Intravascular metastasis at the internal jugular vein from follicular thyroid carcinoma

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Solitary drain-site recurrence after lumpectomy for breast cancer

Locoregional recurrence after breast conservative surgery is not a rare event. However, a metastatic nodule solely at the surgical drain site seems to be extremely unusual. In this report, we present a patient who received a lumpectomy for breast cancer but a metastatic nodule developed at the drain site more than two years after her surgery.ope

초음파에서 악성이 의심되었던 고형 혹의 재 분석

Purpose: The objective of our study was to reconsider the usefulness of many characteristics on US for differentiating benign and malignant masses. Materials and Methods: From February 2000 through April 2001, we retrospectively evaluated 309 solid breast nodules (282 patients) on US, which were categorized suspicious malignancy or suggestive malignancy, prospectively and confirmed by core-needle biopsy or operation. We analyzed the solid nodules, according to eight known malignant characteristics, which have been described in Stavros et al’s study. The sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were calculated. Results: Among 309 lesions diagnosed as suspicious or suggestive malignancy prospectively, 140 lesions (45.31 %) were confirmed as malignant nodules. The mean number of these findings per one nodule was 2.5 (benign nodule: 2.2, malignant nodule: 2.7). Spiculated margin, marked hypoechogenecity, shadowing, and punctate microcalcifications were statistically significant. Odds ratio of punctate calcifications is the highest (19.5), followed by marked hypoechogenecity (3.1), spiculated margin (1.9), spiculated, microlobulated or angular margin (1.7), taller than wide (1.2), additional findings (1), and shadowing (0.6). Conclusion: Ultrasonographic findings are useful to differentiate malignant from benign solid nodules by that of Stavros et al’s.ope

Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method

Background: This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method. Methods: START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5 cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed. Results: Among the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range: 13-58 years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7 kg/m2 (range: 15.9-37.0 kg/m2). All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23 min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29 min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method. Conclusions: START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency.ope

Long-term outcomes of abdominal paraganglioma

Purpose: Paragangliomas (PGL) are rare neuroendocrine tumors derived from chromaffin cells of the autonomic nervous system. We aim to describe our experience and the long-term outcome of abdominal PGL over the last decade. Methods: A retrospective review of patients diagnosed with PGL in our hospital between November 2005 and June 2017 was conducted. All nonabdominal PGL were excluded and the clinicopathological features and long-term outcomes of the patients were analyzed. Results: A total of 46 patients were diagnosed with abdominal PGL. The average age of diagnosis was 55.4 years and there was no sex predilection. The average tumor size was 5.85 cm and they were predominantly located in the infrarenal position (50%). The mean follow-up period was 42 months (range, 1.8-252 months). All patients with metastases had Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) of ≥4. One patient presented with synchronous metastases while 2 developed local recurrence and distant metastases. One presented with only local recurrence. One patient died 5 years after diagnosis. Conclusion: Abdominal PGL is a rare tumor with excellent long-term prognosis. Recurrence although uncommon, can occur decades after initial diagnosis. Long-term follow-up is therefore recommended for all patients with PGL, especially in patients with PASS of ≥4.ope

Unexpected remission of hyperparathyroidism caused by hemorrhage due to the use of fine-needle aspiration biopsy: two cases report

Hyperparathyroidism is not a rare disease; if a parathyroid adenoma is confirmed, the treatment of choice is the surgical resection. Diagnostic use of fine-needle aspiration biopsy (FNAB) for histological confirmation in patients with hyperparathyroidism is controversial. And spontaneous remission of hyperparathyroidism caused by bleeding or infarction of the adenoma rarely occurs. Here we have reported two cases of hyperparathyroidism in which spontaneous remission occurred due to the use of FNAB for diagnosis. The remission was confirmed after surgical removal and pathological review of the adenoma. The first patient diagnosed with primary hyperparathyroidism (PHPT) had neck pain and severe swelling 4 days after FNAB, and spontaneous remission due to intracapsular hemorrhage was confirmed after surgery. In the second patient receiving hemodialysis treatment for end-stage renal disease, hyperparathyroidism spontaneously resolved after FNAB and the parathyroid hormone (PTH) levels normalized after surgery. The first patient maintained a normal level of PTH for 6 years, and the second patient received kidney transplantation 6 years after surgery, and the normal level of PTH was confirmed for 13 years. Caution is needed while performing FNAB for diagnosis of hyperparathyroidism and during decision making regarding whether to observe the patient or perform surgery after spontaneous remission due to bleeding or infarction.ope

Benefit of diverse surgical approach on short-term outcomes of MEN1-related hyperparathyroidism

