• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6451-6455
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• 2015

Background: Primary bone neoplasms are rare, contributing only 0.2% of the global burden of all human malignancies. Osteosarcoma (OS) and chondrosarcoma (CS) are the most common malignancies of bone. The giant cell tumor of bone (GCTb) is a benign tumor with behavior characterized by osteolytic bone destruction. The OS, CS and GCTb affect both sexes, all races and generally have incidence peaks regarding the age of the patient which vary according to the tumor type. We analyzed the incidences of OS, CS and GCTb and their relations with gender and age in patients treated in the National Rehabilitation Institute (INR, for its acronym in Spanish) over a period of nine years. Materials and Methods: In the study period, clinic pathological data for 384 patients were obtained with clinical, radiological and histopathological diagnosis for OS, GCTb and CS. Data analysis was performed using the chi-square and Fisher's exact tests. Results: From 2006 to 2014 were recorded 384 cases of bone malignancies in the database of INR. The GCTb had the highest incidence (53.1%), followed by OS (31.3%) and finally the CS (15.6%). The overall average age was $33.6{\pm}15.8$ years and the overall frequency of gender had a ratio of 1/1.03 male/female. The states with the highest incidence were Distrito Federal and Estado de Mexico with 29.2% and 25.3% respectively. Malignant neoplasms of bone assessed in the course of nine years show three significant increases in 2008, 2011 and 2014 (p=0.14). We found association between sex and tumor type (p=0.03), GCTb and CS predominated in females (54.9% and 56.6% respectively), while for the OS males were most affected (59.1%). Age was different in relation with tumor type (p=0.0001), average age was $24.3{\pm}11.2$ years for OS, $34.5{\pm}13$ years for GCTb and $49.2{\pm}18.5$ years for CS. Furthermore, associations of tumor type with topographic location of the primary tumor (P=0.0001) were found. Conclusions: In this study we can see that incidence of musculoskeletal tumor in our population is continuously increasing and in nine years an approximately 200% increase of musculoskeletal tumor cases was observed.

• 대한골관절종양학회지
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• 제1권2호
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• pp.145-153
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• 1995

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

• 대한족부족관절학회지
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• 제11권1호
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• pp.1-7
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• 2007

Purpose: Tumors arising in the foot and ankle are uncommon and the malignant tumors are known to be rare compared with those of the other sites. We analyzed the clinical data of patients who have been diagnosed as having a tumor of the foot and ankle. Materials and Methods: From 1989 to 2006, we analyzed 185 patients who have been treated surgically and were pathologically confirmed of having tumors of the foot and ankle. Their clinical characteristics were reviewed retrospectively. Results: One hundred and fifty-seven cases were benign (84.9%) and 28 cases (15.1%) were malignant. 108 cases (58.4%) were benign soft tissue tumors and 49 cases (26.5%) were benign bone tumors. Malignant tumors included 17 cases (9.2%) of soft tissue tumors, 8 cases (4.3%) of primary bone tumors and 3 cases (1.6%) of metastatic bone tumors. The most common benign soft tissue tumor was ganglion (23 cases). Enchondroma (9 cases) was the most common among the benign bone tumors. Malignant peripheral nerve sheath tumor was the most common malignant tumor (4 cases). The predilection site for benign tumors was at the forefoot around toes while for the malignant tumor was around the ankle. 4.6% of benign soft tissue tumors and 8.2% of benign bone tumors had locally recurred and 14 cases (50%) of malignant tumor were confirmed as having distant metastasis. Conclusion: The ratio of malignant tumor and its metastasis rate was high. Therefore, the histopathologic confirmation is essential when treating tumors of the foot and ankle.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권1호
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• pp.33-41
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• 2007

