A Calcitonin-Negative Neuroendocrine Tumor Derived from Follicular Lesions of the Thyroid

Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.

A Case of the Ex Utero Intrapartum Treatment Procedure for Fetal Giant Fourth Branchial Cleft Cyst / 대한이비인후과학회지

Large neck masses in the fetus can result in neonatal hypoxia with airway obstruction during a delivery. The ex-utero intrapartum treatment (EXIT) is a procedure that would be helpful in safely securing a fetal airway when the maternal-fetal circulation is being obstructed. Branchial cleft cyst (BCC) is a relatively common congenital malformation in the neck, however, the fourth BCC is very rare. Herein, we present a case of a giant fourth BCC, which was prenatally detected on ultrasound and safely surgically treated to secure an airway with EXIT procedure during the delivery.

Clinical Analysis of Leukoplakia in the Larynx: Long-Term Follow-Up / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Leukoplakia is a clinical term solely designating a white patch or a plaque of the mucosa without considering its histological feature. Leukoplakia ranges microscopically from a hyperplasia to an invasive squamous cell carcinoma. This study attempted to find out the clinical progress and characteristics of leukoplakia in the larynx. SUBJECTS AND METHOD: Included in the study were 154 patients clinically diagnosed as leukoplakia from 1997 to 2010. We reviewed their medical records retrospectively for age, sex, smoking and drinking history, medical record, histopathologic finding, treatment method, and the follow-up records. RESULTS: Histopathologic findings of leukoplakia in the larynx showed hyperkeratosis (101 patients), invasive carcinoma (19 patients), dysplasia (14 patients), nodule (9 patients), papillomatosis (4 patients), chronic inflammation (4 patients) and tuberculosis (3 patients). Of the 128 patients, 39 patients who were diagnosed as hyperkeratosis, dysplasia, nodule or chronic inflammation in the larynx had recurrence and received re-biopsy over 2 times. Eight patients of these 39 who had recurrence had progression to invasive carcinoma. The mean interval between diagnosis of leukoplakia and invasive carcinoma was 53 months (ranged 7-114 month). Heavy smoking (more than 20 pack year) and drinking were significantly associated with recurrence or progression to invasive carcinoma. Age, gastroesophageal reflux disease and treatment method were not associated with recurrence. CONCLUSION: Leukoplakia in the larynx led to various histopathologic diagnoses, high recurrence rate, and progressed to invasive carcinoma even after 5 years. Smoking and drinking should be managed and longterm follow-up is needed.

A Case of Thyroid Hemiagenesis with Concurrent Papillary Thyroid Carcinoma / 대한이비인후과학회지

Thyroid hemiagenesis is an extremely rare congenital abnormality of the thyroid gland, characterized by the absence of one lobe. The true prevalence of this congenital abnormality is uncertain, because the absence of one thyroid lobe usually does not cause clinical symptoms by itself. However, several studies showed that the prevalence of this anomaly was estimated as 0.05-0.2%. Thyroid hemiagenesis is more frequently found in women, and in the left lobe. Commonly found in the remaining lobe are benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. We report a case of 53-year-old woman with an incidentally discovered thyroid nodule. Thyroid ultrasonography and computed tomography scan was performed in order to evaluate the nodule, and they showed the absence of the right thyroid lobe. The nodule was suspected as papillary thyroid cancer and subsequent surgery to remove it confirmed the absence of the right lobe.

Is Comprehensive Neck Dissection a Sole Choice for the Treatment of Recurrent Papillary Thyroid Carcinoma in the Lateral Neck? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. SUBJECTS AND METHOD: A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. RESULTS: Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. CONCLUSION: The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.

