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

The Korean Musculoskeletal Tumor Society (대한근골격종양학회)
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Primary Bone Tumors in Hindfoot

후족부에 발생한 원발성 골종양

  • Shin, Duk-Seop (Department of Orthopedic Surgery, Yeungnam University Medical Center) ;
  • Lee, Sung-Jun (Department of Orthopedic Surgery, Yeungnam University Medical Center)
  • 신덕섭 (영남대학교병원 정형외과) ;
  • 이성준 (영남대학교병원 정형외과)
  • Received : 2013.03.18
  • Accepted : 2013.06.03
  • Published : 2013.06.30
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Abstract

Purpose: Primary bone tumors of hindfoot are uncommon compared with other locations, and there have been few large-group studies. This study was designed to analyze the characteristics and the clinical results of the primary bone tumors of hindfoot. Materials and Methods: Forty five cases in 44 patients who have been diagnosed from 1989 to 2011 were reviewed. The minimum follow-up period was 1 year. We retrospectively reviewed the medical records and images. Results: Twenty six cases were male and 18 cases were female. Mean follow-up period was 33.1 months and mean age was 25.1 years. Forty four cases were benign and 1 case was malignant. Thirty six cases occurred in calcaneus and 9 cases were in talus. The most common benign bone tumor was simple bone cyst (20 cases), followed by intraosseous lipoma (12 cases), and chondroblastoma (4 cases). In calcaneus, there were 18 cases of simple bone cyst, and 12 cases of intrasosseous lipoma. In talus, there were 3 cases of chondroblastoma, 2 cases of simple bone cyst, and 2 cases of intraossesous ganglion. Many patients with hindfoot bone tumors presented with pain, but some were found accidentally. Patients received surgical procedures, such as curettage and bone graft, open reduction and internal fixation, tumor resection, and below knee amputation. Conclusion: Primary bone tumors of hindfoot are rare and can be misdiagnosed as ankle sprain or contusion. Although most are benign, malignant tumors cannot be ruled out, so early diagnosis and appropriate treatment is important.

목적: 후족부에 발생하는 원발성 골종양은 다른 부위에서의 골종양과 비교하여 발생 빈도가 낮고 진단이 늦거나 오진되는 경우가 많은 반면, 이에 대한 대규모 연구 및 보고는 적은 실정으로 후족부의 원발성 골종양의 진단과 치료를 위해 그 임상적 양상에 대하여 알아보고자 하였다. 대상 및 방법: 1989년부터 2011년까지 본원에서 진단 후 최소 1년 이상 추시 가능하였던 후족부 원발성 골종양 환자 44명의 45예 종양을 대상으로 하였다. 환자들의 의무 기록과 영상 검사를 후향적으로 검토하여 후족부 원발성 골종양에 대한 역학적 조사와 임상적 특성, 치료 방법을 확인하였고, 병리학적인 특성을 조사하였다. 결과: 총 44명의 환자 중 남자가 26예, 여자가 18예였으며, 환자들의 평균 연령은 25.1세였고 평균 추시 기간은 33.1개월이었다. 양성 골종양이 44예, 악성 골종양은 1예였으며, 종골에 발생한 골종양이 36예, 거골의 골종양 9예였다. 전체적으로 양성 골종양 중에는 단순골낭종이 20예로 가장 많았으며, 그 다음이 골내지방종이 12예, 연골모세포종 4예 순이었고, 악성 골종양은 유잉 육종이 1예였다. 발생부위 별로 종골에서는 단순골낭종이 18예, 골내지방종이 12예 순이었고, 거골에서는 연골모세포종 3예, 단순골낭종 2예, 골내결절종 2예 등의 순이었다. 환자들의 임상 증상은 통증을 동반하는 경우도 있으나, 우연히 발견되는 경우가 많고 족관절 혹은 후족부의 염좌 또는 타박상으로 오인되는 경우도 많았다. 병적 골절을 동반한 경우는 2예였다. 수술 방법으로는 소파술 혹은 소파술 및 골이식술, 관혈적 정복과 금속고정술 및 골이식술, 종양 절제술, 슬관절 하 절단술 등을 시행하였다. 결론: 후족부에 발생하는 원발성 골종양은 빈도가 드물고 진단이 늦어지는 경우가 많으며, 대부분 양성 종양이었으나 악성종양을 배제할 수 없어 조기 진단과 적절한 치료가 중요할 것으로 사료된다.

