Browsing by Author "Warut Pongsapich"

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    Aggressive fibromatosis of neck and superior mediastinum: A case report
    (2018-06-01) Cheerasook Chongkolwatana; Siriporn Limviriyakul; Worawong Slisatkorn; Warut Pongsapich; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2018, Medical Association of Thailand. All rights reserved. Background: Aggressive fibromatosis is rare in the neck and superior mediastinal area Case report: A 76-year-old woman initially presented with a large anterior neck mass with upper airway obstruction due to tracheal compression. Surgical excision was performed 3 years after the initial presentation, followed by post-operative radiation due to positive margin. No evidence of disease recurrence was observed during the 3-year follow up. Conclusion: Aggressive fibromatosis of head and neck is a challenging lesion due to its infiltrative nature, high propencity to recur and proximity to vital structures. Surgery should be well-planned using imaging and multidisciplinary approaches.
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    BRAF mutation in cytologically indeterminate thyroid nodules: After reclassification of a variant thyroid carcinoma
    (2019-01-01) Warut Pongsapich; Cheerasook Chongkolwatana; Naravat Poungvarin; Kanchana Amornpichetkul; Nutthaya Piyawattayakorn; Pichpisith Vejvisithsakul; Prachya Maneeprasopchoke; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2019 Pongsapich et al. Purpose: Fine-needle aspiration biopsy (FNAB) is regarded by the Bethesda system as the gold-standard investigation for stratifying the risk of malignancy of a thyroid nodule. However, some limitations affect the adequacy of the obtained materials, resulting in 30% of the cytological results remaining in the indeterminate category. We aimed to investigate the diagnostic value of the BRAF mutation in cytologically indeterminate thyroid nodules after the reclassification of a variant thyroid carcinoma. Patients and methods: In this prospective diagnostic study, 76 patients with FNAB findings of atypia of undetermined significance (AUS) and suspicious for malignancy (SUS) were included. The BRAF V600 mutation from FNAB was confirmed by a PCR-based method (Sanger sequencing combined with allele-specific real-time PCR techniques) and immunohistochemistry (IHC). Pathological specimens and features, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), were reviewed and compared to the FNAB results. Results: Using the PCR-based method, the BRAF mutation was positive in 13/76 cases (17.1%), with the diagnostic values of 16.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 82.8% negative predictive value (NPV) in the AUS compared to 73.3% sensitivity, 100% specificity, 100% PPV, and 20% NPV in the SUS. For the IHC technique, only 20 of the 76 cytological specimens were qualified for testing. The BRAF mutation was positive in 13/20 cases, with the diagnostic values of 100% sensitivity, 63.6% specificity, 42.9% PPV, and 100% NPV in the AUS compared to 100% sensitivity and PPV in the SUS. The BRAF mutation was not found in the pathological reports for NIFTP. Conclusion: The malignancy rate is high in our data, with specific and acceptable accuracy rates for the BRAF mutation from FNAB found by using the PCR-based method. NIFTP has been introduced after the pathological reclassification. Molecular diagnosis might be useful to establish the nature of the disease.
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    Clinical effectiveness of hyperbaric oxygen therapy in complex wounds
    (2014-01-01) Supaporn Opasanon; Warut Pongsapich; Sitthichoke Taweepraditpol; Bhoom Suktitipat; Apirag Chuangsuwanich; Mahidol University
    © 2015 Elsevier Inc. All rights reserved. Hyperbaric Oxygen (HBO, HBO2) Therapy is a non-invasive therapy. It has been applied as adjuvant treatment in many medical conditions over the past 50 years. Different treatment protocols have been proven effective for specifically indicated conditions. To evaluate the clinical effectiveness of Hyperbaric Oxygen (HBO) Therapy as an adjunctive treatment for patients with complex wounds. In this prospective cohort study, 40 patients with complex wounds were included. All patients received HBO. HBO was delivered with 100% oxygen for 90 min at 2.0-2.4 ATA. Wound sizes were assessed by one wound surgeon before, during, and every 2 weeks for a total of 12 months after HBO. An analysis of demographic data, wound size and wound photography was performed. Over the 22-month period ending October 31, 2013, 40 patients (21 men and 19 women) with a mean age of 59.73 (range, 29-88) with complex wounds were included. All complex wounds studied were at least 6 months old. The mean wound size was 16.72 cm2 in diameter. Thirty-one patients with complex wounds healed after the completion of a series of HBO treatments (77.5%). Two orocutaneous fistulas were completely closed without further surgery. After 5 HBO treatments, the wound size reduced by 29.7% on average (p = 1.24 × 10-6). After 10 HBO treatments, the wound size statistically significantly reduced by an additional 16.9% (p = 0.0002). There were no complications in this study. Wound healing process was accelerated by HBO. Significant wound size reduction was noted after 5 HBO treatments. Because the biggest reduction in wound size occurred within the first 10 HBO treatments, it is important to conduct these first treatments without interruption. HBO is an effective and safe treatment modality for complex wounds.
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    Giant accessory submandibular sialolithiasis: A case report
    (2020-09-01) Thanion Soopanit; Warut Pongsapich; Prachya Maneeprasopchoke; Faculty of Medicine, Siriraj Hospital, Mahidol University; Chulabhorn Hospital
    © 2020 Elsevier Inc. The accessory submandibular salivary duct is an infrequent anatomical variation, with an extremely rare, intraluminally located stone. We present a distinctive case of the largest accessory submandibular sialolithiasis ever reported in the literature. A 54-year-old male presented with a slow-growing mass in the right submandibular area. An examination revealed a large calcified mass in the ipsilateral tonsillar fossa. A preoperative CT scan demonstrated the continuation of the pathologic calcification between two areas. The submandibular gland, together with the entire stone in the accessory duct, was safely removed using the external approach in order to prevent neurovascular injuries that could otherwise arise from its distorted location.
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    Identification of novel mutation in RANKL by whole-exome sequencing in a Thai family with osteopetrosis; a case report and review of RANKL osteopetrosis
    (2021-07-01) Pongtawat Lertwilaiwittaya; Bhoom Suktitipat; Phongphak Khongthon; Warut Pongsapich; Chanin Limwongse; Manop Pithukpakorn; Siriraj Hospital; Mahidol University
    Background: Osteopetrosis is a rare form of skeletal dysplasia characterized by increased bone density that leads to bone marrow failure, compressive neuropathy, and skeletal dysmorphism. Molecular diagnosis is essential as it guides treatment and prognosis. We report Thai siblings with an ultra-rare form of osteopetrosis. Methods: The older brother and the younger sister presented with chronic mandibular osteomyelitis in their 20s. Since childhood, they had visual impairment, pathological fracture, and skeletal dysmorphism. Quadruplet whole-exome sequencing was performed and confirmed with Sanger sequencing. Novel mutation in TNFSF11 (RANKL) c.842T>G, p.Phe281Cys was identified in a homozygous state in both siblings. Results: Surgical debridement, antibiotic, and hyperbaric oxygen therapy were used and discontinued over a 6-month period with normalization of C-reactive protein. Hematopoietic stem cell transplantation candidacy was excluded by molecular diagnosis. Conclusion: We report a novel mutation in an ultra-rare form of osteopetrosis. Our siblings manifested with a milder phenotype in comparison with nine cases previously published.
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    The implementation of TORS for head and neck surgery in Thailand
    (2021-12-01) Warut Pongsapich; Cheerasook Chongkolwatana; Hataikarn Chuetnok; Narin Ratanaprasert; Siriraj Hospital
    Transoral robotic surgery (TORS) is a novel surgical treatment of head and neck cancers, mainly for limited tumor in oropharynx and supraglottis. Despite the major advantage of favorable postoperative functional outcomes, many obstacles exist during the implementation of TORS, especially in a country where financial resources are modest. We demonstrated our experience of initiating this sophisticated technology at the largest tertiary hospital in Thailand. A retrospective review study was conducted in patients with benign or malignant lesions during 2014–2020 at Siriraj Hospital. Different periods of operation time between initial and subsequent cases were compared to evaluate learning-curve improvement. A total of 36 patients underwent TORS, with median follow-up time of 18 months. The average time of room set-up, anesthesia, and positioning was 37 ± 14, 13 ± 7, and 15 ± 7 min, respectively. Whilst, the average robotic procedure time and total time in room were 44 ± 19 and 118 ± 31 min, consecutively. There was no significant difference in any time interval, except the set-up time between initial and subsequent cases. The worthwhile utilization of TORS could be administered cost-effectively despite the complicated and daunting implementation of TORS. Whilst, meticulous planning and sufficient training prior to the initiation of TORS can favorably shorten the learning curve of operative staffs in the TORS team.
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    Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time
    (2021-04-01) Prachya Maneeprasopchoke; Cheerasook Chongkolwatana; Warut Pongsapich; Ayaka J. Iwata; Dipti Kamani; Gregory W. Randolph; Siriraj Hospital; Harvard Medical School
    Objective: To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM. Methods: A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the “non-IONM group”), while 16 thyroidectomies were performed with IONM (the “IONM group”). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time. Results: With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ (P >.05). No RLN injuries were observed. Conclusions: IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times. Level of evidence: 2.
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    Notch intracellular domain (NICD) expression and clinical manifestations of second primary tumor at esophagus in patients with head and neck squamous cell carcinoma
    (2019-01-01) Tauangtham Anekpuritanang; Warut Pongsapich; Tanasarun Watcharadilokkul; Premyot Ngaotepprutaram; Paveena Pithuksurachai; Sacarin Bunbanjerdsuk; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2019 Anekpuritanang et al. Introduction: Second primary tumor (SPT) is a major factor that affects the survival of head and neck squamous cell carcinoma (HNSCC) patients, and the esophagus is a common site. Detection of SPT is essential for optimal HNSCC treatment planning and follow-up. Mutation of the NOTCH1 gene is common in head and neck cancer. However, details relating to Notch signaling and clinical outcomes among different primary tumors are still inconclusive. This study aimed to identify the role of the Notch signaling pathway in HNSCC, and to compare NOTCH1 expression in HNSCC compared between those with and without SPT at esophagus while focusing on the Notch intracellular domain (NICD). Methods: Twenty-three cases of esophageal SPT and 47 non-SPT controls that were treated at Siriraj Hospital during 2006–2017 were included. Patient information and clinical outcomes were analyzed. NICD expression demonstrated by immunohistochemistry technique in formalin-fixed paraffin-embedded specimens was studied. Results: Mean age of SPTand non-SPTwas 55.13 and 62.09 years, respectively, and 94.3% of patients were male. Regarding SPT detection, 82.6% were synchronous and 17.4% were metachronous. There was significantly more active smoking among SPT than among nonSPT (87.0% vs 51.1%, p=0.01). Active alcohol use was also significantly greater among SPT than among non-SPT (87.0% vs 61.7%; p=0.04). Hypopharynx was the most common primary tumor site among SPT. Three-year and 5-year survival among SPT patients was 38.0% and 25.3%, respectively. NICD expression was absent in 52.2% of SPT, and in 53.3% of non-SPT. NICD expression intensity was mostly weak or moderate. Conclusion: Active smoking and alcohol use were found to be significantly associated with SPT development. A high percentage of NICD inactivation was noted in HNSCC with no significant difference between groups. The Notch signaling pathway is involved in HNSCC tumorigenesis, but may not be a suitable molecular marker for SPT development.
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    Oncoproteomic and gene expression analyses identify prognostic biomarkers for second primary malignancy in patients with head and neck squamous cell carcinoma
    (2019-07-01) Sacarin Bunbanjerdsuk; Nutchavadee Vorasan; Thammakorn Saethang; Tanjitti Pongrujikorn; Duangjai Pangpunyakulchai; Narongsak Mongkonsiri; Lalida Arsa; Nintita Thokanit; Warut Pongsapich; Tauangtham Anekpuritanang; Nuttapong Ngamphaiboon; Artit Jinawath; Somkiat Sunpaweravong; Trairak Pisitkun; Bhoom Suktitipat; Natini Jinawath; Chulalongkorn University; Faculty of Medicine, Prince of Songkia University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Thailand Ministry of Public Health; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2019, United States & Canadian Academy of Pathology. Patients with head and neck squamous cell carcinoma are at increased risk of developing a second primary malignancy, which is associated with poor prognosis and early death. To help improve clinical outcome, we aimed to identify biomarkers for second primary malignancy risk prediction using the routinely obtained formalin-fixed paraffin-embedded tissues of the index head and neck cancer. Liquid chromatography-tandem mass spectrometry was initially performed for candidate biomarker discovery in 16 pairs of primary cancer tissues and their matched normal mucosal epithelia from head and neck squamous cell carcinoma patients with or without second primary malignancy. The 32 candidate proteins differentially expressed between head and neck cancers with and without second primary malignancy were identified. Among these, 30 selected candidates and seven more from literature review were further studied using NanoString nCounter gene expression assay in an independent cohort of 49 head and neck cancer patients. Focusing on the p16-negative cases, we showed that a multivariate logistic regression model comprising the expression levels of ITPR3, KMT2D, EMILIN1, and the patient’s age can accurately predict second primary malignancy occurrence with 88% sensitivity and 75% specificity. Furthermore, using Cox proportional hazards regression analysis and survival analysis, high expression levels of ITPR3 and DSG3 were found to be significantly associated with shorter time to second primary malignancy development (log-rank test P = 0.017). In summary, we identified a set of genes whose expressions may serve as the prognostic biomarkers for second primary malignancy occurrence in head and neck squamous cell carcinomas. In combination with the histopathologic examination of index tumor, these biomarkers can be used to guide the optimum frequency of second primary malignancy surveillance, which may lead to early diagnosis and better survival outcome.
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    Prawn rostrum, a rare migratory esophageal foreign body penetrating the trachea
    (2020-06-01) Warut Pongsapich; Cheerasook Chongkolwatana; Narin Ratanaprasert; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2020 Elsevier Inc. Migration of foreign bodies (FB) is rare. Most FB reported in the literature are fish bones that are eventually found in the lateral soft tissue of the neck and thyroid glands. Here we report a 38-year-old female who accidently swallowed a prawn rostrum that later migrated through the esophagus and partially penetrated the trachea. The tracheal body was removed via endoscopy, but the remainder of the rostrum remained embedded in the deep soft tissue of the neck. Ultimately, the FB was successfully removed by neck exploration under intraoperative computed tomography (CT) guidance.
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    Prevalence of HPV infection in hypopharyngeal and laryngeal squamous cell carcinoma at Thailand's largest tertiary referral center
    (2017-11-02) Warut Pongsapich; Nitathip Eakkasem; Sontana Siritantikorn; Paveena Pithuksurachai; Kshidej Bongsabhikul; Cheerasook Chongkolwatana; Mahidol University
    © 2017 The Author(s). Background: Following the well-established relationship between human papillomavirus (HPV) and cervical carcinoma, the carcinogenicity of this virus has also been confirmed in subsets of head and neck carcinoma (HNCA), but mainly in the oropharynx. Other subsites of HNCA with less known association to HPV have never been studied in Thailand. Accordingly, the aim of this study was to investigate the prevalence of HPV DNA in hypopharyngeal and laryngeal squamous cell carcinoma in Thai population. Methods: This cross-sectional study included hypopharyngeal and laryngeal squamous cell carcinoma patients diagnosed and treated at the Department of Otorhinolaryngology, Siriraj Hospital during the September 2011-December 2013 study period. Presence of HPV genome was confirmed by polymerase chain reaction from pathologically-confirmed fresh specimens. Demographic data and risk factors of HPV infection were evaluated. Results: Eighty patients were included, and 95% of those were male. Only one patient was noted with positive HPV-62 serotype. Most patients consumed tobacco and/or alcohol. Five patients had no risk factors for cancer development. Risk of HPV infection was evaluated by self-reporting questionnaire. The mean age of sexual debut was 20.17 years. Forty-eight patients had multiple sexual partners. Sixteen and seven patients had history of sexually transmitted disease infection and habitual oral sex contact, respectively. Conclusion: There was no oncogenic HPV DNA detected within pathologic specimens of laryngeal and hypopharyngeal cancers in this study. Compared to rates reported from developed countries, the prevalence of HPV-related HNCA in Thailand is very low.