Background and Objectives: The standard surgical procedure for primary hyperparathyroidism is the bilateral exploration. However, the unilateral exploration and direct focused parathyroidectomy have been performed to reduce surgical morbidity. The purpose of this study was to report the surgical outcomes and efficacy of the bilateral exploration, unilateral exploration, and direct focused approaches for primary hyperparathyroidism.Subjects and Method We retrospectively analyzed the surgical outcomes of 87 patients with primary hyperparathyroidism from January 2007 to December 2017. We compared the operative time, complication and recurrence rate between the three operative methods. Results: The most common histopathology was parathyroid adenoma, which was found in 73 cases (83.9%), followed by hyperplasia. In terms of complications, there were two cases of transient vocal cord palsy, one case of hematoma, one case of hypocalcemia and one case of hungry bone syndrome. Recurrence occurred in two (2.3%) out of 87 cases. There was no significant difference in the recurrence rate between the three surgical approaches. Conclusion The success rate of surgery for primary hyperparathyroidism is high. Direct focused parathyroidectomy may be a good option for parathyroid adenoma if the localization tests localize the lesion. The bilateral exploration is effective for parathyroid hyperplasia.

PURPOSE: We evaluated health-related quality of life (HRQOL) in long-term survivors of indolent and aggressive non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS: TheHRQOLwas assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) at diagnosis in NHL patients between 2008 and 2011, and follow-up evaluation was conducted from June 2014 to February 2015 using EORTC QLQ-C30 and the quality of life in cancer survivors (QOL-CS) questionnaire. We used linear mixed models to compare changes in HRQOL between indolent and aggressive NHL over time. RESULTS: The HRQOL of long-term survivors with aggressive NHL improved to the similar level of indolent NHL during the follow-up survey. However, survivors of NHL were found to fear the probability of relapse and second malignancy, and the degree of fear was not different between survivors with aggressive stage I/II or III/IV NHL (p > 0.05). Furthermore, a half of survivors reported impaired sense of psychosocial well-being regardless of aggressiveness and stage during follow-up survey. More than 65% of survivors thought they did not receive sufficient support from others, and patients who had financial difficulties at diagnosis were more frequently associated with suffering from insufficient support. Impaired physical and cognitive functioning at diagnosis was significantly associated with lack of life purpose in long-term survivors. CONCLUSION: The HRQOL of aggressive NHL survivors improved to a similar level to that of indolent NHL. However, the majority of survivors still had fear of relapse, and psychosocial well-being remained unmet needs.
Cohort Studies* ; Diagnosis ; Follow-Up Studies ; Humans ; Lymphoma, Non-Hodgkin* ; Neoplasms, Second Primary ; Prospective Studies* ; Quality of Life* ; Recurrence ; Survivors*

PURPOSE: We investigated the prognostic factors for distant metastasis (DM) in patients with locally advanced oropharyngeal cancer (OPC) treated with surgery and adjuvant radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS: Eighty-five patients treated between January 1995 and August 2014 were evaluated retrospectively. Data regarding the pathological tumour and nodal status, human papillomavirus (HPV) status, treatment characteristics, and pretreatment maximum standardized uptake value (SUVmax) of 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography scan (¹⁸F-FDG PET-CT) were evaluated, and their influence on DM and survival outcomes were analyzed. RESULTS: Median follow-up period was 48.0 months. Recurrence was observed in 20 patients, including locoregional recurrence and DM. DM was observed in 13 patients. A multivariate analysis confirmed that the presence of lymphovascular invasion (p=0.031), lower neck lymph node (LN) involvement (p=0.006), SUVmax ≥ 9.7 (p=0.014), and tumour size ≥ 3 cm (p=0.037) significantly affected DM. HPV status was not associated with DM. Perineural invasion (p=0.048), lower neck LNinvolvement (p=0.008), SUVmax ≥ 9.7 (p=0.019), and tumour size ≥ 3 cm (p=0.033) were also significant factors for the DM-free survival rate. CONCLUSION: Lower neck LN involvement, high SUVmax in pretreatment ¹⁸F-FDG PET-CT, and large tumour size were predictive factors for DM in patients of OPC.
Drug Therapy* ; Electrons ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neck ; Neoplasm Metastasis* ; Oropharyngeal Neoplasms* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Adjuvant chemotherapy is routinely recommended for locally advanced colorectal cancer (CRC). There are very few data for the optimal starting date of adjuvant chemotherapy after the surgery. This study aimed to evaluate the effectiveness of earlier adoption of adjuvant chemotherapy after curative surgery for stage III CRC. METHODS: In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled retrospectively. Patients were categorized into 3 groups representing different timings to initiate the chemotherapy; less than 2 weeks (group 1), 3 to 4 weeks (group 2), and more than 5 weeks (group 3). The overall survival rate (OS) and the relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy. RESULTS: The 5-year OSs of the patients were 73.7% in group 1, 67.0% in group 2, and 55.2% in group 3. The 5-year RFSs of the patients were 48.8% in group 1, 64.7% in group 2, and 57.1% in group 3. There were no significant differences in either the OS or the RFS (P = 0.200, P = 0.405). CONCLUSION: Starting chemotherapy earlier than 6 weeks after surgery does not show any significant difference. Thus, although adjuvant chemotherapy should preferably begin within 6 weeks, the starting date should not necessarily be hastened, and the patient's general condition should be taken into consideration.
Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

