• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.299-306
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• 1990

골 신티그라피에서 신장이 희미하게 보이거나 전혀 안보이게 되는(이하 신장 영상 비출현이라 함) 원인 질환을 파악하고, 또 골 신티그라피에서 골전이가 발견된 여러 악성종양에서 신장 영상 비출현의 빈도 및 신장 영상 비출현의 소견을 보이는 여러 악성종양의 골전이 범위를 관찰하기 위하여, 서울대학교 병원에서 최근 6년간 시행한 골 신티그람 중 신장 영상 비출현의 소견을 보이는 889개를 재검토하였다. 신장영상 비출현의 원인 질환으로는 신부전이 대부분을 차지하였으나(816/889 : 91.8%), 신장 질환이 없는 경우에서는 광범위한 골전이가 가장 많았으며 (53/889 : 6.0%), 그 원발부위는 전립선암 (19/53 : 35.8%), 위암(14/53 : 26.4%), 유방암(5/53 : 9.4%), 폐암(4/53 : 7.5%) 신세포암(2/53 : 3.8%), 방광암(1/53 : 1.9%), 원발부위 미상(8/53 : 15.1%)으로 전립선암과 위암이 가장 많았다. 특히 강직성 척추염 4예, 류마토이드 관절염 3예, 성인형의 골화석증 1예에서 신장 영상 비출현의 소견을 보여 이채로왔으며, 이 밖에 원발성 부갑상선 기능항진증 및 그레이브스병이 각 1예씩 있었으며 원인을 알 수 없는 경우가 10예 있었다. 전립선암 140예중 골 신티그라피에서 골전이가 발견된 예는 108예(77.1%), 이중 신장 영상 비출현의 소견을 보이는 예는 19예(19/108, 17 6%)이었으며, 위암에서는 각각 328예, 162예(49.4%), 14예 (8.6%), 유방암에서는 각각 1754예, 730예 (41.6%), 5예(0.7%), 폐암에서는 각각 1105예, 596예(53.9%), 4예(0.7%), 방광암에서는 각각 247예, 110예(44.5%), 1예(0.9%)로 전립선암에서 신장 영상 비출현의 빈도가 가장 높았으며, 특히 위암에서 골전이 및 신장 영상 비출현의 빈도가 높아 주목되었다. 골전이 및 신장 영상 비출현의 소견을 보이는 악성종양 환자의 골 신티그람 53개중 44개 (83.0%)에서 척추 및 늑골에 미만성, 또는 다발성 침습이 관찰되었다. 또 골전이 부위를 두개골, 척추, 견대부, 늑골, 골반, 사지의 근위부 장골의 6개 부위로 나누어 분석할 경우 49개(92.5%)에서 3부위 이상에 전이가 발견되었고, 35개(66.0%)에서 4부위 이상에 전이가 발견되었으며, 5부위 이상, 6개 부위에 모두 전이가 발견된 것은 각각 20개 (37 7%), 11개(20.8%)이었다. 이상의 성적으로 보아 악성종양 환자의 골 신피그라피에서 신장 영상의 비출현은 종양의 광범위한 골전이를 간접적으로 시사하는 소견으로 생각된다. 여러 악성종양중 전립선암에서 신장 영상 비출현의 빈도가 가장 높았으며, 특히 위암에서 골전이 및 신장 영상 비출현의 빈도가 높음은 주목할 만한 것이라 하겠다.

• The Journal of the Korean bone and joint tumor society
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• v.8 no.2
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• pp.58-62
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• 2002

The incidence of giant cell tumors represents only 5% to 10% of all bone tumors. Occurrence on the small bones of the hand and foot are very rare. They typically present with pain and sometimes a pathologic fracture or even soft tissue extension. The radiographic appearance is highly characteristic. An eccentric osteolytic lesion is seen, producing cortical thinning and expansion, and possessing a delicate trabecular pattern. In tarsal bones, poorly or well-defined osteolytic lesions of variable size are encountered. Surgical treatment remains the preferred therapy. Marginal or wide en bloc resection has had far better results in term of local recurrence. Several authors have suggested extended curettage and cement as an alternative to en bloc resection. Follow-up is necessary to monitor for both local recurrence and the infrequent pulmonary metastases.

