Journal of Yeungnam Medical Science

Case reports

Thyroid storm caused by metastatic papillary thyroid carcinoma tissue after total thyroidectomy: a case report: So Hee Kwon, Min-Ji Kim, Sin Yeong Jung, Jae-Han Jeon; J Yeungnam Med Sci. 2023;40(Suppl):S93-S97. Published online May 17, 2023; DOI: https://doi.org/10.12701/jyms.2023.00199

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Thyroid storm is a life-threatening form of thyrotoxicosis and an endocrinological emergency. We present a case of thyroid storm in a patient with metastatic papillary thyroid cancer. A 67-year-old woman with a history of total thyroidectomy 4 years prior to presentation was admitted with deteriorating mental status, fever, and tachycardia. Laboratory tests revealed severe thyrotoxicosis. Although the patient had no residual thyroid tissue after total thyroidectomy, she had a previously diagnosed metastatic thyroid cancer lesion in the pelvic bone. Despite initial treatment with a standard thyroid storm regimen, the patient died 6 days after hospitalization. The patient had no history of Graves disease; however, a thyroxine receptor antibody was detected postmortem. The patient had a history of exposure to an iodine contrast agent, which is a rare cause of thyrotoxicosis. Thyroxine production from a differentiated thyroid carcinoma is rare but can be a source of clinically significant thyrotoxicosis in patients post-thyroidectomy. Overlapping Graves disease is a common stimulus; however, other causes, such as exogenous iodine, cannot be excluded. This case demonstrates that in the setting of metastatic thyroid carcinoma, thyrotoxicosis cannot be completely ruled out as a cause of suspicious symptoms, even in patients with a history of total thyroidectomy.

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Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock
Eman Elmenyar, Sarah Aoun, Zain Al Saadi, Ahmed Barkumi, Basar Cander, Hassan Al-Thani, Ayman El-Menyar
Diagnostics.2023; 13(19): 3028. CrossRef

Pedunculated mucinous cystic neoplasm of the liver: a case report: Sang-Woo Ha, Shin Hwang, Hyejin Han, Song Ie Han, Seung-Mo Hong; J Yeungnam Med Sci. 2022;39(3):250-255. Published online August 3, 2021; DOI: https://doi.org/10.12701/yujm.2021.01256

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Abstract PDF: In 2010, the World Health Organization classified mucin-producing bile duct tumors of the liver into two distinct entities; mucinous cystic neoplasm of the liver (MCN-L) and intraductal papillary mucinous neoplasm of the bile duct. We present the case of a patient with MCN-L having a uniquely pedunculated shape. A 32‐year‐old woman was referred to our institution with a diagnosis of biliary cystic neoplasm. She had undergone left salpingo-oophorectomy for ovarian cancer 15 years ago. Imaging studies showed an 8 cm-sized well defined, multiloculated cystic lesion suggesting a mucinous cystic neoplasm. The cystic mass was pedunculated at the liver capsule and pathologically diagnosed as MCN-L. The mass was resected with partial hepatectomy. The patient recovered uneventfully. She was discharged 7 days postoperatively. The patient has been doing well for 6 months after the operation. The patient will be followed up annually because of the favorable postresection prognosis of MCN-L.

Original article

The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma: Jin Gu Kang, Young Ah Kim, Jung Eun Choi, Soo Jung Lee, Su Hwan Kang; Yeungnam Univ J Med. 2020;37(3):202-209. Published online April 10, 2020; DOI: https://doi.org/10.12701/yujm.2020.00031

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Abstract PDF

Background
Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC.
Methods
We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed.
Results
CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different.
Conclusion
Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.

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Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis
Yujie Li, Lingling Lao
Brazilian Journal of Otorhinolaryngology.2023; 89(6): 101318. CrossRef
Fine-Needle Pricking Test of the Parathyroid Gland during Thyroid Surgery in Predicting Parathyroid Function
Ying-Jun Wu, Jian-Biao Wang, Fei-Bo Li, Lei Jin, Liang Zhou, Lei Xie, Claudio Casella
International Journal of Endocrinology.2022; 2022: 1. CrossRef

Case Reports

Glandular papilloma of the lung with malignant transformation: Woo Jung Sung; Yeungnam Univ J Med. 2017;34(2):298-302. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.298

