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Clnicopathologic Features of Warthin-like Papillary Carcinoma of the Thyroid.

Jong Ju JEONG ; Yong Sang LEE ; Soon Won HONG ; Sang Wook KANG ; Tae Yon SUNG ; Seung Chul LEE ; Kee Hyun NAM ; Hang Seok CHANG ; Woong Youn CHUNG ; Cheong Soo PARK

Korean Journal of Endocrine Surgery.2007;7(4):257-259. doi:10.16956/kjes.2007.7.4.257

PURPOSE: Warthin-like papillary carcinomawas named owing to its close histologic resemblance to a tumor encountered in salivary gland, and this tumor is a variant of papillary thyroid carcinoma. Among the variants of papillary thyroid carcinoma, the tall cell variant and diffuse sclerosing variant have more aggressive behavior than the classic papillary carcinoma. But Warthin-like papillary carcinoma arises in a background of thyroiditis and it behaves in an indolent fashion. Since then, a few case have reported in Korea. We report here on the clinicopathologic features of five cases of warthin-like papillary carcinoma. METHODS: From Jan. 1996 to Feb. 2008, five patients who were diagnosed with Warthin-like papillary thyroid carcinoma at YUMC were retrospectively reviewed. RESULTS: All 5 patients whose pathologic features were warthin- likepapillary thyroid carcinoma were women (age range: 34~60 years). The tumor size ranged from 0.6 to 2.4 cm. 3 tumors were confined to the thyroid, but 2 tumors had invaded the strap muscles. 3 of the 5 tumors arose in a background of lymphocytic thyroditis. Central nodal metastases were identified in 2 cases. But no lateral nodal or distant metastasis had occurred. The mean duration of follow- up was 16.5 months (range: 5~50 months). 1 patient died because of lung cancer, and there was no recurrence for the other 4 cases during the follow-up period. CONCLUSION: Although the long-term follow-up data on patients with Warthin-like papillary carcinoma is not available, the clinicopathologic data does not show that Warthin-like papillary carcinoma is any more aggressive than the usual papillary carcinoma.

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A Clinical Study of Thyroidectomy Complications: Hoarseness, Hypocalcemia and Hematoma.

Wooseong BEOM ; Dukjin MOON ; Junsik KIM ; Bumsuk PARK

Korean Journal of Endocrine Surgery.2007;7(4):252-256. doi:10.16956/kjes.2007.7.4.252

PURPOSE: The use of thyroidectomy has increased as a diagnostic technique for thyroid disease. However, performance of a, thyroidectomy is accompanied with complications. Post-thyroidectomy complications include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, infection, and thyroid storm. The aim of this study was to determine the clinical incidence and to evaluate complications after a thyroidectomy, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and scaring, following a retrospective review of cases. METHODS: From July 2004 to May 2006, 661 consecutive patients that had undergone a thyroidectomy were identified. Through a retrospective review, we evaluated the incidence and type of complications, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scaring. RESULTS: 1) Recurrent laryngeal nerve palsy was a very serious complication, but had a very low incidence. Eight cases out of 661 cases developed and most of the cases developed after a total thyroidectomy. 2) Hypocalcemia was the most common complication. Each incidence of hypocalcemia of methods of thyroid surgery was significant (P= 0.019) but, thyroid disease did not have significant difference (P=0.071). 3) The incidence of postoperative hematoma was 2.74% (18/655). Graves’ disease was more predominant than other diseases. CONCLUSION: Post-thyroidectomy complications and cosmetic problems include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scar. An understanding of the incidence and review of complications after a thyroidectomy may reduce their incidence.

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Coexistence of Medullary and Papillary Thyroid Carcinoma.

Hak Min LEE ; Yong Sang LEE ; Hae Kyoung LEE ; Ji Sup YUN ; Jong Ju JEONG ; Kee Hyun NAM ; Hang Seok CHANG ; Woong Youn CHUNG ; Cheong Soo PARK

Korean Journal of Endocrine Surgery.2007;7(4):246-251. doi:10.16956/kjes.2007.7.4.246

