Ji-Sup Yun

Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients

The aim of this study was to evaluate and compare the early surgical outcomes of endoscopic and conventional open thyroidectomies in patients with papillary thyroid microcarcinoma (PTMC).

Features of Papillary Thyroid Microcarcinoma in the Presence and Absence of Lymphocytic Thyroiditis

It is known that the prevalence of lymphocytic thyroiditis (LT) is higher in patients with papillary thyroid carcinoma (PTC), that gender influences this association, and that certain features of PTC occur more frequently in patients who also have LT. These relationships have not been studied in patients with papillary thyroid microcarcinomas (PTMC), however. Therefore, we performed a study to compare the clinical and pathological features of patients with PTMC who did and did not have LT. We collected the 323 consecutive patients following excision of PTMC diagnosed as papillary carcinoma on preoperative needle aspiration cytology. We analyzed the demographic, serologic, and pathologic data of those cases with categorization into four groups based on presence of LT and neck lymph node metastasis. In all PTMC, the presence of LT did not influence the frequency of lymph node metastasis (27 of 105 [25.7%] vs. 48 of 218 [22.0%]). Among the patients with metastatic PTMC, LT was noted significantly more often in female than male patients (95.2% vs. 79.8%). In metastatic PTMC, multifocality and bilaterality was more frequent in with LT than without LT (44.4% vs. 29.2%; 29.6% vs. 14.6%). Both the presence of serum thyroglobulin antibody (TgAb; p = 0.016) and serum microsomal antibody (p = 0.013) were highly correlated with the presence of LT. Twenty-seven of 105 patients (25.7%) with PTMC with LT had nodal metastasis. Co-existing LT was noted predominantly in women, influenced more often multifocality and bilaterality of tumors, and higher frequency of metastasis to lateral compartment lymph nodes.

Soft tissue implantation of thyroid adenomatous hyperplasia after endoscopic thyroid surgery.

Soft tissue implantation of thyroid tissue is a very rare event. Needle tract implantation of thyroid carcinoma after fine-needle aspiration(FNA) biopsy has been occasionally reported, but implantation of benign thyroid tumor tissue is extremely rare. Rupture of thyroid tissues during surgery or trauma may cause the thyroid tissue to be implanted and result in multiple palpable nodules in soft tissue of the neck. Several reports have shown the possibility of implantation of normal or hyperplastic thyroid tissues in soft tissue. We herein report a case of implantation of adenomatous hyperplastic tissue in the neck along the trochar and previous operation site after endoscopic thyroid surgery, which was successfully treated by complete excision.

Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port.

A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.

Thyroid Hemiagenesis Associated with Thyroid Adenomatous Hyperplasia and Papillary Thyroid Carcinoma

A69-year-old woman presented with an incidentally discovered nodule in the right thyroid during a routine medical checkup. Ultrasonography and computed tomography disclosed 0.7 0.5 cm– and 2.8 2.2 cm–sized nodules in the right thyroid. The left thyroid, however, was not seen by either imaging method (Figs. 1 and 2). Fine-needle aspiration showed that the smaller nodule was a papillary thyroid carcinoma and the larger nodule was adenomatous hyperplasia. A right total thyroidectomy with central compartment node dissection was performed. The operative findings and histologic examination confirmed the biopsy results of papillary thyroid carcinoma and adenomatous hyperplasia of the right thyroid, together with absence of the left thyroid. Thyroid hemiagenesis is a rare anomaly resulting from the failed embryologic development of a lobe of the thyroid gland. It is more frequently found in women than in men, and absence of the left lobe is more common than absence of the right lobe (1,2). Hemiagenesis is usually diagnosed by imaging methods, including ultrasonography, computed tomography, magnetic resonance imaging, and=or thyroid scanning. Among the pathologic conditions commonly occurring in the remaining lobe are thyroid adenoma, multinodular goiter, Graves’ disease, and chronic thyroiditis. Cooccurrence of hemiagenesis and papillary thyroid carcinoma, however, is extremely rare (3). Treatment is usually individualized, based on coexisting pathologic disorders in the remaining lobe.

Papillary Thyroid Carcinoma with Nodular Fasciitis-like Stroma

The morphologic spectrum of papillary thyroid carcinoma (PTC) is wide, and many different variants have been recognized. Papillary thyroid carcinoma with nodular fasciitis- like stroma (PTC-NFS) is one of the rare variants of a papillary thyroid carcinoma. Because of the rarity of PTC-NFS, the pathogenesis and clinicopathological significance are still unknown. We recently experienced a case of papillary thyroid carcinoma with extensive nodular fasciitis-like stroma. A 45-year-old female was admitted due to thyroid incidentaloma. An sonographic examination revealed well-demarcated nodules in the right lobe of the thyroid. Fine-needle aspiration cytology showed a finding suspicious for PTC, but was not diagnostic. The patient underwent a right hemithyroidectomy with central compartment node dissection. On gross examination, a well-demarcated white solid ovoid mass measuring 1.0×1.0 ㎝ was seen at the upper pole of the right thyroid gland. An intraoperative frozen section also was unable to differentiate between a benign and malignant lesion. An histopathological test showed prominent stromal cell proliferation, exuberant myofibroblastic proliferation associated with deposition of dense bands of collagen, and an area of papillary carcinoma merging with the desmoplastic stroma. Finally, the patent was diagnosed as having a papillary thyroid carcinoma with nodular fasciitis-like stroma.