Bone scan using radioactive isotope can be more effective than conventional X-ray radiograph for finding jaw lesion because it takes an image of the physiologic change of bone. This study is designed to show how available bone scan is able to diagnose jaw lesion better than simple X-ray and CT, as well as to determine a basis of diagnosis for jaw lesion using bone scan. The 77 patients, visiting the Oral & Maxillofacial Surgery, Department of Dankook University Hospital from January 2002. to August 2005. who were diagnosed histopathologically with postoperative malignant tumor, osteomyelitis, and bone infiltrative benign disease. Preoperative X-ray, CT, bone scan were taken and were compared with histopathologic finding. Also to compare specificty of each lesion in bone scan, bone density was measured to compare. The results were as follows. 1. Among the 25 cases of oral malignant tumor of bony invasion, a positive diagnosis associated with histopathologic evaluation, 22 cases(88%) in bone scan, 14 cases(56%) in CT image, and 10 cases40%) in simple X-ray. 2. Among the 31 cases of osteomyelitis, a positive diagnosis associated with histopathologic evaluation, 30 cases(97%) in bone scan, 23 cases(74%) in CT image, and 19 cases(61%) in simple X-ray. 3. Among the 11cases of bone infiltrative benign disease, a positive diagnosis associated with histopathologic evaluation, 11 cases(100%) in bone scan, 10 cases(91%) in CT image, and 6 cases(55%) in simple X-ray. 4. Measurement of bone density in each group showed no statistical significant difference between malignant tumor and osteomyelitis as well as benign bone disease. But, a statistical significance was seen between osteomyelitis and benign bone disease. From this results, bone scan are more sensitive than simple X-ray and CT image in jaw lesion diagnosis, but specificity shows no significant difference. Therefore, it should be suggested that evaluation of bone scan must be carrying out in reference to final histopathologic diagnosis.

• 대한골관절종양학회지
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• 제1권1호
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• pp.23-29
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• 1995

Recently limb-salvage operation is widely used for the treatment of malignant bone tumor. But distal leg is out of range of limb-salvage operation due to its technical problem. We report satisfactory limb-salvage operation with tumor prosthesis in 3 cases of osteosarcoma of the distal tibia and fibula. Two cases involved in the tibia and 1 case in the fibula. Average age at operation was 23 years. Neoadjuvant and adjuvant chemotherapy were performed in all 3 cases. We used custom made tumor prosthesis which is designed by Seoul National University Orthopaedic Department. Overall Functional Evaluations by Enneking rating system were good in all 3 cases. All cases are CDF(continuosly disease free since the surgical procedure) state at mean follow-up 2 year and 9 months. In conclusion limb-salvage with tumor prosthesis is useful treatment modality for malignant bone tumor of distal tibia and fibula. Good functional results and few complications suggests limb salvage of distal lower leg may be replaceable with B-K amputation.

• 대한골관절종양학회지
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• 제9권2호
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• pp.139-147
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• 2003

목적: 양성 골종양을 치료하기 위해 골이식 대체물을 이식하였을 때 골 유합을 얻을 수 있는지 여부와 골 이식 대체물 중 황산칼슘(calcium sulfate)과 수산화인회석 (hydroxyapatite)을 이용하여, 골 이식술 후 유합 정도를 비교하여 골 치유 과정에 대한 두가지 골 이식 대체물의 차이점을 보고하고자 한다. 대상 및 방법: 양성 골종양 환자 중 병소의 소파술 시행 후 골 이식 대체물을 이식한 20례를 대상으로 술전후 단순 방사선 소견상 병소 크기, 신생골의 형성, 병소의 재발 여부와 이식 후 조직학적 소견을 관찰하였다. 결과: 총 20례 중 남자가 13례, 여자가 7례였으며 평균 연령은 15.8세(2~5), 술 후 평균 추시 기간은 3년이었다. 방사선 사진상 병소의 면적은 평균 30.7 $cm^3$였으며, 최종 추시상 전체 20례 중 19례에서 성공적인 결과를 보였으며, 1례에서 병소의 재발을 보였다. 나이, 병소 크기와 병변 종류에 따른 차이는 관찰되지 않았다. 결론: 황산칼슘은 생체 적합성이 뛰어나고, 골 전도 작용이 있으며 새로운 골형성에 비례하여 생체내로 흡수되는 특성을 보였고, 이에 반해 수산화인회석은 골 전도 작용이 있지만, 병변의 크기나 주위 환경에 따라 자가골, 자가 골수 이식, 이종골과 병행 사용시 양호한 골치환 결과를 얻을 수 있을 것으로 사료되며, 황산칼슘에 비해 더 느리게 생체내로 흡수되는 결과를 보였다.

