Gil Soo Son

Comparison of robotic adrenalectomy with traditional laparoscopic adrenalectomy with a lateral transperitoneal approach: a single-surgeon experience

Although several recent studies have demonstrated the feasibility and safety of robotic adrenalectomy, it is unknown whether this procedure has advantages over the traditional laparoscopic approach. This study compared our initial experience using the da Vinci‐S® robotic surgical system during laparoscopic adrenalectomy with our experience with traditional laparoscopic adrenalectomy.

Robotic thyroidectomy using bilateral axillo-breast approach: Comparison of surgical results with open conventional thyroidectomy.

The aim of the present study was to compare the surgical outcomes of robotic thyroidectomy using the bilateral axillo‐breast approach (BABA) with open conventional thyroidectomy.

The First Case of Primary Retroperitoneal Mucinous Cystadenoma in Korea: A Case Report

Primary mucinous cystic cystadenomas of the retroperitoneum are very rarely encountered, and there have been only about 30 cases reported in the literature. The histogenesis of primary mucinous cystadenomas is unclear. Most authors suggested that it develops through mucinous metaplasia in a pre-existing mesothelium-lined cyst. Complete surgical excision is the only treatment and it is required for the final diagnosis and cure. We present here a case report of a 38-year-old Korean woman with primary retroperitoneal cystadenoma. It was a thin-walled, multilocular cyst with a dominant loculus that measured 10.0×7.5×5.5 cm3 in size, and to the best of our knowledge, this is the first such case to be reported in in Korea.

Computer-aided detection (CAD) system for breast MRI in assessment of local tumor extent, nodal status, and multifocality of invasive breast cancers: preliminary study

BackgroundWe aimed to investigate the efficacy of computer-aided detection (CAD) for MRI in the assessment of tumor extent, lymph node status, and multifocality in invasive breast cancers in comparison with other breast imaging modalities.MethodsTwo radiologists measured the maximum tumor size, as well as, analyzed lymph node status and multifocality in 86 patients with invasive breast cancers using mammography, ultrasound, CT, MRI with and without CAD, and 18-fludeoxyglucose positron emission tomography (FDG-PET). The assessed data were compared with pathology.ResultsFor tumor extent, there were no significant differences between pathological size and measured size using mammography, ultrasound, CT, or MRI with and without CAD (P > 0.05). For evaluation of lymph node status, ultrasound had the best kappa coefficients (0.522) for agreement between imaging and pathology, and diagnostic performance with 92.1% specificity and 90.0% positive predictive value. For multifocality, MRI with CAD had the highest area under the receiver operating characteristic curve (AUC = 0.888).ConclusionsCAD for MRI is feasible to assess tumor extent and multifocality in invasive breast cancer patients. However, CAD is not effective in evaluation of nodal status.

Lymphoma Affecting the Breast: A Pictorial Review of Multimodal Imaging Findings

Hematological malignancies rarely affect the breast, and the majority of those that do are lymphomas. In this review, we describe the clinical aspects and multimodal imaging findings of breast lymphoma. We also illustrate the key clinical and radiological findings that allow it to be distinguished from various other malignant and benign diseases of the breast. Breast lymphoma manifests as a breast mass, a change in the subcutaneous tissue or the skin, or enlargement of the associated lymph node on radiological examination. Radiological findings associated with other breast malignancies, such as calcifications, spiculations, or architectural distortions are extremely rare. Skin and subcutaneous changes frequently accompany T-cell lymphoma. Multimodal breast imaging characteristics may aid in the diagnosis of breast lymphoma.

Clinicopathological, immunohistochemical factors and recurrence associated with extrathyroidal extension in papillary thyroid microcarcinoma

