Immunohistochemical and Molecular Markers Associated with Differentiated Thyroid Carcinoma / 대한갑상선학회지

In the last decade, conventional diagnosis of thyroid nodules largely depended on fine-needle aspiration (FNA) and ultrasound. However, FNA has a limited ability to distinguish between benign and malignant lesions, especially in cases with indeterminate cytology. Although the clinical course of differentiated thyroid carcinoma is believed to be favorable, delayed diagnosis can make its clinical management difficult. Many immunohistochemical (IHC) or molecular adjunctive markers have been tested to improve the diagnostic accuracy for thyroid nodules. The common IHC markers galectin-3, Hector Battifora mesothelial-1, and cytokeratin-19 are used alone or as part of panels for both FNA and analysis of surgical specimens. A novel IHC marker, podoplanin, was recently introduced as an adjunctive marker for thyroid cancer diagnosis and prognosis and is associated with the progression of papillary thyroid carcinoma (PTC). Several researchers have identified molecular markers to increase the diagnostic accuracy of thyroid lesions of undetermined significance. Four promising molecular markers have been proposed and thoroughly investigated: B-type Raf kinase (BRAF) and RAS, rearranged in transformation/PTC (RET/PTC), paired box gene 8 (Pax8)/peroxisome proliferator-activated receptor gamma (PPARgamma). BRAF mutations can be measured by immunohistochemistry using an antibody specific to the mutated protein. In this review, we focused on the limitations of current diagnostic tools and on determining the application of the above-mentioned markers to thyroid nodule diagnosis.

Surgical Treatment of Hernias in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

PURPOSE: The incidence of hernia is estimated to be 3~5% in the general population. In patients on continuous ambulatory peritoneal dialysis (CAPD), the incidence of hernia is 6~25% and immediate surgical treatment is critical to maintain CAPD. This study was performed to identify clinical characteristics of hernias in CAPD patients and evaluate the surgical results. METHODS: We retrospectively analyzed 13 prospectively registered patients (male:female=12:1) on CAPD treated with hernia between March 1998 and June 2008 at the Seoul National University Hospital by one surgeon. Perioperatively, patients underwent intermittent hemodialysis via internal jugular catheter indwelled just before the operation. Peritoneal dialysis was resumed between 2 weeks and 2 months after operation. RESULTS: Mean age was 46.6 years (range: 19~71 years). Fifteen hernias developed in 13 patients, of which, 10 (67%) were inguinal and 5 (33%), umbilical. Mean duration from CAPD start to onset of hernia was 31.4 months (range: 0~129 months). All inguinal hernia patients received standard McVay operation, 3 patients with umbilical hernia were repaired with primary herniorrhaphy and 1 patient with large fascial defect needed mesh implant. During mean follow-up periods of 31 months, recurrence was detected in 1 patient in umbilical hernia group. The only complication related to operation was wound hematoma in one patient. Two patients were converted to hemodialysis after operation because of low compliance to peritoneal dialysis in one patient and suspected catheter-related infection in the other. CONCLUSION: Our results indicate that hernia repair can be safely performed with acceptable outcomes in patients on CAPD.