Use of Calretinin, CD56, and CD34 for Differential Diagnosis of Schwannoma and Neurofibroma

BACKGROUND: It is important to differentiate between schwannomas and neurofibromas for the cases in which the histopathologic features overlap. Depending on the tumor type, surgeons can decide on a treatment method and whether to preserve or sacrifice the nerve; the possibility of malignant transformation in the case of neurofibromas also needs to be considered. METHODS: We studied 101 cases of schwannoma and 103 cases of neurofibroma. All the hematoxylin and eosin slides for these cases were reviewed, and tissue microarrays were prepared from the representative areas. Immunohistochemical analysis was performed using antibodies for S-100 protein, calretinin, CD56 and CD34. RESULTS: All the tumors except 3 neurofibromas were positive for the S-100 protein. Calretinin was found in 26.7% of the schwannomas (27/101), but it was not found in any of the neurofibromas. CD56 was positive in 77.2% of the schwannomas (78/101) and in 9.8% of the neurofibromas (10/102). CD34 was positive in 42.5% of the schwannomas (43/101) and in 80.2% of the neurofibromas (81/101). Statistically, calretinin was significantly specific for schwannomas (p<0.001) and CD56 was also sensitive for these tumors (p<0.001). On the other hand, a CD34 expression seemed highly sensitive (p<0.001) for neurofibromas. CONCLUSIONS: We concluded that combined immunohistochemical analysis for calretinin, CD56, and CD34 may be very useful for differentiating schwannomas from neurofibromas.

Result of Laser Cordectomy in Early Glottic Cancer and Observation of Malignant Transformation from Precancerous Lesion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. SUBJECTS AND METHOD: Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. RESULTS: For 47 cases, the mean age was 66 years and the mean follow up period was 22.6 months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. CONCLUSION: Laser cordectomy might be the treatment of choice for patient's convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness.

Altered Patterns of Melanoma Antigen Gene(MAGE) Expression in Benign, Premalignant and Malignant Epithelium of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The degree of dysplasia of premalignant lesion of the larynx is related to malignant transformation. However, no single molecular marker that could be used to predict malignant transformation has been identified. Melanoma antigen genes (MAGE), which are expressed in malignant tissues but not in normal tissues, might provide such a marker. So, we investigated MAGE expressions in the various epithelial lesions of the larynx. SUBJECTS AND METHOD: Nested RT-PCR with MAGE common primers were performed to detect the expression of MAGE A genes in fresh frozen tissues obtained from laryngeal lesions (34 benign, 20 premalignant, 22 malignant epitheliums) and 12 normal oropharyngeal epitheliums. RESULTS: The expression of MAGE was positive in 12 (35.3%) of benign, 10 (50%) of premalignant, 18 (81.8%) of malignant laryngeal epithelium and 1 (8.5%) of normal epithelium. These expressions were different with statistic significance (p=0.003) between benign, premalignant and malignant laryngeal epithelium. CONCLUSION: The MAGE A expression could be utilized as a biomarker to predict malignant transformation of laryngeal epithelium.

Salvage Surgery for Radiation Failures in Early(T1N0, T2N0) Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was undertaken to analyze the complications, recurrences, functional results and survival in patients undergoing salvage surgery for recurrent glottic cancers after previous radiotherapy. SUBJECTS AND METHOD: Records of twenty-seven patients were retrospectively reviewed. There were 26 men and 1 woman with the median age of 63 years. The stage at initial treatment was T1a in 16 patients, T1b in 5 patients and T2 in 6 patients. Fifteen patients underwent total laryngectomy, and 12 patients had partial laryngectomy. Neck dissection was combined for 2 patients who had recurred neck metastasis and for 3 patients electively. All patients have been followed up for at least 1 year or until their death (6-159 months, median 31 months). RESULTS: Overall voice preservation was achieved in 29.6% of the patients. The 5-year overall survival and disease-specific survival rates were 75.0% and 81.2%, respectively. Early and late complications, duration of hospital stay, local recurrences, neck recurrences and disease-specific survival were not significantly different between partial and total laryngectomy. Duration of tube feeding was shorter in partial laryngectomy (p=0.016). Neck recurrence was the most common cause of death, and it occurred in patients with recurred tumor that was locally advanced or re-recurrent after salvage surgery. CONCLUSION: In selected cases, recurrences after failure to radiotherapy in T1-T2 glottic cancer could be salvaged with partial laryngectomy with adequate tumor control and acceptable morbidity. Elective neck dissection is recommended in locally advanced recurrent or re-recurrent glottic cancer.