Keywords

References

  1. Walling AK, Gasser SI. Soft-tissue and bone tumors about the foot and ankle. Clin Sports Med. 1994;13:909-38.
  2. Murari TM, Callaghan JJ, Berrey BH Jr, Sweet DE. Primary benign and malignant osseous neoplasms of the foot. Foot Ankle. 1989;10:68-80. https://doi.org/10.1177/107110078901000205
  3. Steinberg MD, Steinberg LB, Calihman N. Tumors of the foot: benign and malignant. J Am Podiatry Assoc. 1979;69:135-8. https://doi.org/10.7547/87507315-69-2-135
  4. Choi WJ, Shin KH, Lee JW, Han CW. Tumors in the foot and ankle (185 cases). J Korean Foot Ankle Soc. 2007;11:1-7.
  5. Buchner M, Bernd L, Zahlten-Hinguranage A, Sabo D. Bone and soft-tissue tumors of the foot and ankle. Chirurg. 2005;76:391-7. https://doi.org/10.1007/s00104-004-0963-0
  6. Ozdemir HM, Yildiz Y, Yilmaz C, Saglik Y. Tumors of the foot and ankle: analysis of 196 cases. J Foot Ankle Surg. 1997;36:403-8. https://doi.org/10.1016/S1067-2516(97)80089-0
  7. Bakotic B, Huvos AG. Tumors of the bones of the feet: the clinicopathologic features of 150 cases. J Foot Ankle Surg. 2001;40:277-86. https://doi.org/10.1016/S1067-2516(01)80063-6
  8. Young PS, Bell SW, MacDuff EM, Mahendra A. Primary osseous tumors of the hindfoot: why the delay in diagnosis and should we be concerned? Clin Orthop Relat Res. 2013;471:871-7. https://doi.org/10.1007/s11999-012-2570-6
  9. Shin DS, Park SH, Ahn JC. Tumors of the foot. J Korean Bone & Joint Tumor Soc. 2003;9:69-76.
  10. Dhillon MS, Singh B, Singh DP, Prabhu V, Nagi ON. Primary bone tumors of the talus. J Am Podiatr Med Assoc. 1994;84:379-84. https://doi.org/10.7547/87507315-84-8-379
  11. Monroe MT, Manoli A 2nd. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle. Foot Ankle Int. 1999;20:461-3. https://doi.org/10.1177/107110079902000712
  12. Killian JT, Wilkinson L, White S, Brassard M. Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998;18:621-4. https://doi.org/10.1097/00004694-199809000-00013
  13. Glaser DL, Dormans JP, Stanton RP, Davidson RS. Surgical management of calcaneal unicameral bone cysts. Clin Orthop Relat Res. 1999;(360):231-7.
  14. Hollawell SM. Allograft cellular bone matrix as an alternative to autograft in hindfoot and ankle fusion procedures. J Foot Ankle Surg. 2012;51:222-5. https://doi.org/10.1053/j.jfas.2011.10.001
  15. Delawi D, Kruyt MC, Huipin Y, et al. Comparing autograft, allograft, and tricalcium phosphate ceramic in a goat instrumented posterolateral fusion model. Tissue Eng Part C Methods. 2013. [Epub ahead of print]
  16. An HS, Lynch K, Toth J. Prospective comparison of autograft vs. allograft for adult posterolateral lumbar spine fusion: differences among freeze-dried, frozen, and mixed grafts. J Spinal Disord. 1995;8:131-5.
  17. Aumar DK, Dadjo YB, Chagar B. Intraosseous lipoma of the calcaneus: report of a case and review of the literature. J Foot Ankle Surg. 2013;52:360-3. https://doi.org/10.1053/j.jfas.2012.12.019
  18. Greenspan A, Raiszadeh K, Riley GM, Matthews D. Intraosseous lipoma of the calcaneus. Foot Ankle Int. 1997;18:53-6. https://doi.org/10.1177/107110079701800112
  19. Weinfeld GD, Yu GV, Good JJ. Intraosseous lipoma of the calcaneus: a review and report of four cases. J Foot Ankle Surg. 2002;41:398-411. https://doi.org/10.1016/S1067-2516(02)80087-4
  20. Bloem JL, Mulder JD. Chondroblastoma: a clinical and radiological study of 104 cases. Skeletal Radiol. 1985;14:1-9. https://doi.org/10.1007/BF00361187
  21. Edel G, Ueda Y, Nakanishi J, et al. Chondroblastoma of bone. A clinical, radiological, light and immunohistochemical study. Virchows Arch A Pathol Anat Histopathol. 1992;421:355-66. https://doi.org/10.1007/BF01660984
  22. Lee YK, Han IK, Oh JH, Lee SH, Kim HS. Treatment and prognosis of chondroblastoma. J of Korean Bone & Joint Tumor Soc. 2007;13:81-7.
  23. Giudici MA, Moser RP Jr, Kransdorf MJ. Cartilaginous bone tumors. Radiol Clin North Am. 1993;31:237-59.
  24. Han CS, Park PY, Park JS, Park KH. Osteochondroma of the Os calcaneum - A case report -. J of Korean Bone & Joint Tumor Soc. 2008;14:152-6.
  25. Karasick D, Schweitzer ME, Eschelman DJ. Symptomatic osteochondromas: imaging features. AJR Am J Roentgenol. 1997;168:1507-12. https://doi.org/10.2214/ajr.168.6.9168715
  26. Blitz NM, Lopez KT. Giant solitary osteochondroma of the inferior medial calcaneal tubercle: a case report and review of the literature. J Foot Ankle Surg. 2008;47:206-12. https://doi.org/10.1053/j.jfas.2007.12.006
  27. Kennedy JG, Frelinghuysen P, Hoang BH. Ewing sarcoma: current concepts in diagnosis and treatment. Curr Opin Pediatr. 2003;15:53-7. https://doi.org/10.1097/00008480-200302000-00009
  28. Weber KL. Current concepts in the treatment of Ewing's sarcoma. Expert Rev Anticancer Ther. 2002;2:687-94. https://doi.org/10.1586/14737140.2.6.687
  29. Weber KL, Sim FH. Ewing's sarcoma: presentation and management. J Orthop Sci. 2001;6:366-71. https://doi.org/10.1007/s007760100034
  30. Leeson MC, Smith MJ. Ewing's sarcoma of the foot. Foot Ankle. 1989;10:147-51. https://doi.org/10.1177/107110078901000306