• The Journal of the Korean bone and joint tumor society
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• v.6 no.2
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• pp.53-60
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• 2000

Purpose : The purpose of the current study is to evaluate the functional and oncologic results of the limb salvage surgery with intramedullary nailing and cementization in malignant bone tumors of the proximal humerus. Materials and Methods : We reviewed 18 cases of limb salvage surgery of resection and reconstruction with an intramedullary nail and cement-molded humeral head for the malignant bone tumors of the proximal humerus, which performed between August, 1992 through the April, 1998. The diagnoses included the osteosarcoma in 7 patients, chondrosarcoma in 3, the recurrent giant cell tumor in 3, metastatic tumor in 3, multiple myeloma in one patient and the one patient with malignant fibrous histiocytoma. The mean age at the time of surgery was 38 years(range, 15-73 years). The mean follow-up period was 26 months(range, 6-67 months). Results : Average functional score by ISOLS evaluation system was 21.1(70.3%). There were 3 local recurrences and 5 distant metastases. There were one case of shoulder instability and one case of deep infection. The seven patients are continuously disease free state and seven patients are alive with disease. Four patients died from the disease. Conclusion : The limb salvage surgery with intramedullary nailing and cementization in the bone tumors of the proximal humerus may be considered an option for the malignant bone tumors of the proximal humerus in selected patients.

• The Journal of the Korean bone and joint tumor society
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• v.6 no.2
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• pp.69-76
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• 2000

Purpose : Tumors of the foot and ankle are uncommon compared with those arising in the other sites, and the malignant tumors are rare. We analyzed the data of patients who have been diagnosed as having a tumor of the foot and ankle. Materials and Methods : Between 1989 and 1998, we treated 72 patients and analyzed on their clinical characteristics retrospectively. Results : Fifty-three cases were benign. Included are 30 cases of soft tissue tumor and 23 cases of bone tumor. Malignant tumor was in 19 cases (26%), including 17 cases of soft tissue tumor, one cases of metastatic tumor. The most common benign tumor was fibroma in soft tissue and osteochondroma in bone. Malignant melanoma was the most common malignant tumor of the foot (7 cases). The predilection site for benign tumors was around toes while for the malignant tumor mostly arises in the heel. Among 19 malignant tumors, local recurrence developed in 3 cases and the distant metastasis occurred in 8 cases. Conclusion : The ratio of malignant tumor and metastasis was high. Therefore, when we faced with a tumor of the foot and ankle, the histopathologic confirmation is essential through biopsy before the definite initial treatment.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.48-54
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• 2007

Purpose: To evaluate clinical results of the tumor prosthetic replacement for pathologic fracture of the proximal femur with extensive bony destruction due to metastatic bone tumors. Materials and Methods: From 2005 October to 2006 October, resection of proximal femur and tumor prosthesis replacement was performed for metastatic bone tumors extensively involving trochanteric area in 6 patients. The mean age of overall patients was 61(range, 48~77). Mean clinical follow up was 10.5 months (range, 6~16). Primary tumor consisted with multiple myeloma in 2 patients, lung cancer in 1, breast cancer in 1, transitional cell carcinoma of the renal pelvis in 1, unknown origin in 1 patient. $MUTARS^{(R)}$ proximal femur (Implantcast, Munster, Germany) were used in all cases. The functional evaluation in the lower extremities was performed with Musculoskeletal Tumor Society 1993 scores. The degree of pain relief after surgical treatment was assessed with Visual Analogue Scale (VAS). Results: At the final follow up, all of the patients survived. The mean lower extremities functional score of Musculoskeletal Tumor Society 1993 was 17.8(59.3%)(range, 12~25). VAS was improved to 2.5 from 8.5 after the surgical treatment. Ambulation was encouraged as soon as possible and mean duration after surgery for ambulation was 7.3(range, 3~16) days. Post-operatively, there was no surgical infection, periprosthetic fracture or loosening. Dislocation occurred in one out of six cases. Conclusion: Resection of proximal femur and tumor prosthesis replacement for metastatic bone tumors around proximal femur extensively involving trochanteric area seems to be safe procedure in view of post-operative complication, and effective for functional restoration as well as pain relief. Thus, it is accordant to the treatment principle of the metastatic bone tumors.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.120-123
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• 2004

Benign and malignant bone tumors occur most commonly around the knee. The proximal tibia is the most technically demanding site for limb salvage surgery. The most difficult problem using an endoprothesis for proximal tibial resection has been reconstruction of the extensor mechanism. After excision of proximal tibia, we resected distal femur and made a composite with resected distal femur, low heat treated autogenous proximal tibia and endoprothesis. Patella was fixed into the resected down-loaded distal femur. This article shows the new technique and the results of reconstruction of extensor mechanism after prosthetic replacement of the proximal tibia.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.1
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• pp.1-12
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• 2004