Transoral Removal of Submandibular Stone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the treatment of choice for submandibular calculi that lie in the proximal duct or gland parenchyme has been sialadenectomy despite its risk. Recently, minimally invasive techniques including lithotripsy, sialendoscope have been reported, although these techniques have some limitations on large, infected calculi. The aim of this present review is to assess the transoral removal of submandibular calculi. SUBJECTS AND METHOD: The records of a hundred and sixty-three patients who underwent transoral removal of submandibular calculi between January 1, 1995 and July 31, 2004 were retrospectively reviewed. RESULTS: The complete removal of calculi was observed in 147 (90.2%) patients, partial removal with residual calculi in 8 (4.9%) patients and failure of removal in 8 (4.9%) patients. The removal rate of palpable calculi was significantly high. The removal rate of anterior, infection-free calculi was higher than the posterior and infected calculi, but there was no statistical significance. The size of calculi was not related with the removal rate of calculi. A hundred fifty-two (93.3%) of 155 patients in whom some or all of calculi were removed were free of symptoms of calculi. Symptoms were recurred in 19 patients after 2-68 (median 24) months and in 13 patients calculi were removed transorally again. CONCLUSION: The transoral removal of calculi is useful in preservation of the submandibular gland and effective in palpable calculi regardless of location, size, and combined infection.

Effects of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin: Differences Between Immunoradiometric Assay Kits Available / 대한핵의학회잡지

PURPOSE: Thyroglobulin (Tg) is a valuable and sensitive tool as a marker for diagnosis and follow-up for several thyroid disorders, especially, in the follow-up of patients with differentiated thyroid cancer (DTC). Often, clinical decisions rely entirely on the serum Tg concentration. But the Tg assay is one of the most challenging laboratory measurements to perform accurately owing to antithyroglobulin antibody (Anti-Tg). In this study, we have compared the degree of Anti-Tg effects on the measurement of Tg between availale Tg measuring kits. MATERIALS AND METHODS: Measurement of Tg levels for standard Tg solution was performed with two different kits commercially available (A/B kits) using immunoradiometric assay technique either with absence or presence of three different concentrations of Anti-Tg. Measurement of Tg for patient's serum was also performed with the same kits. Patient's serum samples were prepared with mixtures of a serum containing high Tg levels and a serum containg high Anti-Tg concentrations. RESULTS: In the measurements of standard Tg solution, presence of Anti-Tg resulted in falsely lower Tg level by both A and B kits. Degree of Tg underestimation by A kit was more prominent than B kit. The degree of underestimation by B kit was trivial therefore clinically insignificant, but statistically significant. Addition of Anti-Tg to patient serum resulted in falsely lower Tg levels with only A kit. CONCLUSION: Tg level could be underestimated in the presence of anti-Tg. Anti-Tg effect on Tg measurement was variable according to assay kit used. Therefore, accuracy test must be performed for individual Tg-assay kit.

Serial Changes of Serum Thyroid-Stimulating Hormone after Total Thyroidectomy or Withdrawal of Suppressive Thyroxine Therapy in Patients with Differentiated Thyroid Cancer / 대한핵의학회잡지