BACKGROUND AND AIMS Extrathyroidal extension (ETE) is one of the most important factors correlated to poor outcome of papillary thyroid carcinoma (PTC). However, the role of ETE in the prognosis of papillary thyroid microcarcinoma (PTMC) and the factor associated with ETE of PTMC are unclear. We investigated clinicopathological, immunohistochemical factors associated with ETE of PTMC to identify whether PTMC with ETE would have more adverse prognostic factors and higher risk for recurrence. SETTING AND DESIGN We enrolled patients performed thyroidectomy due to PTC between January 2003 and June 2008 and selected patients diagnosed with PTMC among them. We investigated numerous clinicopathological, immunohistochemical factors of selected patients. MATERIALS AND METHODS Data from 325 patients diagnosed with conventional PTMC by intraoperative frozen section and final pathology were recorded retrospectively. STATISTICAL ANALYSIS USED A χ² test or an independent two-sample t-test, multiple logistic regression analysis, the Kaplan-Meier method, and log-rank test. RESULTS Thirty-four percent of patients (325 of 952) had PTMC on final pathology. Among them, the number of patients with and without ETE was 91 and 234, respectively. On both univariate and multivariate analysis; ETE of PTMC correlated with size (P < 0.001); tumor, node, and metastasis (TNM) staging (P = 0.001); multifocality (P = 0.001); lymph node metastasis (P < 0.001); radioactive iodine (RAI) therapy (P = 0.001); and recurrence (P = 0.037). CONCLUSIONS ETE of conventional PTMC is associated with size, multifocality, lymph node metastasis, and recurrence. More extensive surgery should be considered for patients having ETE identified by intraoperative frozen sections, preoperative imaging, and intraoperative finding and other high risk factors.

Toxicities, dose reduction and delay of docetaxel and paclitaxel chemotherapy in breast cancer without distant metastases.

BACKGROUND Docetaxel and paclitaxel are likely to have different toxicity profiles, dose reduction and delays despite their similar medical results in breast cancer patients. AIMS This study examined retrospectively the incidence and severity of certain toxicities, dose reduction and delay of two taxanes. MATERIALS AND METHODS From January 2009 to June 2010, the incidence and severity of toxicities as well as the dose reduction, dose delay, granulocyte colony stimulating factor (G-CSF) in 54 patients with operable lymph node-positive (tumor stage T1, T2, or T3 and nodal stage N1 or N2) and high risk, node-negative (T2 or T3, N0) breast cancer without a distant metastases who received adjuvant chemotherapy - adriamycin, cyclophosphamide, docetaxel (TAC) and adriamycin, cyclophosphamide, paclitaxel (ACP)- were evaluated. STATISTICAL ANALYSIS USED Mann-Whitney test and Fishers exact test. RESULTS AND CONCLUSION The patients in the ACP group experienced more frequent peripheral neuropathy (P=0.025), nausea (P=0.033) than those in the TAC group. Febrile neutropenia was significant in TAC (P=0.001). Increasing age was associated with an increased risk of anemia (P=0.004), fatigue (P=0.009) and pain (P=0.003), and a decreasing body mass index was associated with an increased risk of febrile neutropenia (P=0.009). Dose reduction and delay occurred due to febrile neutropenia and an increase in aspartate aminotransferase (AST)/alanine aminotransferase (ALT). The dose reduction was only significant in the TAC group (P= 0.001). A taxane-based regimen should be chosen for breast cancer patients based on the pharmacokinetics, dosing schedule, clinical activity and toxicity profile that best meet the patients therapeutic needs and quality of life.

Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of malignancy, later referred and treated with robotic surgery successfully. We can learn the following lessons from our case; (1) the RFA for operable primary thyroid malignancy should be avoided, because of the possibility of remnant viable cancer and undetectable nodal metastasis, and (2) robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.

Acquired Omental Cystic Lymphangioma after Subtotal Gastrectomy: A Case Report

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

Immersion ultrasonography of excised nonpalpable breast lesion specimens after ultrasound-guided needle localization.

Objective Ultrasound-guided needle localization has been used prior to the surgical excision of nonpalpable breast lesions. The aim of the study was to assess the feasibility of the use of a saline immersion specimen ultrasound technique (immersion-US) to confirm the successful removal of breast lesions. Materials and Methods The devised immersion-US technique was used to examine the excised tissues of 72 ultrasound-guided needle localized breast lesions of 58 patients (34 benign lesions, 30 high-risk lesions and 8 malignant lesions). Freshly excised specimens were placed in a container filled with saline and one radiologist scanned the surgically excised specimens using a high-frequency linear transducer. We evaluated successful lesion removal and the qualities of the immersion-US images. Miss rates were determined by the use of postoperative ultrasound during follow-up. Results All 72 lesions were identified by the use of immersion-US and satisfactory or excellent quality images were obtained for most lesions (70/72, 97%). Five (7%) lesions were initially identified as incompletely excised, based on the immersion-US findings, and prompt re-excision was undertaken. Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient. Conclusion The immersion-US technique was found straightforward and efficient to perform. Immersion-US was able to determine whether nonpalpable breast lesions had been successfully excised after ultrasound-guided needle localization.