• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.54-59
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• 1996

Liposarcoma is second in frequency only to malignant fibous histocytoma among the soft tissue sarcoma. Many different factors which might affect the survival rate of liposarcoma have been reported by many authors. The purpose of this study was to evaluate survival rate of liposarcoma and define the prognostic factors that affected survival rate. The authors analysed retrospectively 17 patients of liposarcoma in extremities from May 1984 to Dec. 1995 who had been treated in department of orthopaedic surgery of Kosin University Medical Center. All cases were resected with marginal or wide margin. There were 9 men and 8 women. The mean age was 48 years. The follow-up period ranged from 15 to 96 months. We compared the prognosis of the patients with several factors; age, sex, surgical staging, size, site, histologic type and treatment modality. At last follow-up, the presence of local recurrence was in 3 cases and the presence of lung metastasis was in 8 cases. The survival rates by Kaplan-Meier product limit method at 2 years and 5 years were 87% and 57% respectively. The statististically significant difference was estimated in histologic type, but was not estimated in age, sex surgical staging, size, site and treatment modality. In conclusion, the histologic type is considered as the most important factor of the prognosis in liposarcoma. Although it was too few patients for the differences to be statistically significant, we consider that surgical staging, site, size, the radio-therapy and chemothrapy in liposarcoma will affect the prognosis.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.60-64
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• 1996

Giant cell tumor of tendon sheath is a slow-growing, unilateral and solitary lesion that is most commonly seen in the digits of the hand and knee, but occasionally occurs in the hips, ankles, toes and wrists. The lesion is asymptomatic or mildly painful, especially if it is diffuse and located in a major joint. The concepts concerning about the pathogenesis of these lesion have undergone constant revision, which include neoplastic process, inflammation and lipid metabolism. Authors analysized 20 patients with giant cell tumor of tendon sheath about the etiology, clinical findings, pathologic findings and treatment results. The results were as follows: 1. 13 cases were females (65%) and 7 cases were males (35%), and the range of age was from 9 years old to 60 years old. 2. The hand was most frequently involved site in which 14 cases (70%) were included, and the foot was involved in 5 cases (25%). 3. Solitary lesions were 15 cases and multiple lesions were 5 cases. 4. Radiographically, in 3 cases bony erosion was seen. 5. All cases were treated by surgical excision and presented no recurrence. In conclusion, the giant cell tumor of tendon sheath, which has been considered to be benign tumorous conditions appeared to be necessary for complete surgical excision to prevent recurrence.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.78-87
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• 1996

The results of treatment of eighteen lesions of fibrous dysplasia which of them seventeen lesions were treated with surgery were reviewed at the Department of Orthopedic Surgery, College of Medicine, Hanyang University Hospital. We studied to evaluate the functional clinical results and the recurrence according to the type of disease, grafted bone, methods of treatment and location of lesion. We treated sixteen patients(five males and eleven females) and their mean age was 22.6 years. There was no association with skin pigmentation or dysfunction of endocrine system. Twelve patients had a monostotic pattern and four patients had a polyostotic pattern. Twelve lesions were treated with curettage and bone grafting and four lesions in the proximal femur were treated by internal fixation with curettage and bone grafting. One lesion was treated by en-bloc resection. There were eleven satisfactory results in twelve monostotic lesions and there were four satisfactory results in five polyostotic lesions, but the recurrence were four cases, respectively. The two unsatisfactory results were seen in two patients treated by autografting, but there were three recurrence of four lesions in autografting only, one of five in autografting and allografting, four of eight in allgrafting or xenografting. Four of six lesions in upper extremity were recurred after curettage and bone grafting and five of them showed satisfactory results. In pelvic and lower extremity lesions, the recurrence were occurred in two lesions after curettage and bone grafting and in two lesions after internal fixation and bone grafting. The recurrence does not always provide an unsatisfactory functional results and the recurrence showed higher rate in radiologic pattern of ground glass appearance with-out marginal sclerotic rim, but the recurrence according to grafted bone showed similar rates. Curettage and bone grafting is adequate for a symptomatic lesion and firm internal fixation is needed for a lesion in proximal femur. In use of grafted bone, xenograft or allograft may be preferable to autograft because of the disadvantage of autografting like a increased blood loss, prolonged operation times, etc.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.72-77
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• 1996