BACKGROUND: Radioactive iodine (RAI) therapy and whole-body scanning are the fundamentals of treatment and follow-up of patients with differentiated thyroid cancer. It is generally accepted that a Thyroid-Stimulating Hormone (TSH) level of at least 30 micro U/ml is a prerequisite for the effective use of RAI, and that it requires 4-6 weeks of off-thyroxine to attain these levels. Because thyroxine withdrawal and the consequent hypothyroidism are often poorly tolerated, and occasionally might be hazardous, it is important to be certain that these assumptions are correct. We have measured serial changes in serum TSH after total thyroidectomy or withdrawl of thyroxine in patients with thyroid cancer. SUBJECTS AND METHODS: Serum TSH levels were measured weekly after thyroidectomy in 10 patients (group A) and after the discontinuation of thyroxine in 12 patients (group B). Symptoms and signs of hypothyroidism were also evaluated weekly by modified Billewicz diagnostic index. RESULTS: By the second week, 78% of group A patients and 17% of group B patients had serum TSH levels > or= 30 micro U/ml. By the third week, 89% of group A patients and 90% of group B patients had serum TSH levels > or= 30 micro U/ml. By the fourth week, all patients in two groups achieved target TSH levels and there were no overt hypothyroidism. CONCLUSION: In all patients, serum TSH elevated to the target concentration (> or=30 micro U/ml) within 4 weeks without significant manifestation of hypothyroidism. The schedule of RAI administration could be adjusted to fit the needs and circumstances of individual patients with a shorter preparation period than the conventional.

A Case of Pyostomatitis Vegetans which Comes with Ulcerative Colitis / 대한이비인후과학회지

Pyostomatitis vegetans is a rare oral condition characterized by miliary pustules that primarily affect the labial gingiva as well as the buccal and labial mucosa. It is consistently associated with inflammatory bowel disease (IBD) and is a highly specific marker for IBD. Authors are reporting a 45 year-old female patient who developed pyostomatitis vegetans after she was diagnosed as having ulcerative colitis. Our experience indicates that there is an intimate relationship between pyostomatitis vegetans and inflammatory bowel disease (IBD). In a pyostomatitis vegetans patient whose IBD is in dormant state, the diagnosis of IBD can be missed. It is imperative, therefore, to suspect IBD in a patient with pyostomatitis vegetans who has no gastrointestinal symptoms and recommend thorough investigational study of the gatrointestinal system.

Detection of Epstein Barr Virus and HTLV-1 in Head and Neck Lymphomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Extranodal non-Hodgkin's lymphoma (NHL) of the head and neck (H & N) accounts for 10-20% of all cases of NHL. Despite their frequency, the cause of these lymphomas is still poorly understood. Recently, the role of viral origin in NHLs, including Epstein-Barr virus (EBV), as the main cause of sinonasal lymphomas of T/NK cell phenotype and HTLV-1 as a cause of acute T-cell lymphoma/leukemia has been well documented. We investigated the clinicopathologic findings, immunophenotypic profile, and status of EBV and HTLV-1 DNA of patients with H & N lymphoma. MATERIALS AND METHODS: Twenty-seven patients with NHL of H & N region were studied. There were 15 males and 12 females with the median age of 50 years. All patients were reclassified according to the Working formulation (WF) and REAL classificaton. EBV genome DNA and HTLV-1 RNA were surveyed by PCR assay using formalin-fixed and paraffin-embedded tissue blocks. RESULTS: The tonsil was the most commonly involved site (44.4%), followed by nasal cavity (18.5%), nasopharynx (18.5%) and orbit (7.4%). Immunophenotyping revealed 19 cases of B cell lineage, 7 cases of T cell lineage and one case of null cell type. Most of B-cell lymphomas were diffuse large cell lymphomas (58%). Tonsillar lymphomas were all B-cell origin. Four of the five nasal cavity lymphomas and one nasopharyngeal lymphoma showed an angiocentric T/NK cell phenotype with strong association with EBV. EBV genome was detected in 15 of 26 H & N NHLs (57.7%). Seven of 19 B-cell lymphomas (36.8%) and all T/NK or null cell type lymphomas were positive for FBV DNA. However, there was no HTLV-1 positive cases found. CONCLUSIONS: It could be concluded that the high incidence of EBV of angiocentric T/NK-cell lymphomas of the nasal cavity may indicate a probable role of EBV in the development of these lymphomas.

