• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.111-117
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• 2001

Introduction : The Functional muscle transfer is used to reconstruct the injuried muscle and paralysis of the shoulder. Especially transfer of the trapezius has been the treatment of choice but it has disadvantages of inadequate function and deformed contour, and instability of humeral head in case of acromion resection. We report an operation for shoulder reconstruction after wide resection of malignant fibrous histiocytoma, using rotational latissimus dorsi flap and review the operation method and clinical outcome. Materials and Methods : A patient, 53 year old, with malignant fibrous histiocytoma in the acromioclavicular joint area had been underwent wide excision, including the deltoid, clavicular head of pectoralis major, part of trapezius, lateral 1/3 of clavicle and acromion including scapular spine. The rotational latissimus dorsi flap with its neurovascular pedicle was dissected and then placed over the resected area and transfer of muscle attached at coracoid process was done to achieve stability of the humeral head. The range of motion of the shoulder and test of muscle power were evaluated for functional outcome. Total follow-up period is 2 years 11 months. Results : At last follow-up, the range of motion of the shoulder is abduction $90^{\circ}$, flexion $90^{\circ}$, internal rotation $40^{\circ}$, external rotation $50^{\circ}$ and the muscle power is 4 grade in all direction and then we obtained good functional results. There are no complications such as instability or subluxation of the humeral head and deformed contour and he is a disease-free survival state. Conclusions : The transfered latissimus dorsi flap provides adequate lever arm and stabilization and covering of the humeral head by sufficient muscle volume and width. This procedure can be useful not only for the paralysed deltoid reconstruction but also for use in reconstructive surgery after wide resection of the shoulder for malignant tumor.

• Tuberculosis and Respiratory Diseases
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• v.38 no.3
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• pp.309-316
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• 1991

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of late adult life. This tumor occurs principally as a mass on an extremity or in the abdominal cavity or retroperitoneum of adult but primary pulmonary MFH is rare. MFH may be subclassified into storiform-pleomorphic, myxoid, giant cell, inflammatory, and angiomatoid type and the prognosis is no different among the histologic subtypes. We experienced one patient who was consistent with primary MFH of the lung. The patient complained dyspnea and intermittent hemoptysis and showed bilateral suprahilar mass on simple chest film and chest CT. Histological findings by open lung biopsy was storiform-pleomorphic type and individual cells showed histiocyte-like and fibroblast-like appearance.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Journal of Chest Surgery
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• v.33 no.4
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• pp.333-337
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• 2000

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5$\times$8$\times$4cm with a 3$\times$3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.

• The Journal of the Korean bone and joint tumor society
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• v.8 no.1
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• pp.12-19
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• 2002

Purpose : Giant cell tumors(GCT) sometimes undergo malignant transformation after the radiotherapy, but very rarely do without radiotherapy. We reviewed the clinical experiences of the malignant transformation of GCT to suggest the guidelines for diagnosis and treatment of them. Materials and Methods : We examined four patients of pathologically proven malignant transformation of GCT, which occurred after the operative treatment alone without radiation, from September 1985 to January 2001. The mean follow-up period after the malignant transformation was 2.4 years(range, 1.3~4 years). Results : The mean time-interval from the initial diagnosis to the malignant transformation was 6.9 years(range, 2.2~13.5 years). The locations of tumors were soft tissues of proximal upper arm, proximal femur, distal femur and proximal tibia. The histology of malignant GCT was osteosarcoma in 3 cases and malignant fibrous histiocytoma in 1 case. Local recurrence developed in 1 patient and the pulmonary metastasis developed in 3 patients which transformed to osteosarcoma. Conclusion : Thorough sampling of the surgical specimen appears to be a very important factor for diagnosing the malignant transformation of GCT. In case of suspicion of malignancy in radiographs, the incisional biopsy should be followed by definite treatment rather than the improper resection.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.110-115
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• 1999

Pulmonary histiocytosis X is a granulomatous disorder of the lung of unknown cause. Patients with this disease often complain of cough, dyspnea on exertion and, occasionally, chest pain from pneumothorax or bone involvement. However, DI is uncommon in these patients. We report a case of primary pulmonary histiocytosis X with central diabetes insipidus. A 23-year-old man presented with dyspnea suffered from dry cough, exertional dyspnea, polydipsia and polyuria for 4 months. He was a heavy smoker. He was found to have reticulonodular interstitial opacities on chest X-ray film. High-resolution computed tomography revealed thin-walled cysts of various sizes in both lungs. Open lung biopsy was done. On light microscopic examination revealed proliferation and infiltration of Langerhans cells. Immunohistochemically, Langerhans cells showed strong cytoplasmic staining with S-100 protein and electronmicroscopic examination showed Birbeck granules in Langerhans cells. Water deprivation test showed central-type diabetes insipidus and brain MRI showed no abnormal lesion on suprasellar region. Smoking cessation was recommended. He was treated with oral desmopressin.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.485-495
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• 1998

Purpose : The major goal of the therapy in the soft tissue sarcoma is to control both local and distant tumor. However, the technique of obtaining local control has changed significantly over the past few decades from more aggressive surgery to combined therapy including conservative surgery and radiation and/or chemotherapy. We retrospectively analyzed the treatment results of the postoperative radiation therapy of soft tissue sarcoma and its prognostic factor. Materials and Methods : Between March 1983 and June 1994, 50 patients with soft tissue sarcoma were treated with surgery and postoperative radiation therapy at Kang-Nam St. Mary's hospital. Complete follow up was possible for all patients with median follow up duration 50 months (range 6-162 months). There were 28 male and 32 female patients. Their age ranged from 6 to 83 with a median of 44 years. Extremity (58$\%$) was the most frequent site of occurrence followed by trunk (20$\%$) and head and neck (12$\%$). Histologically malignant fibrous histiocytoma (23$\%$), liposarcoma (17$\%$), malignant schwannoma (12$\%$) constitute 52$\%$ of the patients. Daily radiation therapy designed to treat all areas at a risk for tumor spread upto dose of 4500-5000 cGy. A shrinking field technique was then used and total 55-65 Gy was delivered to tumor bed. Twenty-five patients (42$\%$) received chemotherapy with various regimen in the postoperative period. Results : Total 41 patients failed either with local recurrence or with distant metastasis. There were 29 patients (48$\%$) of local recurrence. Four patients (7$\%$) developed simultaneous local recurrence and distant metastasis and 8 patients (13$\%$) developed only distant metastasis. Local recurrence rate was rather higher than of other reported series. This study included patients of gross residual, recurrent cases after previous operation, trunk and head and neck Primary This feature is likely explanation for the decreased local control rate. Five of 29 Patients who failed only locally were salvaged by re-excision and/or re-irradiation and remained free of disease. Factors affecting local control include histologic type, grade, stage, extent of operation and surgical margin involvement, lymph node metastasis (p<0.05). All 21 patients who failed distantly are dead with progressive disease at the time of this report. Our overall survival results are similar to those of larger series. Actuarial 5 year overall survival and disease free survival were 60.4 $\%$, 30.6$\%$ respectively. Grade, stage (being close association with grade), residual disease (negative margin, microscopic, gross) were significant as a predictor of survival in our series (p<0.05). Conclusion : Combined surgery and postoperative radiation therapy obtained 5 year survival rate comparable to that of radical surgery.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.439-445
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• 2008

Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.