Medical POSTGRADUATES No. 3, Vol. 38, 2010 Morphologic Findings of Lymphoplasmacytic lymphoma/waldenstrom macroglobulinemia Fig. 1 Fig. 2a Fig

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1 M e d i c a l P O S T G R A D U A T E S Abstracts

2 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Morphologic Findings of Lymphoplasmacytic lymphoma/waldenstrom macroglobulinemia Fig. 1 Fig. 2a Fig

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4 REFERENCES 1. Foucar K. (2001) : Bone marrow pathology 2nd ed. ASCP press, American Society of Clinical Pathology, pp Swerdlow SH, Campo E, Harris NL, Jaffe ES et al. 3. (2009) : (2008) : WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC: Lyon, pp : E Public, pp

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8 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Changes in Medical Leadership from France to Germany and U.S.A. 91

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12 Fig. 2 REFERENCES 1. Ackerknecht, Erwin H (1982) : A short history of 2. medicine, The Johns Hopkins University Press. (2003) :, 3. Caroline Hannaway and Ann La Berge (1998) : Constructing Paris Medicine, Amsterdam-Atlanta, GA 4. Shryock, Richard H (1969) : The development of modern medicine, Hafner 5. Roy Porter (1998) : The greatest benefit to mankind, HarperCollins 6. Kenneth M. Ludmerer (1996) : Learning to Heal, the Development of American Medical Education, Johns Hopkins University Press 95

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17 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Current Epidemiologic Trend of Thyroid Cancer 100

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21 REFERENCES 1. Ahn YO, Shin MH, Kim JP. Korea, Seoul. In; Parkin DM, Whelan SL, Ferlay J, et al. eds. (2002) : Cancer Incidence in Five Continents. Vol VIII. IARC Scientific Publication No, 155, International Angency for Research on Cancer. World Health Organization, Lyon, pp Ahn YS, Park RM, Koh DH. (2008) : Cancer admission and mortality in workers exposed to ionizing radiation in Korea. J Occup Environ Med, 50 : Bae JS, Chae BJ, Park WC, et al. (2009) : Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J Surg Oncol, 10 : Bastos HN, Antao MR, Silva SN, et al. (2009) : Association of polymorphisms in genes of the homologous recombination DNA repair pathway and thyroid cancer risk. T h y r o i d, 19 : Bradly DP, Reddy V, Prinz RA, et al. (2009) : Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. S u r g e r y, 146 : Chen AY, Jemal A, Ward EM. (2009) : Increasing incidence of differentiated thyroid cancer in the United States, C a n c e r, 115 : Chung JH. (2008) : Prevalence of thyroid nodules detected by ultrasonography in adults for health checkup and analysis of fine needle aspiration cytology. J Kor Society Endocrnol, 23;6 : (Korean) 8. Colonna M, Bossard N, Guizard AV, et al. (2009) : Descriptive epidemiology of thyroid cancer in France: incidence, mortality and survival. Ann Endocrinol, 2009 Dec 24 (Epub ahead of print). 9. Dal Masso I, La Vecchia C, Franceschi S, et al. (2000) : A pooled analysis of thyroid cancer studies. V. Anthropometric Factors. Cancer Causes Control, 11 : Enewold L, Kangmin Z, Ron E, Marrogi AJ, et al. (2009) : Rising Thyroid Cancer Incidence in the United States by Demographic and Tumor Characteristics, Cancer Epidemiol Biomarkers Prev, 18 : Franceschi S, Preston-Martin S, Dal Maso L, et al. (1999) : A pooled analysis of case-control studies of thyroid cancer. IV Benign thyroid diseases. C a n c e r Causes Control, 10 : Gimm O. (2001) : Thyroid cancer. Cancer Letters, 163 : Hall SF, Walker H, Siemens R, et al. (2009) : Increasing detection and increasing incidence in thyroid cancer. World J Surg, 33 : Haymart MR, Glinberg SL, Liu J, et al. (2009) : Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrionol, 71 : Imaizumi M, Usa T, Tominaga T, et al. (2006) : Radiation dose-response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki automic bomb survivors years after radiation exposure. J A M A, 25 : Iribarren C, Hasclkorn T, Tekawa IS, Friedman GD. (2001) : Cohort study of thyroid cancer in a San Francisco bay area population. Int J Cancer, 93 : Jung KW, Won YJ, Park S, et al. (2009) : Cancer statistics in Korea: incidence, mortality and survival in J Kor Med Sci, 24 : Laney N, Meza J, Lyden E, et al. (2010) : The prevalence of vitamin D deficiency is similar between thyroid nodule and thyroid cancer patients. Int J E n d o c r i n o l, 2010 Article ID , 7 pages 19. Leitzmann MF, Brenner A, Moore SC, et al. Prospective study of body mass index, physical activity and thyroid cancer. Int J Cancer 2009 Sep 30 [Epub ahead of print] Mack WJ, Preston-Martin S, Dal Maso L, et al. (2003) : A 20. pooled analysis of case-control studies of thyroid cancer: cigarette smoking and consumption of alcohol, coffee, and tea. Cancer Causes Control, 14 : Meinhold CL, Park Y, Stolzenberg-Solomon RZ, et al. (2009) : Alcohol intake and risk of thyroid cancer in the NIH-AARP Diet and Health Study. Br J Cancer, 101 : Montanaro F, Pury P, Bordoni A, et al. (2006) : Unexpected additional increase in the incidence of thyroid cancer among a recent birth cohort in Switzerland. Eur J Cancer Prev, 15 : Navarro Silvera SA, Miller AB, Rohan TE. (2005) : Risk 104