Angiocentric Immunoproliferative Lesions of the Nasal Cavity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In the past years angiocentric immunoproliferative lesion was described as various terms and histologically characterized by polymorphism, angiodestruction, and necrosis. This study was carried out to analyze the clinical profile, the results of treatment, and immunohistochemical nature of the angiocentric immunoproliferative lesion of the nasal cavity. In addition, we aimed to estimate the significance of Epstein-Barr virus infection as a causative agent in this disease. MATERIAL AND METHODS: We performed clinical and pathologic review of patients with the destructive sinonasal lesions, who were treated at the department of Otolaryngology, Kyungpook National University. Immunohistochemical staining was done in 28 cases and EBER in situ hybridization was done in 14 cases. RESULTS: The overall five-year survival rate was 62%. Immunohistochemical study showed positive reaction to the T-cell surface marker and Epstein-Barr virus was detected in all tested cases. CONCLUSION: Nasal cavity AIL was non-Hodgkin's lymphoma, and of T-cell origin, and was closely related with the Epstein- Barr virus infection. It may be worthwhile to evaluate its pathogenesis in relation with Epstein-Barr virus infection and study the appropriate treatment method.

The Effect of Glucocorticosteroids on Eosinophil Apoptosis Primed by Cultured Nasal Polyp Epithelial Cell Supernatant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Eosinophil infiltration into inflammatory site is a characteristic histological finding in patients with allergic rhinitis, bronchial asthma, and nasal polyps. The regulation of eosinophil survival and apoptosis may play a major role in tissue eosinophilia, and glucocorticosteroids (GCs) have been used therapeutically for nasal polyps. The purpose of this study is to investigate the effect of commonly used GCs on eosinophil survival and apoptosis primed by nasal polyp epithelial cells. MATERIALS AND METHODS: Peripheral blood eosinophils were incubated in increasing concentrations (10-10M) to GCs (triamcinolone, dexamethasone, budesonide, and fluticasone propionate) from January, 1990 to December, 1999 prior to the addition of human nasal polyp epithelial cell conditioned media (HECM). Eosinophil viability was measured with a MTS assay and apoptosis was analyzed with the caspase-3 staining. RESULTS: GCs suppressed the HECM induced prolongation of eosinophil survival with apoptotic change of cells from 2 days after incubation. Fluticasone propionate showed the strongest effects and triamcinolone showed the weakest effects. CONCLUSION: GCs may diminish eosinophilic infiltration into nasal polyp by decreasing eosinophil viability, and abrogate the promoting effect of nasal epithelial cells.

Reconstruction of Multiple Defects after Head and Neck Cancer Ablation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The traditional form of reconstruction of multiple defects after head and neck cancer ablation has been the two-combined regional flaps or that of one regional flap and skin graft. Such flaps, however, have functional and aesthetic problems such as donor site morbidity, and post-operative stenosis and fistula. MATERIALS AND METHODS: We reviewed clinical data of eleven head and neck cancer patients who have been reconstructed with bilobed flaps or gemini flaps after ablation from November 1988 to October 1998. The patients were divided into four groups. Type I flap is bilobed flap consisting of one bed and fused skin, type II flap is gemini flap consisting of one bed and separated skin, type III flap is gemini flap consisting of separated skin and bed, and type IV flap is bilobed flap or gemini flap composed of free bone graft. RESULTS: The survival rate of bilobed flaps and gemini flaps was 91%. The most common complication was fistula, followed by donor vein thrombosis and total loss of flap. CONCLUSIONS: The advantages of bilobed flaps and gemini flaps were one-stage operation, and aesthetic effect for reduced bulk of thinned radial free forearm flap, and diminished morbidity of donor site. Bilobed flaps and gemini flaps were also used for salvage operation of the patients who had been treated with concomitant chemo-radiotherapy, or combined chemo-radiotherapy, or radiotherapy alone for malignant tumors of head and neck.