PURPOSE: The simultaneous occurrence of two distinct neoplasms derived from different cells of origin is a recognized entity. It presents uncommonly in all organs,and very rarely in the thyroid gland. METHODS: Six patients with concurrent medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) were seen between January 2000 and June 2007. Clinicopathological features were evaluated, and follow-up for the patients was obtained. RESULTS: All patients were female, with ages ranging from 39 to 63 years (mean age, 55.4 years). Five of six patients were incidentally detected during a medical check-up. The medullary carcinomas measured from 0.5 to 4.0 cm in diameter (mean diameter, 1.72 cm), while the papillary carcinomas ranged from 0.2 to 1.4 cm in diameter (mean diameter, 0.72 cm). Treatment consisted of a total thyroidectomy (n=5) and hemithyroidectomy (n=1) with central compartment node dissection. In twopatients, prophylactic bilateral neck dissection was also added. Supplemental radioactive iodine treatment was administered in five patients. During a mean follow-up period of 41.8 months, two patients showed recurrence in the lateral neck nodes, one recurrence from a papillary carcinoma and the other recurrence from a medullary carcinoma. After re-operation for the recurrent lesions, allof the patients were alive andfree of disease. CONCLUSION: Attention should be given to the possibility of the simultaneous occurrence of MTC and PTC. Treatment for concurrent MTC and PTC should be based on the treatment for MTC, considering the more aggressive behavior of the tumor than PTC.

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Predictive Factors Related to Lymph Node Metastases in Patients with Papillary Thyroid Microcarcinomas Less than 5 mm in Size.

Hee Seon RYU ; Hye Won RO ; Jin Seong CHO ; Min Ho PARK ; Jung Han YOON ; Young Jong JEGAL

Korean Journal of Endocrine Surgery.2007;7(4):242-245. doi:10.16956/kjes.2007.7.4.242

PURPOSE: Papillary thyroid cancer is the most common histological type of malignancy that originates from the thyroid. The disease has an excellent prognosis, despite characteristically being associated with lymph node metastases. According to the World Health Organization, a papillary thyroid microcarcinoma (PTMC) is defined as papillary carcinoma measuring ≤1 cm in the greatest dimension. We present the clinico-pathological features and investigate predictive factors related with lymph node metastases in patients with papillary thyroid microcarcinomas less than 5 mm in size. METHODS: Between January 2003 and June 2005, 75 patients underwent surgical treatment for thyroid papillary cancer less than 5 mm in size at the Department of Endocrine Surgery at our hospital. We analyzed the age of patients, gender, presence of symptoms, multifocality, combined thyroid disease, tumor size, capsular invasion, presence of a lymph node metastasis, tumor location, operative method and postoperative complications by use of Pearson's chi-squared test. RESULTS: Lymph node metastases most frequently occurred in patients with a lateral neck mass at presentation (p=0.004). Patients with capsular invasion of the thyroid showed a high rate of lymph node metastases (p=0.027). In patients with combined thyroid disease such as thyroiditis, more lymph node metastases were observed (p=0.018). CONCLUSION: Preoperative symptoms at presentation (especially a lateral neck mass) and tumors with capsular invasion had a high potential to cause lymph node metastases. Factors such as a lateral neck mass, capsular invasion, and combined thyroiditis may be predictive of a lymph node metastasis and are helpful in the determination of proper treatment.

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The Zuckerkandl's Tubercle is a Useful Anatomical Landmark for the Detection of Both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery.

Ji Sup YUN ; Jong Ju JEONG ; Yong Sang LEE ; Kee Hyun NAM ; Woong Youn CHUNG ; Hang Seok CHANG ; Cheong Soo PARK

Korean Journal of Endocrine Surgery.2007;7(4):237-241. doi:10.16956/kjes.2007.7.4.237

PURPOSE: Zuckerkandl's tubercle (ZT) of the thyroid gland is a well-documented anatomical structure. This study evaluated the anatomical relationship of the ZT in terms of the recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SP). METHODS: The study included 325 patients (ten patients with benign tumors and 315 patients with malignancies) who underwent thyroid surgery between February and June 2007. Tubercles were classified according to size: Grade 0 (unrecognizable), Grade I (≤ 5 mm), Grade II (6~10 mm) and Grade III (>10 mm). The incidence and size of the ZT and its positional relationship to the RLN and SP were investigated during thyroid surgery. RESULTS: ZTs were identified in most patients (right thyroid 89.3%, left thyroid 85.6%). The percentageof tubercles according to grade and location was as follows: Grade 0, right thyroid 10.7% and left thyroid 14.4%; Grade I, right thyroid 7.9% and left thyroid 11.1%; Grade II, right thyroid 43.5% and left thyroid 38.5%; Grade III, right thyroid 37.9% and left thyroid 35.9%. The most common RLN course was in a groove between the ZT and the main body of the thyroid. Most of the SPs are situated cranial to the ZTs and were located at the 1 or 2 o'clock position (96.1%) in the left thyroid and at the 10 or 11 o'clock position (95.2%) in the right thyroid. A greater distance between the ZT and the SP was seen with a decreasing size of the ZT. CONCLUSION: The ZT was identified during most thyroidectomies, and there was a constant relationship between the ZT and either the RLN or SP. Therefore, identification of the ZT and an understanding of the relationship between the ZT and either the RLN or SP are essential for the performance of safe thyroid surgery.