22 factors for thyroid cancer: A prospective cohort study. Int. J. C a n c e r, 116 : Parkin DM, Bray F, Ferlay J, Pisani P. (2005) : Global cancer statistics, CA Cancer J Clin, 55 : Parkin DM, Whelan SL, Ferlay J, et al. eds. (2002) : Cancer Incidence in Five Continents. Vol VIII. IARC Scientific Publication No, 155, International Angency for Research on Cancer. World Health Organization, Lyon 26. Plesko I, Macfariane GJ, Obsitnikova A, et al. (1994) : Thyroid cancer in Slovakia, : incidence, mortality and histological types. Eur J Cancer Prev, 3 : Preston-Martin S, Franceschi S, Ron E, Negri E. (2003) : Thyroid cancer pooled analysis from 14 case-control studies: what have we learned? Cancer Causes Control, 14 : Randi G, Ferraroni M, Talamini R, et al. (2008) : Glycemic index, glycemic load and thyroid cancer risk. Ann Oncol, 19 : Renehan AG, Tyson M, Egger M, et al. (2008) : Bodymass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. L a n c e t, 371 : Reynolds RM, Weirt J, Stockton DL, et al. (2005) : Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin Endrinol, 62 : Ron E, Kleinerman RA, Boice JD Jr., et al. (1987) : A population-based case-control study of thyroid cancer. J N C I, 79 : Scheiden R, Keipes M, Bock C, et al. (2006) : Thyroid cancer in Luxembourg: a national population-based data report ( ). BMC Cancer, 6 : Shakhtarin VV, Tsyb AF, Stepanenko VF, et al. (2003) : Iodine deficiency, radiation dose, and the risk of thyroid cancer among children and adolescents in the Bryansk region of Russia following the Chernobyl power station accident. Int J Epidemiol, 32 : Shin MH, Oh HK, Ahn YO. (2008) : Ten year trend of cancer incidence in Seoul, Korea: J Prev Med Public Health, 41 : (Korean) 35. Sung J, Song YM, Lawlor DA, et al. (2009) : Height and site-specific cancer risk: a cohort study of a Korean adult population. Am J Epidemiol, 170 : Troung T, Baron-Dubourdieu D, Rougier Y, et al. (2010) : Role of dietary iodine and cruciferous vegetables in thyroid cancer: a countrywide case-control study in New Caledonia. Cancer Causes Control, Apr 2 (Epub ahead of print) 37. Ward MH. Kilfoy BA, Weyer PJ, et al. (2010) : Nitrate Intake and the risk of thyroid cancer and thyroid disease. E p i d e m i o l o g y, 21 : Zivaljevic V, Vlajinac H, Jankovic R, et al. (2003) : Casecontrol study of female thyroid cancer- menstrual, reproductive and hormonal factors. Eur J Cancer Prev, 12 :

23 106 Fig. 1 Fig. 2 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Sonographic Evaluation of Thyroid Nodules Fig. 1.

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3% 70.7% 44-87.1% 43.4-80% 27% 26.5-35.2% 94.3-97.2% 68.4-95.1% 73.5-49.2% 32.7-83.

26 Table 1 Fig. 7. Table 1 Table 1. Sonographic features Sensitivity Specificity PPV* NPV % % % 70.7% % % 27% % % % % % % % % % % % % * PPV: positive predictive value NPV: negative predictive value 109

27 REFERENCES 1. Gharib H, Goellner JR. (1993) : Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med, 118 : Silver RJ, Parangi S. (2004) : Management of thyroid incidentalomas. Surg Clin North Am, 84 : Hegedus L. Clinical practice. (2004) : The thyroid 4. nodule. N Engl J Med, 351 : ,,,,,. (2002) : and malignant lesions in the management of thyroid., 46 : Nam-Goong IS, Kim HY, Gong G, et al. (2004) : Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf), 60 : Tan GH, Gharib H. (1997) : Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern M e d, 126 : Kim EK, Park CS, Chung WY, et al. (2002) : New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol, 178 : Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB, Jr. (2003) : Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound M e d, 22 : Frates M C, Benson CB, Doubilet PM, Cibas ES, Marqusee E. (2003) : Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules? J Ultrasound Med, 22 : ; quiz Cappelli C, Castellano M, Pirola I, et al. (2007) : The predictive value of ultrasound findings in the management of thyroid nodules. Q j m, 100 : Papini E, Guglielmi R, Bianchini A, et al. (2002) : Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-doppler features. J Clin Endocrinol Metab, 87 : Lee MJ, Kim EK, Kwak JY, Kim MJ. (2009) : Partially cystic thyroid nodules on ultrasound: probability of malignancy and sonographic differentiation. T h y r o i d, 19 : Cappelli C, Pirola I, Cumetti D, et al. (2005) : Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? C l i n Endocrinol (Oxf), 63 : Tae HJ, Lim DJ, Baek KH, et al. (2007) : Diagnostic value of ultrasonography to distinguish between benign nodules. T h y r o i d, 17 : Kim MJ, Kim EK, Kwak JY, Park CS, Chung WY, Nam KH, Youk JH. (2008) : Differentiation of thyroid nodules with macrocalcifications: role of suspicious sonographic findings. J Ultrasound Med, 27 : Holden A. (1995) : The role of colour and duplex Doppler ultrasound in the assessment of thyroid nodules. Australas Radiol, 39 : Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. (2003) : Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med, 22 : Iannuccilli JD, Cronan JJ, Monchik JM. (2004) : Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound M e d, 23 : American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12 : Cooper DS, Doherty GM, Haugen BR, et al. (2009) : Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. T h y r o i d, 19 : Moon HJ. Kim EK, Kwak JY, Kim MJ. (2010) : Can vascularity on power Doppler ultrasonography predit thyroid malignancy. R a d i o l o g y, 2010 in press. 22. Fish SA, Langer JE, Mandel SJ. (2008) : Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am, 37 :

28 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Pathologic Characteristics of Papillary Microcarcinoma Table 1 Table 1. Associated with favorable prognosis Papillary microcarcinoma Encapsulated variant Encapsulated follicular variant Oncocytic variant Similar prognosis to conventional type Follicular variant Cribriform-morular variant Associated with aggressive behavior Diffuse sclerosing variant Tall cell variant Columnar cell variant 111

29 Table 2 Fig. 1 Fig. 2 Fig. 1. Fig. 3 Table 2. I. Nondiagnostic or Unsatisfactory II. Benign III. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance IV. Follicular Neoplasm or Suspicious for Follicular Neoplasm V. Suspicious for Malignancy VII. Malignant 112

30 113 Fig. 2.

31 114 Table 3 Fig. 3.

32 Table 3. Author No. of Multifocality Nodal Distant Recurrence Mortality Follow up cases (%) metastasis(%) metastasis(%) Rate(%) (%) (year) Lo et al Roti et al Appetecchia et al Baudin et al Pelizzo et al Pellegriti et al. 13) Chow et al. 14) Arora et al. 12) Park et al. 10) Lombardi et al. 11)