Metastaic bone tumors are usually accompanied with severe pain. The treatment modalities for this pain are so variable that patients are sometimes afraid of using them. Salmon calcitonin has a function to increase beta-endorphines followed by increasing the blood level of prostaglandin and thromboxan A2, which results in analgesic effect. This drug also has been known to decrease bone resorption. There were a few reports that parenteral use of salmon calcitonin decrease the pain from metastatic bone tumor. We wanted to know the effectiveness and tolerability of nasal spray of salmon calcitonin in relieving bone pain with metastatic tumor. We analyzed the effectiveness in the aspects of pain, sleep, performance status, mobility, supplementary analgesic use. The biologic effect of salmon calcitonin was analysed with CBC, Ca/P, BUN/Cr, uric acid. Simple radiography, alkaline phosphatase, osteocalcin, pyrilink-K were used as parameters for bone change. Eighteen cases of metastatic bone tumors took nasal spray of salmon calcitonin($Miacalcic^{(R)}$, 200IU/day) for 4 weeks, to relieve bone pain. With Wilcoxon Matched-Pairs Signed Ranks Test, we could find pain decreased significantly at 3 week and mobility become improved at 4 week of salmon calcitonin use. Other parameters didn't show any significant changes. We think the analgesic effect is mainly due to effect not on the local bone lesion but on the central nervous system, and that increased dose of salmon calcitonin can induce earlier and stronger analgesic effect.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.88-93
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• 1996

Neurilemmomas are the most common benign tumor of the peripheral nerve trunks, and arises from the cells in the sheath of Schwann. Neurilemmomas are well encapsulated and may be separated easily from surrounding tissue and lie completely within a larger nerve trunk, with bundles of neurofibrils spread out over the surface of the tumor. A careful dissection and retraction of the nerve bundles will allow the tumor to be enucleated from the parent nerve without any significant interference with the function of the nerve. Resection of the involved nerve is seldom necessary and should be avoided if at all possible. Our aim in microscopic excision of neurilemmoma of extremities is to reduce any disturbance of the intact neurofibrils of the parent nerve. Thirteen cases of neurilimmomas were treated by microscopic excision at the Department of Orthopaedic Surgery, Korea University Hospital between January 1990 and March 1995. The results was as follows ; 1. The average age at surgical intervention was 40.1 years. Cases in fourth and fifth decades predominated. 2. In their anatomical distribution, 8 cases were in the upper extremity and 5 cases in the lower extremity. 11 cases were on the flexor surface. 3. On the operative field, all the tumors were well encapsulated, however 1 case of 13 was adherent to the periosteum of fibula. 4. In all cases, the tumor were enucleated from the parent nerve without any injury to nerve under high-power magnification, preserving individual fascicles, and sensory and motor function.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.94-100
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• 1996

Ossifying fibroma is one of a group of fibro-osseous lesions which arises typically within the jaw bones and only rarely affects the long bones. Ossifying fibroma of the long bones almost involve exclusively the tibia but may also involve the fibula. Ossifying fibroma of the long bones is distinct from fibrous dysplasia, adamantinoma and nonossifying fibroma with regard to age of the patient, site, radiographic appearance, histological features, and clinical course. We are reporting the cases of seven patients with a tumor-like lesion that named osteofibrous dysplasia. It is most commonly found in the tibia and fibula of a child ten years of age or younger. Of the seven cases reported in this study, only one patient was younger than ten years. In all cases, the lesions were usually located in the tibial diaphysis. The average duration of clinical manifestation was 5.2 years. The clinical symptoms were anterior bowing of the tibia in 2 cases, buldging of the tibia in 2 cases, and mass overlying the tibia in 3 cases. On the roentgenography, it shows multiple radiolucent lesion with intervening sclerotic rim of the tibial diaphysis. In seven patients, 6 cases were confirmed with biopsy. We had done curettage and bone graft in three cases, VFG was done in one case. The other three cases underwent conservative management.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.27-32
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• 1996