Total Surface Area Is Useful for Differentiating between Aggressive and Favorable Multifocal Papillary Thyroid Carcinomas

Purpose The purpose of the present study was to identify more useful parameters for predicting behaviors of multifocal papillary thyroid carcinoma (PTC). Materials and Methods We investigated dominant tumor diameter (TD), total tumor diameter (TTD), and total surface area (TSA) in tumors from 588 patients and evaluated their usefulness as parameters for assessment of tumor behaviors in multifocal PTCs. Results In 588 PTCs, tumor multifocality was found in 179 PTCs (30.4%). Multifocal tumors were significantly associated with extrathyroidal extension, lymph node metastasis, and higher tumor stage grouping (p<0.001, p<0.001, and p<0.001, respectively). The rates of nodal metastasis increased with greater TSA and TTD in PTCs. Multifocal papillary thyroid microcarcinomas (mPMCs) with TSA >3.14 cm2 had higher rates of nodal metastasis than mPMCs with TSA ≤3.14 cm2 (p=0.038); however, there was no significant difference between mPMCs with TTD >1.0 cm and with TTD ≤1.0 cm (p=0.325). In addition, nodal metastasis was more frequent in mPMCs with TSA >3.14 cm2 than in unifocal papillary thyroid microcarcinomas (uPMCs) (TD ≤1.0 cm) (p=0.002), but not overt unifocal PTCs (TD >1.0 cm) (p=0.244). Conclusion Our results suggest that mPMCs with TSA >3.14 cm2 show more aggressive behavior than uPMCs and mPMCs with TSA ≤3.14 cm2. TSA could be useful in distinguishing aggressive mPMCs from favorable cases.

Feasibility of Preoperative Axillary Lymph Node Marking with a Clip in Breast Cancer Patients Before Neoadjuvant Chemotherapy: A Preliminary Study

BackgroundThe aim of this study was to determine the feasibility of image-guided marker-clip placement in axillary lymph nodes (ALNs) for breast cancer upon initial presentation and to assess the reliability of this method with sentinel lymph node biopsy (SLNB) for axillary restaging after neoadjuvant chemotherapy (NAC).MethodsBetween June 2015 and August 2016, a marker clip was placed at a clinically positive ALN under ultrasonography (US) guidance before initiation of NAC in 20 patients. Preoperative localization of marker-clipped LNs was performed, and the localized LNs were removed by SLNB. We compared the postoperative results of the marker-clipped LNs, SLNs and ALNs.ResultsImage-guided marker-clip placements and localization of marker-clipped LNs were performed successfully in 20 patients. A total of 24 marker clips were inserted, and 23 marker-clipped LNs were successfully retrieved during surgery (identification rate, 23/24, 95.8%). In the 11 patients with pathologically confirmed metastatic marker-clipped LNs, four became negative after NAC, and seven maintained metastatic residues on the marker-clipped LNs. Three of the seven patients had metastatic residues on the ALNs, and two of the three patients also had negative SLNs. Marker-clipped nodes accurately predicted the axillary nodal status in these two patients compared with SLNs alone.ConclusionImage-guided marker-clip placement on positive ALNs before NAC and removal with SLNB is technically feasible. This technique can improve the accuracy of the residual disease evaluation on the axilla, especially in patients with negative SLNB results, and can identify candidates for limited axillary surgery after NAC.

The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study.

Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port) were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA) and posterior retroperitoneal approach (PRA) were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P = 0.038), time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P = 0.042), and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P ≤ 0.001), whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P = 0.002). Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study

Purpose The aim of this study was to compare postoperative pain between single-incision, gasless, endoscopic transaxillary thyroidectomy (SET), and conventional open thyroidectomy. Methods From March to December 2015, patients with thyroid disease underwent total thyroidectomy or lobectomy. Patients clinical and pathological characteristics, postoperative pain score using visual analog scale (VAS) were compared between the 2 groups. The primary endpoint was postoperative pain evaluated by VAS score and postoperative analgesic use. Operation time and length of postoperative hospital stay were secondary outcome measures. Results Conventional, open cervical surgery was performed on 30 patients (group O) and SET was performed on 27 patients (group E). Pain scores in shoulder area, which is the ipsilateral side of the tumor location at 1 hour and 24 hours after surgery, were higher in group E patients (P < 0.05). Pain scores 7 days after surgery did not differ between the 2 groups according to the locations (P < 0.05). Conclusion In conclusion, endocrine surgeons should be concerned about immediate higher postoperative pain scores in patients who undergo SET.