About 20%–30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.
Adrenalectomy ; Aged ; Autografts ; Calcium ; Female ; Humans ; Hyperparathyroidism* ; Hyperparathyroidism, Primary ; Hypoparathyroidism ; Lymph Node Excision ; Multiple Endocrine Neoplasia Type 2a* ; Multiple Endocrine Neoplasia* ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Pheochromocytoma ; Recurrence ; Thyroid Neoplasms ; Thyroidectomy ; Transplantation, Autologous ; Ultrasonography

About 20%–30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.
Adrenalectomy ; Aged ; Autografts ; Calcium ; Female ; Humans ; Hyperparathyroidism* ; Hyperparathyroidism, Primary ; Hypoparathyroidism ; Lymph Node Excision ; Multiple Endocrine Neoplasia Type 2a* ; Multiple Endocrine Neoplasia* ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Pheochromocytoma ; Recurrence ; Thyroid Neoplasms ; Thyroidectomy ; Transplantation, Autologous ; Ultrasonography

OBJECTIVES: Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors. METHODS: Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis. RESULTS: Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6+/-1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32+/-0.18 cm) than the primary tumors (0.63+/-0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors. CONCLUSION: In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up.
Humans ; Hyperplasia ; Incidence ; Mass Screening ; Medical Records ; Multivariate Analysis ; Neoplasms, Multiple Primary ; Preoperative Care ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

PURPOSE: Breast ultrasonography (US) has been widely used in the preoperative examination of patients with breast cancer. Breast Imaging Reporting and Data System (BI-RADS) category 3 (C3) lesions (probably benign) are regarded as having a low probability of malignancy (< or =2%). The purposes of this study were to verify the malignancy rates for synchronous BI-RADS C3 lesions in patients with breast cancer and consider appropriate management strategies for these lesions. METHODS: Between January 2010 and January 2013, a total of 161 patients underwent surgery in our institute for breast cancer and synchronous BI-RADS C3 lesions. In the US reports, we found records of 219 synchronous BI-RADS C3 nodules in 161 patients. They were excised during surgery for breast cancer management. Stepwise logistic regression analysis was used to identify predictors of malignancy for synchronous BI-RADS C3 lesions. RESULTS: The rate of malignancy among the 219 BI-RADS C3 lesions was 9.6%. In simple logistic regression analysis, the size of the primary tumor (p<0.001), pathologic T (pT) stage (p=0.002), and progesterone receptor (PR) status of the primary tumor (p=0.029) were significant predictive factors. In multiple logistic regression analysis, the pT stage and PR status of the primary tumor remained significant predictors (p=0.004 and p=0.003, respectively), and human epidermal growth factor receptor 2 (HER2) was identified as another significant factor (p=0.006). CONCLUSION: In patients with breast cancer who are scheduled for surgery, needle biopsy or excision should be considered for synchronous BI-RADS C3 lesions identified on preoperative US when the primary tumor has the following risk factors: large size, high PR expression, and HER2 positivity.
Biopsy, Needle ; Breast ; Breast Diseases ; Breast Neoplasms* ; Follow-Up Studies* ; Humans ; Information Systems ; Logistic Models ; Neoplasms, Multiple Primary ; Predictive Value of Tests ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Risk Factors ; Ultrasonography* ; Ultrasonography, Mammary

Cases of pancreatic ductal adenocarcinoma with multiple masses accompanying underlying pancreatic diseases, such as intraductal papillary mucinous neoplasm, have been reported. However, synchronous invasion without underlying pancreatic disease is very rare. A 61-year-old female with abdominal discomfort and jaundice was admitted to our hospital. Abdominal computed tomography (CT) revealed cancer of the pancreatic head with direct invasion of the duodenal loop and common bile duct. However, positron emission tomography-CT showed an increased standardized uptake value (SUV) in the pancreatic head and tail. We performed endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for the histopathologic diagnosis of the pancreatic head and the evaluation of the increased SUV in the tail portion of the pancreas, as the characteristics of these lesions could affect the extent of surgery. As a result, pancreatic ductal adenocarcinomas were confirmed by both cytologic and histologic analyses. In addition, immunohistochemical analysis of the biopsy specimens was positive for carcinoembryonic antigen and p53 in both masses. The two masses were ultimately diagnosed as pancreatic ductal adenocarcinoma, stage IIB, based on EUS-FNB and imaging studies. In conclusion, the entire pancreas must be evaluated in a patient with a pancreatic mass to detect the rare but possible presence of synchronous pancreatic ductal adenocarcinoma. Additionally, EUS-FNB can provide pathologic confirmation in a single procedure.
Adenocarcinoma, Mucinous/pathology/*ultrasonography ; Carcinoma, Pancreatic Ductal/pathology/*ultrasonography ; *Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Female ; Humans ; Middle Aged ; Neoplasms, Multiple Primary/pathology/*ultrasonography ; Pancreas/pathology ; Pancreatic Neoplasms/pathology/*ultrasonography