We report a case of Langerhans cell sarcoma presented as a solitary mass in the left supraclavicular area in a 31-year-old woman. Computed tomography revealed a relatively well-defined and lightly enhancing mass in the left supraclavicular area, measuring 5.5x4.5x3.2 cm. Excision was subsequently performed. Microscopically, the specimen consisted of an enlarged and partially effaced lymph node. Nests of different size composed of atypical tumor cells were located in the paracortex and the medulla of the lymph node. The tumor cells exhibited abundant eosinophilic or clear cytoplasm and displayed marked nuclear atypia and increased mitotic figures. Infiltration of many eosinophils was identified in the periphery and between the tumor cells. The tumor cells were reactive for CD1a and S100 protein. Ultrastructually, they were found to have Birbeck granules in the cytoplasm.
Adult ; Antigens, CD1 ; Cytoplasm ; Eosinophils ; Female ; Humans ; Langerhans Cell Sarcoma ; Lymph Nodes

PURPOSE: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. MATERIALS AND METHODS: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. RESULTS: The patients had a median age of 53 years (range: 19~75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5~83.3) after CCRT and followed by adjuvant chemo-therapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9~90.5) and 54.2% (95% CI: 36.7~71.7), respectively (p= 0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1+/-2.9 weeks vs. 9.0+/-1.2 weeks, p= 0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p= 0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). CONCLUSIONS: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.
Anorexia ; Appointments and Schedules ; Chemoradiotherapy ; Cisplatin ; Humans ; Nasopharyngeal Neoplasms ; Nausea ; Retrospective Studies ; Saints ; Treatment Outcome ; Vomiting

BACKGROUND: Second-line chemotherapy offers advanced non-small cell lung cancer (NSCLC) patients a small, but significant increase in survival. Docetaxel is usually administered as a 3-week schedule, yet there is significant toxicity with this therapy. Therefore, a weekly schedule has been explored in several previous trials. In this retrospective study, we compared the efficacy and safety of a weekly schedule and a 3-week schedule of docetaxel monotherapy in a second-line setting. METHODS: Docetaxel was administered as 75 mg/m2 on day 1 every 3 weeks or as 37.5 mg/m2 on day 1 and 8 every 3 weeks until disease progression or severe toxicity developed. RESULTS: From October 2003 to March 2006, a total of 37 patients received docetaxel monotherapy and 36 patients could be evaluated. A total of 135 cycles were administered and then evaluated. The median overall survival was 13.3 months (95% confidence interval: 6.3~20.3) for the weekly schedule and 10.7 months (95% confidence interval: 8.3~13.0) for the 3-week schedule (p=0.41). The median time to progression was 3.0 months (95% confidence interval: 1.9~4.0) and 2.8 months (95% confidence interval: 1.0~4.6), respectively (p=0.41). The response rate was 16.7% for the weekly schedule and 21.1% for the 3-week schedule. The major form of hematologic toxicity was grade 3-4 neutropenia (3-week: 38.9%, weekly: 9.5%). The non-hematologic toxicities were similar between the two schedules. There were no treatment-related deaths. CONCLUSIONS: A docetaxel weekly schedule was very tolerable and it had comparable activity to that of the 3-week docetaxel schedule. Considering the efficacy and tolerability, a docetaxel weekly schedule can be an alternative schedule for the standard treatment of NSCLC in a second-line setting.
Adult ; Aged ; Antineoplastic Agents/*administration & dosage/adverse effects ; Carcinoma, Non-Small-Cell Lung/*drug therapy/pathology ; Drug Administration Schedule ; Female ; Humans ; Lung Neoplasms/*drug therapy/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Taxoids/*administration & dosage/adverse effects ; Treatment Outcome