Surgical excision is the preferred treatment for multiple endocrine neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT), although controversy regarding the surgical strategy exists. We retrospectively investigated the short-term outcomes of PHPT by various surgical extents. Thirty-three patients who underwent parathyroidectomy due to MEN1-related PHPT at Yonsei Severance Hospital between 2005 and 2018 were included (age [mean ± SD], 43.4 ± 14.1 [range, 23-81] years). Total parathyroidectomy with auto-transplantation to the forearm (TPX) was the most common surgical method (17/33), followed by less-than-subtotal parathyroidectomy (LPX; 12/33) and subtotal parathyroidectomy (SPX; 4/33). There was no postoperative persistent hyperparathyroidism. Recurrence was high in the LPX group without significance (1 in TPX, 2 in SPX, and 3 in LPX, p = 0.076). Permanent and transient hypoparathyroidism were more common in TPX (n = 6/17, 35.3%, p = 0.031; n = 4/17, 23.5%, p = 0.154, respectively). Parathyroid venous sampling (PVS) was introduced in 2013 for preoperative localisation of hyperparathyroidism at our hospital; nine among 19 patients operated on after 2013 underwent pre-parathyroidectomy PVS, with various surgical extents, and no permanent hypoparathyroidism (p = 0.033) or post-LPX recurrence was observed. Although TPX with auto-transplantation is the standard surgery for MEN1-related PHPT, surgical extent individualisation is necessary, given the postoperative hypoparathyroidism rate of TPX and feasibility of PVS.ope

Inter-observer variation for US assessment of thyroid nodule

의학과/석사[한글]갑상선 결절은 흔한 내과적 질환으로 그의 일차적 진단 기기는 초음파 검사이다. 그러나, 초음파 검사는 검사 수행자에 매우 의존적인 검사로 수행자에 따른 편차가 크다. 본 연구에서는 갑상선 결절의 초음파 검사에서 영상의학과 전문의들 사이의 결절의 모양 기술 및 최종 평가의 판정 일치도와 각 전문의의 개인별 판정 일치도 및 정확도를 알아보고자 한다. 144명의 환자에서 204개의 갑상선 결절을 판정대상으로 하였으며, 전체 204개의 결절 중 악성은 89예, 양성은 115예였다. 5년 이상의 전문의 경력을 보유한 4명의 영상의학과 전문의가 4-6주 간격을 두고 독립적으로 두 번 관찰을 하였으며, 결절의 에코, 조성, 경계, 방위, 석회화, 혈류에 대한 기술 및 최종 판정을 하였다. 관찰자 간, 관찰자 내의 판정 일치도는 Cohen’s kappa statistics를 이용하였으며, 최종 판정의 정확도를 계산하였다. 관찰자 간의 일치도는 에코가 약간의 일치도(κ=0.34), 조성, 경계, 석회화 및 최종 판정이 보통의 일치도(κ=0.59, κ=0.42, κ=0.58 그리고 κ=0.54)를 보였으며, 방위 및 혈류가 상당한 일치도(κ=0.61, κ=0.64)를 보였다. 관찰자 내의 일치도는 거의 대부분이 κ>0.61의 상당한 일치도를 보였다. 네 명의 관찰자의 평균 민감도와 특이도, 양성 예측도, 음성 예측도 및 정확도는 각각 88.2%, 78.7%, 76.2%, 89.6% 그리고 82.8%였다. 결론적으로 숙련된 영상의학과 전문의들의 갑상선 결절의 기술 및 평가는 대부분 보통 이상의 일치도를 보였으며, 결절에 대한 최종 판정 역시 상당히 정확하였다. [영문]Thyroid nodules are common medical problem and their first diagnostic tool is US equipment. However ultrasonographic examination is very dependant on operators so there are observer variations. In this study we evaluated inter- and intra-observer variations for US assessment of thyroid nodule description and diagnosis by four radiologists, additionally estimated the diagnostic accuracy. A total of 204 thyroid nodules of 144 patients were reviewed; there were 89 cases of benign and 115 cases of malignancy. Four radiologists, who have more than 5 year of experience, had reviewed independently twice with 4-6 weeks intervals. The echogenicity, composition, margin, orientation, calcification, vascularity and final assessment were evaluated. Inter- and intra-observer variations were assessed with Cohen’s kappa statistics and accuracy was calculated. For inter-observer variations, the echogenicity showed slight agreement (κ=0.34), fair agreements (κ=0.59, κ=0.42, κ=0.58, and κ=0.54, respectively) were found in the composition, margin, calcification and final assessment, and substantial agreements (κ=0.61 and κ=0.64, respectively) were noted in the orientation and vascularity. For intra-observer variability, almost of them showed substantial agreement more than κ>0.61. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of four radiologists were as followed; 88.2%, 78.7%, 76.2%, 89.6%, and 82.8%. In conclusion, experienced radiologists showed more than the moderate degree of agreement in US assessment for thyroid nodule, and their final assessment were quietly accurate.ope

Aberrant Cervical Thymic Cyst in an Adult: Case Report

Although cervical thymic cyst is rarely reported in adults, it should be considered as a differential diagnosis of cystic lesion developed on the lower lateral neck. Despite showing nonspecific image findings, sonography and sonography-guided aspiration biopsy are useful to distinguish cervical thymic cyst from other cystic lesions on the neck.ope