Purpose: The current study was performed to analyze the oncological and functional results, and the patient, the limb and the prosthesis survival of osteosarcoma around the knee in children according to the treatment options. Materials and Methods: From 1982 to 2002, 63 patients with osteosarcoma around the knee underwent surgical treatments before 16 years of age. Surgical treatment options were amputation, endoprosthetic replacement, and implantation of low heat-treated autogenous bone graft after wide resection of tumor. The mean age of patients was 11.5 years (4.4~16), and the mean follow-up period was 6.1 years (2.1~16.8). All patients had neoadjuvant and adjuvant chemotherapy. All endoprosthses were extendible types. Anatomical locations of osteosarcoma were distal femur in 40 patients, and proximal tibia in 23 patients. As regard to Enneking stage, 4 patients had stage $II_A$, 50 patients had stage $II_B$, and 9 patients had stage III tumors. Results: The 5 year survival rate of stage $II_B$ patients was 72.7% in amputation, 83.7% in endoprosthesis, and 100% in low heat-treated autogenous bone graft. The 5 year survival rate of salvaged limb was 84.4% in endoprosthesis, and 80% in low heat-treated autogenous bone graft. The survival rate of prosthesis was 92.7% at 5 years, 67.4% at 10 years in endoprosthesis, and 75% at 5 years in low heat-treated autogenous bone graft. Mean functional outcome scores were 8.7 points in amputation, 20.6 points in endoprosthesis, and 16 points in low heat-treated autogenous bone graft. Distant metastasis occurred 15.8% in amputation, 27% in endoprosthesis and local recurrence occurred 8.1% in endoprosthesis, 14.3% in low heat-treated autogenous bone graft. Major complications happened 26.3% in amputation, 35.1% in endoprosthesis, and 28.6% in low heat-treated autogenous bone graft. Conclusion: Limb salvage procedure had functionally better results than amputation in children with osteosarcoma around the knee. Reconstruction with endoprosthesis after resection of tumor had good results in children as adults. In certain circumstances as too small bone for endoprosthesis or minimal bony destruction or too skeletally immature patient, low heat-treated autogenous bone graft may be a good treatment option. Low heat-treated autogenous bone graft may be considered as not only a substitute for endoprosthesis but also a temporary method before endoprosthesis.

• The Journal of the Korean bone and joint tumor society
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• v.15 no.2
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• pp.93-103
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• 2009

Purpose: We evaluated the outcomes of surgical reconstructions using recycled autograft augmented with VFG for bone defects caused by tumor resections. Materials and Methods: Ten patients with a malignant or locally aggressive bone tumor who were managed with recycled autograft augmented with VFG and followed up minimum 1 year were evaluated for bone union, functional result and complications. The influence of various factors on bone union and functional outcomes were also analyzed. Results: Bone unions were obtained at 13 of 20 junctions. Average union time was 3.7 months at metaphyseal junctions and 8 months at diaphyseal junctions (P<0.05). At diaphyseal junctions, younger aged group and intramedullary location group showed earlier bone union (P<0.05). The mean functional score was 81%. There were 3 nonunions, 4 delayed unions and 2 recycled bone resorption combined with fractures. Conclusion: To obtain excellent results, proper microvascular technique, sufficient length of VFG bridging both junctions, stable internal fixation and protection of reconstructed bone until union are necessary.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.199-202
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• 2009

Desmoplastic fibroma of bone is an extremely rare tumor that was first described by Jaffe in 1958. It histologically resembles the desmoid tumor of soft tissue. It is known as locally aggressive tumor but we experienced definitely benign and resembling simple bone cyst radiographically. We report a case of desmoplastic fibroma of bone and it should be included in the differential diagnosis list of any lytic bone lesion. The radiograph, MR imaging features, radiological and pathological differential diagnosis of the case are described, and literatures are reviewed.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.194-198
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• 2005

Chondroblastoma is relatively rare benign neoplasm with predilection for the epiphysis of long bones. Benign chondroblastomas of bone compromise approximately 1% of benign bone tumors in several reported series. Chondroblastoma in the carpus is extremely rare in english literature. We report the case of a chonroblastoma in the carpal scaphoid.