Microvenular hemangioma is an uncommon aquired vascular tumor, occurring in young to middle-aged adults of both genders. It usually presents as a small, solitary, purple-to-red papule, nodule or plaque on the extremities or trunk. Histologically, the tumor is composed of small branching venules with collapsed lumina and conspicuous pericytes infiltrating the full thickeness of the reticular dermis. Herein, we report a case of microvenular hemangioma, clinically mimicking Kaposi's sarcoma, on the toe of the right foot in a 44-year old male.
Adult ; Dermis ; Extremities ; Foot ; Hemangioma* ; Humans ; Male ; Pericytes ; Sarcoma, Kaposi* ; Toes ; Venules

Castleman's disease, also known as angiofollicular lymphoid hyperplasia or giant lymph-node hyperplasia, is an unusual form of a lymphoproliferative disorder, and is divided clinically into a solitary and a multicentric form. The multicentric form of Castleman's disease is almost always of the plasma cell type. This can coexist with Kaposi's sarcoma in some cases. Kaposi's sarcoma is a multicentric, proliferative, vascular tumor involving cutaneous and visceral tissue. Iatrogenically-developed, immunosuppression-associated Kaposi's sarcoma is usually the result of immunosuppressive therapy. A 61-year-old man diagnosed as the plasma cell type of Castleman's disease, who had been treated with prednisolone for 2 years, was referred to the department of dermatology with numerous skin lesions consisting of confluent, violaceous-colored papules and plaques on his palm and soles. Histologic examination of the cutaneous lesions showed consistency with Kaposi's sarcoma. We report a rare case of Kaposi's sarcoma associated with multicentric Castleman's disease.
Dermatology ; Giant Lymph Node Hyperplasia* ; Herpesvirus 8, Human ; Humans ; Hyperplasia ; Lymphoproliferative Disorders ; Middle Aged ; Plasma Cells ; Prednisolone ; Sarcoma, Kaposi* ; Skin

Cushing's disease is an ACTH-producing pituitary corticotrope adenoma. This pituitary adenoma exhibits an unrestrained ACTH secretion resulting in hypercortisolemia. A 27-year-old female visited us with a 3-year history of diffuse hair loss on the scalp. Her past medical history included recently-developed hypertension and 10 years of increased weight gain and oligomenorrhea. Central obesity, hirsutism, acne, violet striae on the abdomen, lower and upper extremities, and christmas tree-shaped alopecia on the scalp were observed upon physical examination. The secretion of cortisol was not suppressed in both a low and high dose dexamethasone suppression test. A brain MRI detected a pituitary microadenoma in the sella turcica. Based on the clinical and laboratory findings, we diagnosed androgenetic alopecia associated with Cushing's disease. After surgical removal of the pituitary adenoma, the alopecia showed a remarkable improvement. We report a case of Cushing's disease found in a patient with androgenetic alopecia.
Abdomen ; Acne Vulgaris ; Adenoma ; Adrenocorticotropic Hormone ; Adult ; Alopecia* ; Brain ; Dexamethasone ; Female ; Hair ; Hirsutism ; Humans ; Hydrocortisone ; Hypertension ; Magnetic Resonance Imaging ; Obesity, Abdominal ; Oligomenorrhea ; Physical Examination ; Pituitary Neoplasms ; Scalp ; Sella Turcica ; Upper Extremity ; Viola ; Weight Gain