Recent advances in imaging techniques, surgery and combination anti-cancer chemotherapy have brought high survival rates in osteosarcoma. To investigate the survival rate, local recurrence and complications in treatment, we analysed 25 osteosarcoma cases who had been treated with preoperative neo-adjuvant chemotherapy, surgery and post operative chemotherapy at Department of Orthopedic Surgery, Catholic University. From May 1988 to April 1995, 42 cases of stage IIB osteosarcoma were admitted in Department of Orthopedic Surgery. Among them, 17 cases who didn't follow our treatment guidance were excluded in this study. The average age were 19 years. There were 21 males and 4 females. The involved sites were 4 humerus, 10 femur, 10 tibia and 1 talus. Eleven cases had received intraarterial cisplatin and intravenous adriamycin chemotherapy, and 7 T-10 protocol and 7 intravenous ifosfamide, ADR, methotrexate, cisplatin. Twenty-three cases were treated with limb salvage surgery, and 2 amputation. The average follow-up was 35 months(3~82). There were 14 cases of continuous disease free, 9 cases of died of disease, 1 case of alive with disease, and 1 case of no evidence of disease at final follow-up. There were three cases of local recurrence at 6,8 and 12 months after operation. The estimated Kaplan-Meier's 5 year survival rates for all, ADR-cisplatin group, T-10 protocol group, and ifosfamide regimen group were 6%, 73%, 44% and 72%, respectively.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.17-22
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• 1999

Over 60 cases were enlisted, but only 31 cases among 24 patients were eligible with a minimum follow-up of 1 year and complete medical documents with imaging data. There were 18 boys and 6 girls, and 7 patients had bilateral lesions. The age of the patients ranged from 2 to 20 years(mean:10.5 years). At their first visit, most lesions had a highly characteristic location and radiographic appearance of radiolucent lesion(s) ranging from 1 to 3cm, except for one case of 5.5 cm in the posteromedial comer of distal femoral metaphysis. The margins were generally well-defined, although some were ill-defined. After reviewing our cases from the viewpoint of clinical course and radiographic patterns, we divided these lesions into two types. Type I is the osteolytic lesion excavated into the posteromedial aspect of the distal femur without cortical defect; and type II is the buldged out lesion of the femur with cortical irregularity into the surrounding soft tissues. Both types have distinctive clinical courses. Type I lesions were easy to make a definite diagnosis with plain radiographs alone, but in type II, it was sometimes very difficult to differentiate it from malignant tumors or chronic localized osteomyelitis. For this lesion, Gd-enhanced MRI was the most effective method for differential diagnosis. In this study, biopsy was not necessary to confirm the diagnosis. Clinical symptoms of type I were very minor or even absent. Many of them were accidentally found after minor trauma around the knee joint. Clinical symptoms disappeared far earlier than radiographical lesions. No treatment such as restriction of activity or drugs was necessary. For type II, the clinical symptoms were more accentuated and lasted longer, and it was necessary to restrict the activity for a certain period in many cases. However, all were self-limited.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.29-34
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• 1999

Chondroblastoma is an uncommon neoplasm in bone, occurring at the epiphysis or apophysis of growing long bones and is known to have a recurrence rate of around 10% after surgical treatment. We reviewed 14 patients of pathologically proven chondroblastoma, who were surgically treated, from December 1987 to August 1997. The location of tumors was proximal femur in 4 cases, distal femur in 4 cases, proximal tibia in 2 cases, patella in 1 case, proximal humerus in 1 case and calcaneus in 1 case. The most common complaint was pain. In all nine cases in which MRI was performed, the MR imaging showed a lobulated low signal intensity(SI) rim. Low SI foci within the tumor were present in 4 of 9 cases and corresponded to calcification seen on radiographs or CT. Bone marrow edema was also present in 4 of 9 cases on MR imaging. The average duration of follow-up was 2 years, 5 months, ranging from 1 year to 7 years, 2 months. Twelve patients were treated by curettage and autogenous bone graft, one by curettage only, and one by curettage and bone cementing. Two cases which showed local recurrence were treated with curettage and bone graft. Two recurred cases had the presence of bone marrow edema on MR imaging. The presence or absence of bone marrow edema may be a useful indication of tumor activity, although further study will be required.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.44-50
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• 1999

Neurilemmoma is a benign encapsulated nerve sheath tumor originated from peripheral nerve. Previously its preoperative diagnosis had mainly depended on the history, physical examination, electrodiagnostic test, ultrasonography, bone scan. But only with these diagnostic modalities, exact preoperative diagnosis was nearly impossible. Therefore operation was performed under the impression of lipoma or just simple soft tissue tumor. Recently, the advent of magnetic resonance imaging(MRI) has made it easier to diagnose neurilemoma before surgery. MRI also helps to determine the extent of lesion and operative procedures. We performed marginal excision in 24 cases, evaluated those cases with respect to the sex, age, location, chief complaint, duration of illness, preoperative diagnosis, involved nerve, imaging studies, size of mass, complication, duration of follow-up and report with review of the literature.