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/ultrasonography ; Carcinoma, Papillary/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*epidemiology ; Neoplasms, Second Primary/diagnosis/*epidemiology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/ultrasonography ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: An appendiceal mucocele refers to an abnormal dilatation of the appendiceal lumen by mucus. It is a rare clinical entity with a reported prevalence rate of 0.2~0.3% of all appendectomies. The purpose of our study was to identify the clinical characteristics of and the proper surgical management for appendiceal mucoceles. METHODS: The hospital records of 24 eligible patients were reviewed. We analyzed demographic data, and pathological and clinical data. RESULTS: There was a significant difference in size (P<0.009) between simple mucoceles (mean, 1.95 cm) and cystadenomas (mean, 3.6 cm). While ultrasonography was the most commonly used test to establish the diagnosis (14 patients), computed tomography and colonoscopy also provided fundamental information in 5 and 2 patients, respectively. An appendectomy was performed in most cases (20 cases, 83%). A cecectomy was performed in 3 cases, and an ileocecal resection was performed in only one case. Among the cases requiring a cecectomy, a laparoscopic cecectomy was performed in one case. A synchronous tumor was present in 5 cases. Three patients had gastric cancer, 1 patient had gallbladder cancer, the other one had endometriosis. CONCLUSIONS: Our study shows that appendiceal mucoceles most frequently present as acute appendicitis and that preoperative diagnosis is difficult to make. All mucoceles should probably be removed to eliminate the chance of progression to malignancy. Also of note was the elevated incidence of associated neoplasms, especially gastrointestinal carcinomas. Some recommend surveillance colonoscopy in patients with a diagnosis of an appendiceal mucocele. We had three cases accompanied by gastric malignancy. Therefore, we suggest that surveillance gastrofiberscopy may be indicated.
Appendectomy ; Appendicitis ; Colonoscopy ; Cystadenoma ; Diagnosis ; Dilatation ; Endometriosis ; Female ; Gallbladder Neoplasms ; Hospital Records ; Humans ; Incidence ; Mucocele* ; Mucus ; Neoplasms, Multiple Primary ; Prevalence ; Stomach Neoplasms ; Ultrasonography

PURPOSE: The increased detection of hypercalcemia during health screening has been increased the diagnosis of hyperparathyroidism. The surgical treatment of primary hyperparathyroidism has been changing from standard exploration for all 4 parathyroid glands to minimally invasive surgery focused to abnormal gland. For the latter, exact preoperative localization is necessary. The aims of this study were to evaluate clinical features of patients with primary hyperparathyroidism and the preoperative localization methods. METHODS: A retrospective study was performed for 61 patients with primary hyperparathyroidism in Samsung Medical Center. RESULTS: There were 19 males and 42 females whose ages ranged from 12 to 76 years. Among 61 patients with primary hyperparathyroidism, there were 51 adenomas, 7 hyperplasias and 3 adenocarcinomas. Preoperative parathyroid hormone (PTH) level was increased in all patients except in a MEN IIA associated patient. Among the methods for preoperative localization, ultrasonography detected 47 of 55 cases (85.5%), (99m)Tc-sestamibi scan 40 of 49 cases (81.6%), MRI 3 of 5 cases (60.0%), CT 9 of 18 cases (50.0%) and Tl-Tc subtraction scan 6 of 9 cases (66.7%). In 26 patients who have been diagnosed as single nodular lesion in the same area by the parathyroid scan and ultrasonography, we could find a single parathyroid adenoma in that area during exploration. Postoperative PTH level of all patients but one were normalized. CONCLUSION: Single gland disease detected by both parathyroid scan and ultrasonography was mostly due to adenoma which can be treated safely by unilateral exploration or minimally invasive surgery.
Adenocarcinoma ; Adenoma ; Diagnosis ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hyperplasia ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Minimally Invasive Surgical Procedures ; Multiple Endocrine Neoplasia Type 2a ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Retrospective Studies ; Ultrasonography

Diffuse hepatic hemangiomatosis without extrahepatic lesions is extremely rare in adults. A case of diffuse hepatic hemangiomatosis involving right lobe in a 50-year-old woman was presented. The hemangiomatosis was demonstrated by ultrasonography, computerized tomography (CT) and magnetic resonance image (MRI), and was confirmed histopathologically. Although diffuse hepatic hemangiomatosis is a rare disease in adults, its diagnosis should be considered in patients with diffuse tumor growth in one or both hepatic lobes and distinguished from malignant tumors. The present case is the first documented case of diffuse hepatic hemangiomatosis in an adult in Korea.
Case Report ; Female ; Hemangioma, Cavernous/ultrasonography ; Hemangioma, Cavernous/surgery ; Hemangioma, Cavernous/radiography ; Hemangioma, Cavernous/pathology+ACo- ; Human ; Liver Neoplasms/ultrasonography ; Liver Neoplasms/surgery ; Liver Neoplasms/radiography ; Liver Neoplasms/pathology+ACo- ; Magnetic Resonance Imaging ; Middle Age ; Neoplasms, Multiple Primary/ultrasonography ; Neoplasms, Multiple Primary/surgery ; Neoplasms, Multiple Primary/radiography ; Neoplasms, Multiple Primary/pathology+ACo- ; Tomography, X-Ray Computed

Diffuse hepatic hemangiomatosis without extrahepatic lesions is extremely rare in adults. A case of diffuse hepatic hemangiomatosis involving right lobe in a 50-year-old woman was presented. The hemangiomatosis was demonstrated by ultrasonography, computerized tomography (CT) and magnetic resonance image (MRI), and was confirmed histopathologically. Although diffuse hepatic hemangiomatosis is a rare disease in adults, its diagnosis should be considered in patients with diffuse tumor growth in one or both hepatic lobes and distinguished from malignant tumors. The present case is the first documented case of diffuse hepatic hemangiomatosis in an adult in Korea.
Case Report ; Female ; Hemangioma, Cavernous/ultrasonography ; Hemangioma, Cavernous/surgery ; Hemangioma, Cavernous/radiography ; Hemangioma, Cavernous/pathology+ACo- ; Human ; Liver Neoplasms/ultrasonography ; Liver Neoplasms/surgery ; Liver Neoplasms/radiography ; Liver Neoplasms/pathology+ACo- ; Magnetic Resonance Imaging ; Middle Age ; Neoplasms, Multiple Primary/ultrasonography ; Neoplasms, Multiple Primary/surgery ; Neoplasms, Multiple Primary/radiography ; Neoplasms, Multiple Primary/pathology+ACo- ; Tomography, X-Ray Computed