kinases/*biosynthesis ; Thyroid Neoplasms/*metabolism/pathology

Forgotten mediastinal goiter is an extremely rare disease. It is most often the consequence of the incomplete removal of a ‘ plunging’ goiter, but it can sometimes be attributed to a concomitant, unrecongnized primary mediastinal goiter which is not connected to the thyroid. A primary mediastinal goiter(autonomous intrathoracic goiter) essentially caused by an abnormal embryonic development of the thyroid gland and a thyroid gland formation located in the thorax or the mediastinum. The differential diagnosis with ordinary recurrence was based on the absence of parenchymatous or vascular connections with the cervical thyroid gland. It is fed by local intrathoracic vessels and observed in the absence of previous thyroidectomy. Nevertheless, for primary mediastinal goiter, sternum-splitting incision will be required in most cases as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision. In this study we report a case of forgotten mediastinal goiter and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this diasease are identified.
Diagnosis, Differential ; Embryonic Development ; Female ; Goiter* ; Hemorrhage ; Mediastinum ; Pregnancy ; Rare Diseases ; Recurrence ; Thorax ; Thyroid Gland ; Thyroidectomy

Cribriform-morular variant (CMV) is a rare histologic subtype of papillary thyroid carcinoma (PTC). Patients with familial adenomatous polyposis (FAP) could be associated with several comorbid diseases including thyroid cancer. Most thyroid cancers in them are PTCs, but infrequently CMV types can occur. The FAP concomitant CMV-PTCs are found predominantly in young women and reveals lower recurrence rate. Moreover, this variant shows circumscribed morphology and rarely metastasizes to node. Because the incidence of thyroid carcinoma is higher than that in general population, comprehensive evaluation of thyroid gland should be performed for the patients with FAP. Because thyroid cancer could be first manifestation of FAP, colonic screening should be considered in CMV-PTC patient. We report two cases of CMV-PTCs concurrent with FAP.
Adenomatous Polyposis Coli* ; Carcinoma, Papillary* ; Colon ; Female ; Humans ; Incidence ; Mass Screening ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms