The Journal of the Korean bone and joint tumor society (대한골관절종양학회지)

The Korean Musculoskeletal Tumor Society (대한근골격종양학회)
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Secondary Chondrosarcoma Arising from Osteochondroma(tosis)

골연골종(증)에서 발생한 속발성 연골육종

  • Cho, Hyun-Min (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Rhee, Seung-Koo (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Kang, Yong-Koo (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Chung, Yang-Guk (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Lee, An-Hi (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Park, Jung-Mi (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University) ;
  • Bahk, Won-Jong (Department of The Musculoskeletal Oncology Group, School of Medicine, Catholic University)
  • 조현민 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 이승구 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 강용구 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 정양국 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 이안희 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 박정미 (가톨릭대학교 의과대학 근골격계종양연구회) ;
  • 박원종 (가톨릭대학교 의과대학 근골격계종양연구회)
  • Received : 2010.04.10
  • Accepted : 2010.06.09
  • Published : 2010.06.30
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Abstract

Purpose: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). Materials and Methods: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and fi ve were female. The mean age was 34 years. The mean follow-up period was 54 months. Results: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. Conclusion: Comprehensive understanding of clinical, radiological and pathological features of secondary chondro sarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.

목적: 발생 빈도가 드문 골연골종(증)에서 기인한 속발성 연골육종의 임상적, 방사선학적, 조직병리학적 소견과 더불어 수술적 치료의 결과를 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법: 1992년 1월 1일부터 2004년 12월 31일까지 골연골종(증)에서 발생한 속발성 연골육종에 대해 수술적 치료를 받은 14명을 대상으로 환자들의 임상기록, 단순 방사선 및 전산화 단층촬영/자기공명영상, 병리조직 슬라이드를 후향적으로 조사하였다. 남성 9명, 여성 5명이었으며, 평균 나이는 34세(14-75세)였다. 평균 추시 기간은 54개월이었다. 결과: 모든 환자에서 소아기나 사춘기 전, 후부터 종괴를 가지고 있었으며, 방사선학적 소견은 종양의 표면이 불규칙하거나 경계가 불분명하거나, 분산된 무기질 침착 소견을 동반한 골파괴 음영 및 점상 석회화를 동반한 연부조직 종괴가 관찰되었다. 자기공명영상소견은 상기 방사선학적 소견을 반영하는 불균등신호 강도(inhomogeneous signal)의 불규칙한 경계를 지닌 종괴가 보이며, 연골모(cartilage cap)의 두께가 2예를 제외하고는 모두 1 cm 이상으로 두꺼웠다. 수술적 치료는 10명에서 광범위절제술, 3명에서 변연절제술 그리고 1명에서 절단술을 시행하였다. 결론: 골연골종(증)에서 드물기는 하나 속발성 연골육종이 발생할 수 있으므로, 임상적, 방사선학적 그리고 조직병리학적 소견을 종합적으로 이해하고 주의 깊게 추시 관찰 하여, 조기에 광범위 절제술을 시행할 경우 좋은 치료결과를 기대할 수 있을 것으로 사료된다.

Keywords

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