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The Significance of bcl-2 and P53 Expressions in the Papillary Thyroid Cancer.

Woong Bae JI ; Jeoung Won BAE ; Sang Uk WOO ; Gil Soo SON ; Jae Bok LEE ; Bum Whan KOO ; Yang Seok CHAE

Korean Journal of Endocrine Surgery.2007;7(4):231-236. doi:10.16956/kjes.2007.7.4.231

PURPOSE: Papillary thyroid cancer (PTC) has a good prognosis, and it's known to be related to the apoptosis of papillary thyroid cancer. The expression of bcl-2 is thought to be associated with the inhibition of apoptosis. We evaluated the differences of bcl-2 and P53 between PTC and the control (normal tissue and benign lesion). We then analyzed the correlation between the bcl-2 and P53 expressions and the classic prognostic factors. METHODS: Between January 2001 and December 2005, 30 patients who underwent total thyroidectomy for the PTC were included in this study and immunohistochemical staining was performed on the tumors. RESULTS: bcl-2 was expressed in 18 cases (60%) in their PTC (P<0.05). The expression of P53 was not significantly related with the clinicopathological factors, but P53 was expressed in 9 cases (30%) of PTC (P<0.05). The positive staining for was noted in 18 cases (62.1%) of the PTC tissue among the 30 patients, and as the TNM stage progresses, the expression rate of was significantly decrease for 7 stage I cases (100%), for 4 stage ll cases (80%) and for 7 stage ll cases (38.9%). CONCLUSION: bcl-2 was expressed more as the TNM stage of PTC decreases. So bcl-2 is possibly useful as a prognostic factor for PTC, but further studies are needed for confirming its significance.

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Early Symptoms and Clinical Manifestations in Korean Patients with Multiple Endocrine Neoplasia.

Ki Ho KIM ; Min Young KOO ; Sung Mo HUR ; Se Kyung LEE ; Jun Ho CHOE ; Jeong Eon LEE ; Jee Soo KIM ; Jae Hoon CHUNG ; Seok Jin NAM ; Jung Hyun YANG ; Jung Han KIM

Korean Journal of Endocrine Surgery.2010;10(4):266-275. doi:10.16956/kjes.2010.10.4.266

PURPOSE: Multiple endocrine neoplasia (MEN) syndrome is an inherited, autosomal dominant disease that presents as a combination of several endocrine tumors. Early diagnosis of this syndrome is difficult, because of the nonspecific symptoms and signs. This study analyzed early manifestations and clinical characteristics in patients with MEN syndrome. METHODS: Medical records were retrospectively reviewed and telephone interviews were conducted with 35 patients diagnosed as MEN syndrome at Samsung Medical Center from December 1994 to December 2009. RESULTS: The 35 patients had been diagnosed as MEN1 (n=14), MEN2A (n=19) and MEN2B (n=2). The early manifestations of the 14 MEN1 patients were related with hyperparathyroidism (n=5), pituitary tumor (n=3), and pancreatic endocrine tumor (n=2). There were tumors of the parathyroid gland in all 14 patients, anterior pituitary in eight patients, and pancreatic islet cells in seven patients. Four cases were incidentally detected during the screening examination. Six cases harbored a MEN1 gene mutation. The twenty-one patients diagnosed with MEN2 comprised medullary thyroid cancer (n=20), adrenal pheochromocytoma (n=15), and hyperparathyroidism (n=4). The MTC-related symptoms in the 21 MEN2 patients included neck mass or discomfort in 12 patients and pheochromocytoma-related symptoms in seven patients. Two cases were detected through familial genetic screening test. The RET gene mutationwas detected in 19 cases. CONCLUSION: Early manifestations of MEN syndrome were very different between the types of MEN and the types of its presenting tumor. The early diagnosis and proper management of MEN requires awareness of the clinical characteristics of each expressed tumor and is influenced by genetic screening methods.
Early Diagnosis ; Genetic Testing ; Humans ; Hyperparathyroidism ; Interviews as Topic ; Islets of Langerhans ; Male ; Mass Screening ; Medical Records ; Multiple Endocrine Neoplasia Type 1 ; Multiple Endocrine Neoplasia Type 2a ; Multiple Endocrine Neoplasia Type 2b ; Multiple Endocrine Neoplasia* ; Neck ; Parathyroid Glands ; Pheochromocytoma ; Pituitary Neoplasms ; Retrospective Studies ; Thyroid Neoplasms

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A Study on the Risk Factors for Recurrence of Recurrent Papillary Thyroid Cancer after Surgery.