Epstein Barr Virus-Associated Angiocentric T Cell Lymphoma in Nasal Cavity of Renal Transplantation Recipient / 대한이비인후과학회지

Posttransplant lymphoproliferative disorder (PTLD)is recognized as a significant and morbid complication of organ transplantation. The majority of PTLD is of B cell origin and strongly associated with Epstein Barr virus (EBV). T cell origin is uncommon and has a poor prognosis. There are only a few cases of PTLD of T cell origin, associated with EBV. We have experienced a case of angiocentric T cell lymphoma in nasal cavity, associated with EBV in a renal transplanted recipient. The patient was 25 years old woman who received transplant from her brother in 1995. Angiocentric T cell lymphoma was developed 33 months after the transplantation. We detected EBV mRNA in the neoplastic cells by in situ hybridization. She was treated by radiotherapy and is in complete remission state at present.

Comparison Study for Mucosal Malignant Melanoma ofHead and Neck according to Primary Sites / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal melanomas of head and neck are rare and show poor prognosis. Present study was undertaken to compare clinical features, treatment, recurrence and survival rates in the primary sites of head and neck mucosal melanoma. MATERIALS AND METHODS: From 1983 to 1992, 19 patients with malignant melanoma of the mucosal membrane of the head and neck were presented and treated at Kyungpook National University hospital. RESULTS: There were 12 males and 7 females with an average age of 50.7 years. Ten patients presented tumors in the oral cavity, six patients in nasal cavity and paranasal sinus, and three patients in laryngopharynx. The average duration of symptoms was 20.0 months in nasal sites and 3.7 months in oral sites. Seventeen patients were treated by surgery or combined surgery and radiotherapy (5 nasal melanomas, 9 oral melanomas, 3 laryngopharyngeal melanomas). Fifteen patients developed tumor recurrence, except for two patients with oral melanoma who were alive without disease. There were local recurrences in all five patients with nasal melanoma, and in two of seven patients with oral melanoma. However, there were regional recurrences or distant metastases without local recurrence in five of seven patients with oral melanoma, and in all three patients with laryngopharyngeal melanoma. 3YSR was 40.3%, with 50.0% in nasal melanomas and 24.0% in oral melanomas. 5-YSR was 17.2, with 16.7% in nasal melanomas and 12.0% in oral melanomas. CONCLUSION: The major factors in the failure of treatment were regional recurrence and distant metastasis in oral melanoma, but local recurrence in nasal melanoma. Patients with nasal melanoma showed higher survival rates than those with oral melanom, although there was no statistical difference in the survival rates.

Expression of Epstein-Barr Virus in Inverted Papilloma by In Situ Hybridization and Polymerase Chain Reaction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pathogenesis and etiology of inverted papilloma (IP) has not yet been clearly defined. The relationship between sinonasal IP and various strains of human papillomavirus (HPV) has been examined previously. Yet, there is little consensus regarding the incidence or role of HPV in IP. This study was performed to investigate the possible role of EBV in IP and to draw a relationship between histopathologic progression and EBV status. MATERIALS AND METHODS: This study is comprised of 19 cases of IP and 10 cases of turbinate mucosa as control. To find out the presence of EBV in paraffin block, we used PCR and ISH. Also, the author examined coexisting areas of dysplasia or malignant transformation and compared histologic findings with the results of molecular biologic studies. RESULTS: In PCR, the EBV genome was detected in 15 of 19 sinonasal IP (78.9%). By using ISH with the EBV oligonucleotide probe, EBV mRNA were found to be scattered throughout the epithelium in the IP with a similar incidence in PCR (13/19, 68.4.7%). One case of malignancy and all three dysplasia cases had EBV genome in PCR. In the middle turbinate mucosa which were used as control, 3/4 of the cases showed EBV genomes that are positive to PCR. CONCLUSION: The above results imply that EBV plays a role in the pathogenesis of IP and also indicate that the middle turbinate might be a site of viral persistence.