33 REFERENCES 1. 2.,,, (2008) : 1., 23 : Rosai J (2004) : Rosai and Ackerman s Surgical Pathology. 9th ed. Mosby, London 3. LiVolsi VA, Albores-Saavedra J, Asa SL, et al. (2004) : Papillary carcinoma. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C, (eds ). World Health Organization Classification of Tumors: Pathology and Genetics of Tumors of Endocrine Organs. IARC Press, Lyon 4. Kovacs GL, Gonda G, Vadasz G, et al. (2005) : Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. T h y r o i d, 15 : Cibas ES, Ali SZ (2009) : NCI Thyroid FNA State of the Science Conference. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol, 132 : (2005) : associated with invasion and metastasis of papillary. thyroid carcinoma. Br J Cancer, 93 : , 16 : Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ (1992) : Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50- year period. S u r g e r y, 112 : Baudin E, Travagli JP, Ropers J, et al. (1998) : Microcarcinoma of the thyroid gland: the Gustave- Roussy Institute experience. Cancer, 83 : Yamashita H, Noguchi S, Murakami N, et al. (1999) : Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. C a n c e r, 8 6 : Park YJ, Kim YA, Lee YJ, et al. (2010) : Papillary microcarcinoma in comparison with larger papillary thyroid carcinoma in BRAF (V600E) mutation, clinicopathological features, and immunohistochemical findings. Head Neck, 32 : Lombardi CP, Bellantone R, De Crea C et al. (2010) : Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area. World J Surg, Jan 6. [Epub ahead of print] 12. Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahey TJ 3rd (2009) : Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? T h y r o i d, 19 : Pellegriti G, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A (2004) : Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab, 89 : Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) : Papillary microcarcinoma of the thyroid- Prognostic significance of lymph node metastasis and multifocality. C a n c e r, 98 : Schlumberger MJ (1998) : Papillary and follicular thyroid carcinoma. N Engl J Med, 338 : Noguchi S, Yamashita H, Uchino S, Watanabe S (2008) : Papillary microcarcinoma. World J Surg, 32 : Zou M, Al-Baradie RS, Al-Hindi H, Farid NR, Shi Y (2005) : S100A4 (Mts1) gene overexpression is 18. Khoo ML, Beasley NJ, Ezzat S, Freeman JL, Asa SL (2002) : Overexpression of cyclin D1 and underexpression of p27 predict lymph node metastases in papillary thyroid carcinoma. J Clin Endocrinol Metab, 87 : Wreesmann VB, Sieczka EM, Socci ND, et al. (2004) : Genome-wide profiling of papillary thyroid cancer identifies MUC1 as an independent prognostic marker. Cancer Res, 64 : Karlidag T, Cobanoglu B, Keles E, et al. (2007) : Expression of Bax, p53, and p27/kip in patients with papillary thyroid carcinoma with or without cervical nodal metastasis. Am J Otolaryngol, 28 : Xing M, Westra WH, Tufano RP, et al. (2005) : BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab, 90 : Trovisco V, Soares P, Sobrinho-Simoes M (2006) : B- RAF mutations in the etiopathogenesis, diagnosis, and prognosis of thyroid carcinomas. Hum Pathol, 37 : Min HS, Choe G, Kim SW, et al. (2008) : S100A4 expression is associated with lymph node metastasis in papillary microcarcinoma of the thyroid. Mod Pathol, 21 :

34 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Management of Well-differentiated Thyroid Cancer 117

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36 Table 1. Very low risk Low risk Intermediate risk High risk Age at diagnosis <45 yrs <45 yrs Young pts. (<45 yrs) >45 yrs - Classic PTC >4cm - vascular invasion -extrathyroidal extension. - worrisome histology c of any size Tumor size <1 cm 1-4 cm Older pts. (>45 yrs) >4 cm - Classic PTC <4cm - extrathyroidal extension. - worrisome histology c of <1-2cm Histology Classic PTC, Classic PTC, See above Worrisome confined to thyroid a confined to thyroid a (Age + Histology + size) Histology c >1-2 cm Completeness Complete resection Complete resection Complete resection Incomplete of resection resection L/N involvement None apparent Present or absent b Present or absent b Present or absent b Distant metastasis None apparent None apparent None apparent Present - very low risk low, risk column - high risk incomplete resection distant metastasis age, tumor size, histology high risk - columnrisk factor intermediate risk - a : vascular invasion extrathyroidal extension - b : L/N involvement c : tall cell-, columnar cell-, insular variant, poorly differentiated histology Reference : Tuttle RM et al, J Surg Oncology 97 : 712,

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51 Medical POSTGRADUATES No. 3, Vol. 38, 2010 Abstracts Bibliometric Indicators : Quality Measurements of Scientific P u b l i c a t i o n Valerie Durieux et al. Radiology, 255(2) : , 2010 Brain Endothelial Cells Synthesize Neurotoxic Thrombin in Alzheimer s Disease Xiangling Yin et al. Am J Pathol, 176(4) : , 2010 Pro-survival of Estrogen Receptor-Negative Breast Cancer Cells is Regulated by a BLT2-Reactive Oxygen Species-Linked Signaling P a t h w a y Jung-A Choi et al. Carcinogenesis, 31(4) : ,

52 Colorectal and Extracolonic Cancers Detected at Screening CT Colonography in Asymptomatic Adults Perry J. Pickhardt et al. Radiology, 255(1) : 83-88, 2010 Decrease in Breast Density in the Contralateral Normal Breast of Patients Receiving Neoadjuvant Chemotherapy : MR Imaging E v a l u a t i o n Jeon-Hor Chen et al. Radiology, 255(1) : 44-52,

53 Pediatrics, 125(4) : , 2010 Racial/Ethnic Differences in Early-Life Risk Factors for Childhood O b e s i t y Elsie M. Taveras et al. Pediatrics, 125(4) : , 2010 Ethics Consultation in Children's Hospitals: Results From a Survey of Pediatric Clinical Ethicists Jennifer C. Kesselheim et al. 136

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김범수

김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis