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A Case of Multiple Cervico-Mediastinal Parathyroid Adenomatosis

Beom Mo KOO ; Moon Seung BEAG ; Seung Woo KIM

Korean Journal of Head and Neck Oncology.2020;36(1):49-52. doi:10.21593/kjhno/2020.36.1.49

The most common cause of primary hyperparathyroidism is a single adenoma accounts for more than 85% and about 1-2% in multiple occurrence. The adenoma arises mainly in the neck and rarely in the mediastinum. The simultaneous occurrence is extremely rare. A 73-year-old man came to our clinic complained about sense of falling forward during last eight months. The brain MRI and vestibular function test showed non-specific findings but total calcium and intact parathyroid hormone levels were markedly elevated. Radiologic studies and sesta-MIBI scan revealed multiple masses in lower paratracheal area and superior mediastinum. We performed mass excision with transcervical approach and all of them were diagnosed as parathyroid adenoma. After surgery, intact PTH and calcium levels returned to the normal range and his symptoms were dramatically improved. We report the unique and rare disease entity with a brief literature review.

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A Case of Parotid Tuberculosis Mimicking Benign Tumor of Parotid Gland

Gyo Han BAE ; Jung Suk KIM ; Woong Jae NOH

Korean Journal of Head and Neck Oncology.2020;36(1):45-47. doi:10.21593/kjhno/2020.36.1.45

Tuberculosis of parotid gland is extremely rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or as primary involvement. Because of the clinical and radiological similarity, parotid tumor and parotid inflammatory disease take priority over the tuberculosis of parotid when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of tuberculosis of parotid gland in patient with a slowly growing parotid mass. However, its treatment is primarily medical if the positive diagnosis is well established. We have recently experienced a case of tuberculosis of parotid gland that was considered as the benign tumor preoperatively, but which was confirmed as tuberculosis of parotid gland after extracapsular dissection. We report it with a review of literature.

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A Treatment of Basal cell Carcinoma on the Face of a Xeroderma Pigmentosum Patient: A Case Report

Jaehyun BAE ; Dongkeun JUN ; Jeenam KIM ; Myungchul LEE ; Donghyeok SHIN ; So Dug LIM ; Hyungon CHOI

Korean Journal of Head and Neck Oncology.2020;36(1):39-44. doi:10.21593/kjhno/2020.36.1.39

Xeroderma pigmentosum is a rare autosomal recessive disease, related to defects in DNA repair mechanism. It presents skin lesions on sun-exposed areas, leading to various skin cancer. Skin lesions can be treated with cryotherapy, skin resurfacing, 5-FU, Imiquimod, topical T4 endonuclease V, radiotherapy and genetic therapy, but invasive skin cancer should be treated by a surgery. We report a 12-year-old female xeroderma pigmentosum patient with recurrent basal cell carcinoma successfully treated by skin grafting. In that there is no cure for this disease, prevention and patient education is most important.

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A Case of Secretory Carcinoma of the Soft Palate

Ju Ho LEE ; Jung Ho HA ; Jeon Yeob JANG

Korean Journal of Head and Neck Oncology.2020;36(1):33-38. doi:10.21593/kjhno/2020.36.1.33

Secretory carcinoma of salivary gland origin is a recently described tumor that harbors a characteristic ETV6-NTRK3 translocation that is identical to secretory carcinoma of the breast. The majority of tumors were located in the parotid gland and other major salivary glands, while the minority occurred in a minor salivary gland. We present a case of a 71-year-old female who was diagnosed with low-grade salivary gland cancer presenting in the soft palate accompanying lymph node metastasis. Peroral wide excision, selective neck dissection, reconstruction with radial forearm free flap was performed. The final pathology report indicated secretory carcinoma of the soft palate. The patient was followed-up without evidence of recurrence for one year. At present, it is difficult to accurately assess prognosis and treatment for the secretory carcinoma of the minor salivary gland origin. Continuous follow-up with various cases is needed further.

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A Case of Nasofrontal Dermoid Cyst Via Transcollumelar Approach

Kang Hyun LEE ; Sung Min LEE ; Sang Wook KIM ; Ki Joon PARK ; Dong-Kyu KIM

Korean Journal of Head and Neck Oncology.2020;36(1):27-31. doi:10.21593/kjhno/2020.36.1.27

The midline nasal dermoid cysts are rare congenital neoplasms, which are diagnosed frequently in childhood. Masses are often noticeable at birth gaining size over time with recurrent infections and usually arise from the nasal cavity or lower 1/3 of the nasal dorsum. CT scan as the primary investigation is helpful to determine accurately the size and extent of the lesion as well as the integrity of adjacent bony structures. MRI scan is recommended to rule out an intracranial extension or sinus tracts. Treatment of choice is the complete surgical excision preserving the cyst wall. Here in, we present an unusual case of nasofrontal dermoid cyst in a 19-year-old boy without radiographic evidence of transcranial extension. In this case, we surgically removed nasofrontal dermoid cyst via transcolumellar approach. We also corrected saddle nose deformity after mass removal. Therefore, in this case, we experienced a successful case in which the nasofrontal dermoid cyst was totally removed without facial scar and deformity.

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A Case of Kimura’s Disease Without Eosinophilia

Hyesoo KIM ; Sunwoo KIM ; Jin LEE ; Sang Hyuk LEE

Korean Journal of Head and Neck Oncology.2020;36(1):21-25. doi:10.21593/kjhno/2020.36.1.21

Kimura's disease is a rare disease of unknown etiology, commonly presenting with slow-growing head and neck subcutaneous nodules. It primarily involves the head and neck region, presenting as deep subcutaneous masses and is often accompanied by regional lymphadenopathy and salivary gland involvement. Clinically it is often confused with a parotid tumor or lymph node metastasis. It is difficult to diagnose before surgery, and fine needle aspiration cytology has only limited value. Even though this disease has not shown any malignant transformation, it is often difficult to cope with because of its high recurrence rate. Surgery, steroids, and radiotherapy have been used widely as the first-line recommendation, but none of them is standard procedure until now because of high recurrence rates. The recurrence of the disease reported up to 62%. We recently experienced a case of Kimura's disease, not accompanying peripheral eosinophilia, on the parotid gland treated by surgical resection in an 82-year-old woman with polycythemia vera. Here, we report this case with a review of the literature.

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A Case of Basal Cell Adenocarcinoma Arising from the Bilateral Parotid Gland

Ju Hyun YUN ; So Jeong LEE ; Sohl PARK ; Han Su KIM

Korean Journal of Head and Neck Oncology.2020;36(1):15-19. doi:10.21593/kjhno/2020.36.1.15

Basal cell adenocarcinoma is 1 ~ 2 % of salivary gland carcinoma. It was recently classified as low grade malignancy. It is low grade malignant counterpart of basal cell adenoma. It has similar morphologic attributes with basal cell adenoma, but it has distinctive malignant potential including infiltrative growth into surrounding tissues and distant metastasis. Recently, we have experienced a case of basal cell adenocarcinoma arising from the bilateral parotid gland in a 38-year old woman who was previously operated on superficial parotidectomy due to pleomorphic adenoma. We report this rare case with a review of literature.

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Effectiveness of Intraoperative Neuromonitoring According to the Mechanism of Recurrent Laryngeal Nerve Injury During Thyroid Surgery

Sung-Chan SHIN ; Byung-Joo LEE

Korean Journal of Head and Neck Oncology.2020;36(1):9-14. doi:10.21593/kjhno/2020.36.1.9

Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

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Head and Neck Oncologic Care During the COVID-19 Pandemic

Jae Won CHANG

Korean Journal of Head and Neck Oncology.2020;36(1):1-8. doi:10.21593/kjhno/2020.36.1.1

It is well established that cancer patients are more susceptible to infection because of the immunosuppressive status caused by both disease itself and anticancer treatment, including surgery and chemoradiation. Head and neck cancer (HNC) patients are generally at high-risk for coronavirus disease 2019 (COVID-19) infection and serious adverse outcomes. Although there is an urgent need for guidance in the delivery of safe, quality oncologic care, no international consented recommendation addressed the management of HNC patients in COVID-19 due to limited data. In this review, we summarized the consideration for head and neck oncologic care in the context of the COVID-19 pandemic, based on the data and the very recent recommendations from the Korean Cancer Association and National Cancer Center. COVID-19 should be taken into consideration in the comprehensive management of HNC patients, and multidisciplinary evaluation of multilevel surgical-risks, discussion of optimized strategy, and shared-decision-making with the patient are needed to maximize both the safety from infectious pandemic and outcome of surgical and oncologic care.

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A Case Report of Patient with Left Neck Mass and a History of Thyroid and Ovarian Cancer in Head and Neck

Yong Jun JEONG ; Kyoung Ho OH ; Soon Young KWON

Korean Journal of Head and Neck Oncology.2020;36(2):73-77. doi:10.21593/kjhno/2020.36.2.73

Ovarian cancer is common malignant disease with high mortality in the female. However, lymph node metastasis in the head and neck of ovarian cancer is very rare than in para-aortic, pelvic lymph node. A 49-year-old female patient came to our clinic with a left neck mass. After total thyroidectomy and left selective neck dissection for the cervical neck level II, III, IV, V, VI for ovarian cancer and thyroid cancer, she had already undergone chemotherapy (Paclitaxel+Carboplatin) 18 month ago. CT scan showed only lymph node enlargement in left neck level II. Positron emission tomography-computed tomography (PET-CT) revealed a hypermetabolic lesion in same area but no other hypermetabolic lesion, especially in the pelvic and abdominal cavity. Fine needle aspiration cytology revealed metastatic carcinoma. The serum level of CA-125 was elevated to 43.8U/mL, whereas other tumor markers (CA 19-9, CEA) were in the normal range. She underwent a revision of selective neck lymph node dissection for the cervical neck levels I, II, and III, and on the review of surgical pathology, metastatic carcinoma was suspected. Thus, we performed immunohistochemical staining for the tissue; as a result, it was finally diagnosed as metastatic ovarian cancer (positive for CK7, ER and PR, and negative for CK20). Adjuvant chemotherapy (Paclitaxel+Carboplatin) was planned on the tumor board, and the patient successfully received chemotherapy.

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