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Glandular papilloma of the lung is one of three histologic types of solitary endobronchial papillomas. It is known as an uncommon benign neoplasm. No malignant glandular papillomas have been reported. Herein, the first case of granular papilloma with malignant transformation is reported. A 74-year-old man with huge right lung mass extended upper and lower lobe was admitted to the hospital complaining of progressive cough and dyspnea. An open lung biopsy was performed. Microscopically, the tumor showed papillary growth pattern with thick fibrovascular cores. The stroma of the fibrovascular cores shown the infiltration of lymphoplasmacytic cells and proliferation of capillaries. The epithelial cells surrounding the papillary fronds were cilliated columnar cells with focal cellar atypia, and frequent mitoses. Suspicious pleural invasion foci were identified. The Ki-67 labeling index was about 24.3% and p53 labeling index was about 31.7%. Glandular papilloma is known as a benign neoplasm, which is lack of atypia and mitosis. In present case, there were several indications of malignant transformation, such as cellular atypia, frequent mitosis, architectural distortion, and pleural invasion. Pathologists must be aware that glandular papilloma can have a changes of malignant transformation. Further studies about disease behavior and molecular characteristics are needed.

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Adenocarcinoma-Papillary Cystic Pattern Arising in a Mixed Squamous and Glandular Papilloma of the Lung
Ae Ri An, Seung Yong Park, Jong Hun Kim, Kum Ju Chae, Myoung Ja Chung
International Journal of Surgical Pathology.2020; 28(6): 658. CrossRef

POEMS syndrome misdiagnosed as bone metastasis in a patient with thyroid cancer.: Sang Ah Baek, Hun Mo Ryoo, Sung Hwa Bae, Yoon Young Cho, Seong gyu Kim, Ga Young Kim, Min Keun Kim; Yeungnam Univ J Med. 2015;32(2):122-126. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.122

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Abstract PDF: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a monoclonal plasma cell disorder. Patients with POEMS syndrome also have various clinical manifestations including generalized edema, pleural effusion, ascites, papilledema, and sclerotic bone lesions. These manifestations can lead to a misdiagnosis or delayed diagnosis. We recently experienced a 51-year-old male patient with POEMS syndrome whose sclerotic bone lesion was misdiagnosed as malignant bone metastasis of papillary thyroid carcinoma. We reassessed the patient and found polyneuropathy, hepatosplenomegaly, hypothyroidism, partial hypopituitarism, immunoglobulin G lambda-type monoclonal gammopathy, hypertrichosis, ascites, and multiple sclerotic bone lesions, all of which led us to a diagnosis of POEMS syndrome. Treatment with thalidomide and dexamethasone resulted in clinical and radiological improvement. The patient has remained in remission after peripheral blood stem cell transplantation.

Columnar variant of papillary carcinoma in the thyroglossal duct cyst with progression to lung metastasis.: Yujung Yun, Hye Jung Park, Young Ki Lee, Yongin Cho, Beoduel Kang, Hyun Ju Kim, Jung Hee Lee, Moo Nyun Jin, Dong Yeob Shin; Yeungnam Univ J Med. 2014;31(2):103-108. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.103

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Abstract PDF: Thyroglossal duct cyst (TGDC) carcinoma generally shows a favorable prognosis. If metastasis is present latently, it may not threaten the patient's life immediately. It has been shown, however, that larger than 1 cm papillary carcinoma (PC), level VI metastasis to the lymph node (LN), which is the nearest to the thyroid, independently predicts a worse prognosis. In the case presented herein, a 61-year-old female patient was diagnosed with an about 3 cm PC in the TGDC, particularly the columnar variant subtype, one of the aggressive variants. She had occult papillary thyroid microcarcinoma, but no LN metastasis. Even though she underwent the Sistrunk procedure and total thyroidectomy with central compartment neck dissection followed by high-dose radioactive iodine remnant ablation, however, the cancer cells spread to level IV neck LN, and finally to the lung. Therefore, when a patient is diagnosed with an aggressive histologic variant of PC in the TGDC, even without LN metastasis, the invasive surgical approach and close postoperative surveillance are necessary, with consideration of the risk of disease progression. Therefore, if it is possible to stratify the risk for patients, higher-risk patients can be offered a more invasive therapeutic approach.

A Case of Biliary Papillomatosis with Cystic Dilatation of Bile Duct.: Yoo Mi Park, Kwangwon Rhee, Sun Och Yoon, Ji Yoon Ha, So Young Park, Jung Ho Lee, Sung Ill Jang; Yeungnam Univ J Med. 2012;29(2):136-140. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.136

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Abstract PDF: A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis (BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.

