Clinicopathologic Features of Papillary Thyroid Carcinoma Coexisting with Hashimoto's Thyroiditis / 대한내분비외과학회지

PURPOSE: Hashimoto's thyroiditis (HT) is an important cause of hypothyroidism caused by autoimmune chronic lymphocytic thyroiditis. In order to attain a better understanding for use in treatment of papillary thyroid carcinoma (PTC) coexisting with HT, we conducted an analysis of the clinicopathologic features, as well as the importance of HT as a prognostic factor. METHODS: In this retrospective study, we analyzed 341 patients who were histopathologically diagnosed with PTC following surgery. RESULTS: PTC coexisting with HT was observed in 19.6% (67 patients) of all PTC patients. A statistically significant gender difference was observed in the group with HT (two male vs. 65 female), with a higher positive rate of anti-thyroglobulin antibody and smaller tumor size, compared to the PTC group without HT. When tumor size increased, a lower coexistence rate of HT was observed. No significant differences were observed in multifocality, cervical lymph node (LN) metastasis, coexistence of benign nodule, and extent of LN dissection. However, frequency of extrathyroidal extension was significantly lower and total thyroidectomy rate was higher in the group with HT. TNM stage and AMES stage were similar in both groups; frequency of high MACIS score showed a significant decrease in the group with HT. The recurrence rate and disease- free survival in patients with PTC were not significantly affected by coexistence of HT. CONCLUSION: We found a significant relationship with gender, extrathyroidal extension, and tumor size in PTC coexisting with HT. However, no significant differences in recurrence rate and disease-free survival were observed between groups. Therefore, coexistence in PTC could not be applicable as a prognostic factor of PTC.

Prognostic Significance of Minimal Extrathyroidal Extension of Papillary Thyroid Carcinomas / 대한내분비외과학회지

PURPOSE: Extrathyroidal extension (ETE) is a risk factor for the recurrence of a papillary thyroid carcinoma (PTC). In the TNM 6(th) classification system, an extrathyroidal invasion of a differentiated thyroid carcinoma has been classified as T3 (minimal invasion), T4a (extended invasion), and T4b (more extensive unresectable invasion) according to tumor invasion. We investigated the clinicopathologic characteristics, recurrence, and disease-free survival (DFS) of minimal ETE (mETE). METHODS: We retrospectively evaluated 332 patients who underwent a thyroidectomy for PTC from January 2005 to December 2006. RESULTS: Of the 332 patients, 103 (31.0%) were found to have a PTC with mETE and 229 (69.0%) patients had a PTC without mETE. In PTC, mETE was related to gender, tumor size, multifocality, Lymph node (LN) metastasis, underlying Hashimoto's thyroiditis, and surgery. But there is no significant difference in age, recurrence, and LN metastasis between the mETE and No mETE groups. Multivariate analysis demonstrated that LN metastasis (odds ratio=2.273; 95% confidence interval 1.280~4.037) was recognized as an independent factor for mETE (P=0.005). Disease-free survival was not significantly different between patients with and without mETE (P=0.153). We analyzed the effect of LN metastasis in groups with and without mETE. Based on the presence or absence of LN metastasis, disease-free survival (DFS) rates between each group showed no significant differences. CONCLUSION: Minimal ETE had no impact on DFS in patients with PTC. Therefore, an appropriate surgical approach and postoperative follow-up are required for tumors with mETE.

Clinical Outcomes and Risk Factors of Traumatic Pancreatic Injuries

PURPOSE: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. METHODS: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. RESULTS: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). CONCLUSION: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.