• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.37-42
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• 2007

Purpose: Because of the anatomical characteristics, it is difficult to perform radical operation in spinal tumor. Numerous operations on primary and metastatic spinal tumor have been performed and among those total en bloc spondylectomy has produced decent clinical result. Clinical and radiological results have been analyzed based on five total en bloc spondylectomy on primary and metastatic spinal tumor. Materials and Methods: Patients included in this study were one with primary and four with metastatic spinal tumors, from June 1997 to January 2006. Two of the four were originated form kidney. One was from breast and the other one was not identified. McAfee's 4 point scale, VAS and Frankel's classification have been used as clinical assessment of pain and neurological symptoms. Clinical assessment have been conducted for every 3 months after operation including local recurrence, bone union and complications. Results: Assessment of pain decreased from average of 3 before operation to 1.6 after operation in McAfee's scale and VAS decreased from average of 9.2 to 1.6. Neurological deficit after operation improved from C to D in Frankel's category. Local recurrence has been detected on metastatic adenocarcinoma of L4 during follow up. Conclusion: Total en bloc spondylectomy is evidently useful operational method for primary and metastatic spinal tumor since it completely decompresses spinal nerves, decreases axial pain immediately and improves the quality of remaining life.

• The Journal of the Korean bone and joint tumor society
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• v.12 no.2
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• pp.148-154
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• 2006

Purpose: Numerous operations on primary and metastatic spinal tumor have been performed and among those total en bloc spondylectomy has produced decent clinical result, This article introduce 1 case of metastatic spine tumor of C3,C4 who treated with total en bloc spondylectomy.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.1
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• pp.44-50
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• 2008

Purpose: To evaluate usefulness in diagnosing primary malignant lesion of metastatic bone tumor using $^{18}F$ FDG PET/CT. Material & Methods: Retrospective analysis was executed on 5,452 patients who were taken with $^{18}F$ FDG PET/CT between December 2003 and December 2007. 180 patients who had not any history of malignancy and complained musculoskeletal pain and had ill-defined osteolytic lesion in plain X-ray, were included. 96 male and 84 female were enrolled and mean age was 59.1 year old (22~90). We analyzed diagnostic accuracy, age and sex distribution of primary malignant lesion, location of metastatic lesion. Results: We could confirmed primary malignant lesion in 152 cases (84.4%). Most common malignant primary lesion was lung (28.3%), breast (18.9%) and gastrointestinal system (16.7%) and spine was the most common metastatic location of primary malignant lesion. Conclusion: $^{18}F$ FDG PET/CT is a effective molecular imaging detecting primary malignant lesion in patients having metastatic bone lesion without history of malignancy.

• 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.7 no.4
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• pp.133-138
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• 2001

Purpose : To analyze the clinical behaviors and survivorship of metastatic bone tumors. Materials and Methods : One hundred and ninty-eight metastatic bone tumors had been diagnosed from January 1982 to December 1998. Age and sex distribution, primary cancer types. metastatic sites, duration from diagnosed of primary tumors to bony metastases and survivorship were analysed. Results : Mean age was 57(24~86) years old. Lung(32.3%) and breast(16.2%) cancers were two most common primary foci. The spines was the most common site of metastases especially lumbar region(38%). Survivorship analysis was done in one hundred and fifteen patients who had been followed up. The mean survival period was 15.3 months. The survivorship of hepatoma(7.1 Mons), lung(8.72 Mons) and renal cell(4.8 Mons)cancers was relatively shorter and breast cancer(54.1 Mons) longest. Conclusion : The mean age of metastatic bone tumors of this study was older than the past reports. The axial skeletons especially spine was predominant metastatic site. The survivorship of metastatic bone tumor decreased sharply as time goes by, so early diagnosis is clue for longer survival after bony metastases.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1340-1344
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• 2001

This is a rare case of cerebral metastasis from malignant fibrous histiocytoma(MFH) of the soft tissue. A 62-year-old man underwent craniotomy for resection of multiple intracerebral masses under the impression of metastatic brain tumor with unknown primary site. Preoperative investigation failed to detect any extracranial lesion. At six months after the operation and whole brain radiotherapy, right shoulder mass was detected to grow and excised. Specimen from the brain and shoulder lesions revealed identical pathological findings of malignant fibrous histiocytoma except existence of glial fibrillary acidic protein(GFAP)-positive cells only in brain lesions. Palliative radiotherapy was performed for subsequently developing metastatic lesions in skeletal system. At twelve months after initial diagnosis recurrent lesion at right shoulder was detected and chemotherapy is given. This case is unique because metastatic brain lesion from MFH is rare and also cerebral metastasis as an initial manifestaion of MFH has not been reported before. Another important finding is that there was expression of GFAP only in brain lesions but not in extracranial primary site lesion. Although the presence of GFAP-positive cells is thought as one of characteristic histological findings of primary intracrainal MFH, our observation supports the hypothesis that GFAP-positive cells in primary intracranial MFH may be nonneoplastic astrocytes secondarily involved by MFH.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.93-99
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• 2002

Purpose : We intended to decrease late CNS reaction after radical radiotherapy for an intracranial germinoma by using combined neoadjuvant chemotherapy and involved-field radiotherapy. The efficacy in terms of its acute toxicity and short-term relapse patterns was analyzed. Materials and Methods : Eighteen patients were treated with combined neoadjuvant chemotherapy and radiotherapy between 1995 and 2001. The chemotherapy regimen used was the Children's Cancer Group (CCG) 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) for 5 patients younger than 16 years, BEP (bleomycin, VP-16, cisplatin) for 12 patients, and EP (VP-16, cisplatin) for 1 patient. The radiotherapy covered the whole craniospinal axis for 5 patients, the whole brain for 1, and the partial brain (involved field) for 12. the primary lesion received tumour doses between 3,960 and 5,400 cGy. Results : The male to female ratio was 16:2 and the median age was 16 years old. The tumors were located in the pineal gland in 12 patients, in the suprasellar region in 1, in the basal ganglia In 1, in the thalamus in 1. Three patients had multiple lesions and ventricular seedings were shown at MRI. In 3 patients, tumor cells were detected in the cerebrospinal fluid and MRI detected a spinal seeding in 2 patients. The response to neoadjuvant chemotherapy was complete remission in 5 patients, partial remission in 12, and no response in 1. However, after radiotherapy, all except 1 patient experienced complete remission. The toxicity during or after chemotherapy greater than or equal to grade III was remarkable; hematologic toxicity was observed in 11 patients, liver toxicity in none, kidney toxicity in none, and gastrointestinal toxicity in one. One patient suffered from bleomycin-induced pneumonitis. Radiotherapy was therefore stopped and the patient eventually died of respiratory failure. The other 17 are alive without any evidence of disease or relapse during an average of 20 months follow-up. Conclusion : A high response rate and disease control was experienced, which was the same as observed other studies and the morbidity from chemotherapy-induced toxicity was similar. With these results, the results from adjuvant chemotherapy and involved-field radiotherapy cannot be concluded to be equal to those from extended-field radiotherapy. The long term follow-up study on later complications are required in order to draw definite conclusions on the optimal management with minimum side effects.