A Case of Mixed Papillary Thyroid Tumor and Squamous-Cell Carcinoma.: Ho Su Kim, Jong Ryeal Hahm, Tae Sik Jung, Jung Hwa Jung, Soo Kyoung Kim, Sang Min Lee, Soon Il Chung; Yeungnam Univ J Med. 2011;28(2):206-210. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.206

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Abstract PDF

The occurrence of a mixed tumor containing papillary thyroid carcinoma (PTC) and primary squamous-cell carcinoma (SCC) is rare because there is no squamous epithelium in the thyroid gland. Reported herein is a 30-year-old female with mixed PTC and primary SCC of the thyroid presented as thyroid incidentaloma. Fine-needle aspiration biopsy of the thyroid nodule revealed the presence of malignant thyroid cells. The histopathological examination following total thyroidectomy yielded two mixed, morphologically distinct histotypes that included PTC and SCC. After total thyroidectomy, the patient underwent radioactive iodine therapy. No recurrence or metastasis occurred during the 20-month follow-up period after the operation.

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Meta-Analysis of Squamous Cell Carcinoma of Thyroid
Hyun Seok Shim, Oh Jin Kwon, Joon Seok Ko, Jung Je Park, Jin Pyeong Kim, Chan Ryeul Jeong, Seung Hoon Woo
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2013; 56(7): 425. CrossRef

A Case of Functionary Cystic Parathyroid Adenoma with Papillary Thyroid Carcinoma.: Woo Jin Chang, Hyun Hee Jung, Sang Hyen Park, Se Hoon Sohn, Ji Sung Yoon, Hyoung Woo Lee, Kyu Chang Won, In Ho Cho; Yeungnam Univ J Med. 2010;27(2):139-145. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.139

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Abstract PDF: Cystic parathyroid adenoma is one of rare causes of hyperparathyroidism, and tends to cause increased serum level of parathyroid hormone, alkaline phosphate and serum calcium level similar to when compared to those of solid adenoma.

Original Articles

Evaluation of Computed Tomography and Magnetic Resonance Imaging of Sinonasal Inverted Papilloma.: Chang Hoon Bai, Young Jung Seo, Seok Choon Lee, Seung Min Chen, Un Hoi Baek, Eun Chae Jung, Si Youn Song, Yong Dae Kim; Yeungnam Univ J Med. 2005;22(2):191-198. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.191

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Abstract PDF: BACKGROUND
Computed tomography (CT) is commonly used to evaluate the degree of sinus involvement in cases of inverted papilloma (IP). However, CT cannot differentiate tumor from adjacent inflammatory mucosa or retained secretions. By contrast, magnetic resonance imaging (MRI) has been reported to be useful in distinguishing IP from paranasal sinusitis. This study investigated whether preoperative assessment with MRI and CT accurately predict the extent of IP. MATERIALS AND METHODS: CT and MRI were retrospectively reviewed in 9 cases of IP. Patients were categorized into stages based on CT and MRI findings, according to the staging system proposed by Krouse. The involvement of IP in each sinus was also assessed. RESULTS: Differentiation of IP from inflammatory disease may be more successful in routine cases where the inflammatory mucosa has low signal intensity on T1-weighted images and very high signal intensity on T2-weighted images. CT imaging could not differentiate tumor from adjacent inflammatory mucosa or retained secretions. CONCLUSION: Preoperative MRI of IP can predict the location and extent of the tumor involvement in the paranasal sinuses and sometimes predicts malignant changes.

Cervicography as a Screening Test for Cervical Cancer.: Doo Jin Lee, Sung Ho Lee; Yeungnam Univ J Med. 1999;16(2):169-180. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.169

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BACKGROUND
Uterine cervical cancer is the most common malignant tumor of the women in Korea. This study was undertaken to evaluate the usefulness of the cervicography as a screeningg test of cervical cancer. MATERIALS AND METHODS: Cervicography was taken from 482 women at department of obstetrics and gymecology, at Yeungnam University Hospital from March 1, 1998 to October 31, 1999, of the 482 women, 172women were excluded from the study for various reasons, and 310 women completed the study. Three-hundred and ten women had cervical cytology(Papanicolaou smear), cervicography and colposcopy, and punch biopsy was undertaken if any of the test result was abnormal. RESULTS: The most common age group was 35-39, and 40-44, 45-49 in order and most common reason for having a screening test was regular check for cervical cancer. The mean duration from the last Pap smear was 17.1 months, and 64 women(20.4%) never had any prior screening tests. Of the 310 women, 254 women were categorized as normal or having benign disease such as cervicitis, erosion or metaplasia. Biopsy was taken from 56 patients and the results were 26 chromic cervicitis, 4 mild dysplasia, 6 moderate dysplasia, 2 severe dysplasia, 14 carcinoma in situ and 4 invasive carcinoma. The results of cytology and cervicography were well correlated(p<0.05) The sensitivity of cytology and cervicography were 86.7% and 76.9%, respectively and the sensitivity and specificity of cervicography were 56.7% and 96.2%, respectively. False negative rate of cervicography(43.3%) was much higher than those of cytology(13.3%)(p<0.05), but false positive rate of cervicography(3.8%) was much lower than that of cytology(23.1%)(p<0.05). CONCLUSION: It seems inappropriate to use cervicography as a single scerrning test for cervival cancer, but it may be an effective complementary test for cytology to lower the false negative rate of cytology.