Tae Kwun HA ; Sung Mock RYU ; Sang Hyo KIM

Korean Journal of Endocrine Surgery.2010;10(4):261-265. doi:10.16956/kjes.2010.10.4.261

PURPOSE: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. METHODS: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. RESULTS: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. CONCLUSION: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence.
Humans ; Incidence ; Lung ; Lymph Nodes ; Male ; Multivariate Analysis ; Neck ; Neoplasm Metastasis ; Population Characteristics ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms*

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Pattern of Cervical Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma according to Tumor Size.

Gun KIM ; Hyun Jong KANG ; Kyoung Sik PARK ; Nam Sun PAIK ; Young Bum YOO

Korean Journal of Endocrine Surgery.2010;10(4):256-260. doi:10.16956/kjes.2010.10.4.256

PURPOSE: Prognosis of papillary thyroid carcinoma (PTC) is very favorable, but PTC frequently invade adjacent soft tissue and metastases to cervical lymph node. We evaluated the pattern of cervical neck lymph node metastasis in PTC according to tumor size. METHODS: From August 2005 to January 2009, 353 patients were underwent surgery for PTC. Among these patients, total thyroidectomy with cervical neck lymph node dissection were done in 266 patients. We subdivided patients into four groups according to size and compared the clinicopathologic characters between groups. And we confirmed the factors affecting central neck node metastasis. RESULTS: The mean age of patients of diagnosis was 49.1 years and female to male ratio was 5.8:1. Cervical lymph node metastasis were in 47.0% of the total cases. Cervical lymph node metastases and invasion to adjacent structure increased with tumor size. But, there were no significant differences in tumor size, invasion to adjacent structure, multifocality or bilaterality according to cervical lymph node metastasis. Early diagnostic age and sexuality were significantly related to cervical lymph node metastasis of PTC. CONCLUSION: PTC showed the aggressiveness with increasing tumor size. Tumor size was not related to cervical lymph node metastasis. These findings suggest that tumor size can help treat PTC, can`t be used by prediction factor of cervical lymph node metastasis.
Diagnosis ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Male ; Neck* ; Neoplasm Metastasis* ; Prognosis ; Sexuality ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

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Incidental Findings of Thyroid Detected by PET-CT during Cancer Follow-up.

Joong Suck KIM ; So young CHOI ; Hyo Keun NO ; Sei Joong KIM ; Youn Jeong KIM ; In Young HYUN ; Young Mo KIM ; Young Up CHO

Korean Journal of Endocrine Surgery.2010;10(4):249-255. doi:10.16956/kjes.2010.10.4.249

PURPOSE: The incidence of thyroid cancer is increasing in Korea, partially owing to the development of diagnostic tools. Positron emission tomography (PET)-computed tomography (CT), in particular, has generally been used for evaluation of metastasis and follow-up of malignancy. METHODS: We retrospectively investigated 2,833 patients with PET-CT for metastasis work-up or cancer follow-up, which was performed between January 1998 and May 2008 at Inha University Hospital. Of them, abnormal thyroid findings were discovered in 181 patients and we studied the result of further evaluation or follow-up PET-CT. RESULTS: Thyroid cancer was diagnosed in 26 patients, including metastatic cancer in 3 patients, and non-operated primary cancer in 2 patients. Other 21 patients received operation, which in all histopathologically revealed papillary carcinoma. The mean age of the 21 patients was 55.4 years. Nine patients had a history of radiotherapy. The site of malignant nodule was discordant between PET-CT and histopathologic result in 6 patients. The mean size of malignant nodules was 9.45 mm (0.1~23 mm) with microcarcinoma in 10 patients (47.6%). The mean interval between diagnoses was 15.8 months, and in 4 patients operations for two malignancies were performed in a same day. The incidence of thyroid cancer was significantly high in female patients, but the differences of incidence among different cancer groups were not significant for female patients. CONCLUSION: Early diagnosis of synchronous or secondary thyroid cancer by PET-CT in cancer patients can make early treatment and better strategies for multiple malignancies possible.
Carcinoma, Papillary ; Diagnosis ; Early Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Incidental Findings* ; Korea ; Neoplasm Metastasis ; Positron-Emission Tomography ; Radiotherapy ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms

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