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Physico-Chemical Characterization of Bioactive Mixed Ligand Complexes of Antimony with 3,5-Diarylsubstituted Pyrazolinates and O,O’-Alkylene Dithiophosphates
Kanchan Lata Singh, Afshan Siddiqui, Kajal Singh, U.N. Tripathi
Chemistry & Chemical Technology.2019; 13(4): 407. CrossRef

Changes of Blood Gases, Plasma Catecholamine Concentrations and Hemodynamic Data in Anesthetized Dogs during Graded Hypoxia Induced by Nitrous Oxide.: Sae Yeon Kim, Sun Ok Song, Jung In Bae, Jae Kyu Cheun, Jae Hoon Bae; Yeungnam Univ J Med. 1998;15(1):97-113. Published online June 30, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.1.97

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Abstract PDF: The sympathoadrenal system plays an important role in homeostasis in widely varing external environments. Conflicting findings, however, have been reported on its response to hypoxia. We investigated the effect of hypoxia an the sympathoadrenal system in dogs under halothane anesthesia by measuring levels of circulating catecholamines in response to graded hypoxia. Ten healthy mongreal dogs were mechanically ventilated with different hypoxic gas mixtures. Graded hypoxia and reoxygenation were induced by progressively decreasing the oxygen fraction in the inhalation gas mixture from 21%(control) to 15%, 10% and 5% at every 5 minutes, and then reoxygenated with 60% oxygen. Mean arterial pressure, central venous pressure and mean pulmonary arterial pressure were measured directly using pressure transducers. Cardiac output was measured by the thermodilutional method. For analysis of blood gas, saturation and content, arterial and mixed venous blood were sampled via the femoral and pulmonary artery at the end of each hypoxic condition. The concentration of plasma catecholamines was determined by radioenzymatic assay. According to the exposure of graded hypoxia, not only did arterial and mixed venous oxygen tension decreased markedly at 10% and 5% oxygen, but also arterial and mixed venous oxygen saturation decreased significantly. An increased trend of the oxygen extraction ratio was seen during graded hypoxia. Cardiac output, mean arterial pressure and systemic vascular resistance were unchanged or increased slightly. Pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR) were increased by 55%, 76% in 10% oxygen and by 82%, 95% in 5% oxygen, respectively(p<0.01). The concentrations of plasma norepinephrine, epinephrine and dopamine increased by 75%, 29%, 24% in 15% oxygen and by 382%, 350%, 49% in 5% oxygen. These data suggest that the sympathetic nervous system was activated to maintain homeostasis by modifying blood flow distribution to improve oxygen delivery to tissues by hypoxia, but hemodynamic changes might be blunted by high concentration of nitrous oxide except PAP and PVR. It would be suggested that hemodynamic changes might not be sensitive index during hypoxia induced by high concentration of nitrous oxide exposure.

A Clinicopathological Study of Solid and Papillary Neoplasm of Pancreas.: Joon Hyuk Choi, Mi Jin Gu, Hong Jin Kim; Yeungnam Univ J Med. 1998;15(1):36-46. Published online June 30, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.1.36

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Abstract PDF: Solid and papillary epithelial neoplasm of pancreas is a rare tumor, usually affecting young women, and its histogenesis is still controversial. This study was performed to define the clinicopathologic features and cellular origin of this tumor. Eight female cases of solid and papillary epithelial neoplasm of pancreas were studied by analyzing the clinicopathologic findings and immunohistochemical and electron-microscopic findings. The age of eight cases ranged from 21 to 54 years (mean, 34 years). The tumors developed in the tail (4 cases), body-tail (2 cases), body (1 case) and head (1 case). The mean diameter of tumors was 9.3 cm (range, 5.5 to 13 cm). Tumors showed solid, cystic and hemorrhagic areas. Histologically, the tumor cells were uniformly round or polygonal in shape, and formed solid sheets and papillary pattern. On the immunohistochemical stain, 8 cases (100%) were immunoreactive for alpha1-antitrypsin, 7 cases (87.5%) for cytokeratin, 7 cases (87.5%) for progesterone receptor, 6 cases (75%) for vimentin, and 1 case (12.5%) for synaptophysin, respectively. None of them were immunoreactive for estrogen receptor. Electron microscopic examination showed many mitochondria, annulate lamellae and canaliculi-like gap. These findings suggest that solid and papillary epithelial tumor of pancreas possibly originates from totipotential stem cells.

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