• 대한골관절종양학회지
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• 제20권1호
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• pp.41-45
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• 2014

성장기 인접 성장판에 영향을 주어 하지의 외반 변형을 보이는 대퇴골 종양이 발견되었다. 골간에 긴 골수내 종양은 성장판 근처의 골간단에서 격막에 의해 나누어졌으며 병리 검사상 저등급 연골육종으로 진단 되었다. 성장기 점진적 하지 변형이 골종양의 성장판 영향에 따른 증상일 수 있다.

• 대한골관절종양학회지
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• 제1권1호
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• pp.52-59
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• 1995

Metastatic cancer is the most common tumor of the skeleton. The prevalence of pathologic fracture may increase as patient survival is prolonged by improved cancer therapy. With recent advances in orthopaedic procedure and medical management of terminal cancer patients, it is generally agreed that aggressive treatment should be undertaken for patient with pathologic fracture secondary to metastatic disease, and a team approach should be utilized. The authors have reviewed twenty cases of pathologic fracture of the long bone due to metastatic tumor treated in the Department of Orthopedic Surgery, Yonsei University College of Medicine, from April 1989 to April 1994 and the following results were obtained. 1. The mean age at surgery was 58.4 years (ranged from 24years to 86years) and among 20 cases, 10 cases were male and the others were female. 2. The most frequent site of pathologic fracture in long bone is femur(15 cases, 75%), and followed by humerus(4 cases, 20%), tibia(1 case). 3. The frequently encountered primary tumors that metastases to long bone are those of the lung(7 cases, 35%), breast(4 cases, 20%), and prostate(2 cases, 10%). 4. The operative procedure was performed by resection of the tumor mass extensively, and we used polymethylmetacrylate for filling the dead space after resection, in all cases. 5. The mean survival period after operation is 9.2 months(ranged from 1 month to 4 years and 9 month). 6. The results of postoperative pain relief status were graded as fair to excellent in 17 cases(85%).

• 대한골관절종양학회지
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• 제20권1호
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• pp.7-13
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• 2014

목적: 대퇴골 근위부에 발생한 악성 골 종양의 치료로 사지 구제술을 시행하는 경우 환자의 생존과 더불어 술 후 보행 등의 기능회복이 중요하다. 대퇴골 근위부의 악성 골 종양에 의한 통증 또는 병적 골절이 발생한 환자에 대하여 종양 대치물을 이용한 사지 구제술 시행 후 임상 결과에 대해서 분석하였다. 대상 및 방법: 2005년 2월부터 2014년 1월까지 대퇴골 근위부 악성 골 종양을 진단 받고 통증 또는 병적 골절이 발생하여 대퇴골 근위부 절제술 및 종양 대치물을 이용한 사지 구제술을 시행한 20예(19명)를 대상으로 하였다. 평균 연령은 63.1세(범위 35-86세)였으며 남자가 14예, 여자가 6예였다. 평균 추시 기간은 20개월(1-94개월)이었고, 전이성 골 종양 15예, 골육종 4예, 다발성 골수종 1예였으며, 전이성 병변의 원발 암은 폐암 4예, 간암 3예, 신장암 3예였고, 유방암, 갑상선암, 대장암, 전립선암, 악성 방추 세포암이 각각 1예씩 이었다. 사용된 종양 대치물은 모두 조립형 종양 대치물로 Kotz's$^{(R)}$ Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey)가 3예에서 사용되었고, MUTARS$^{(R)}$ proximal femur system (Implantcast, Munster, Germany)이 17예에서 사용되었다. 수술 전 후의 동통 정도를 Visual Analogue Scales(VAS)로 평가하였으며, 술 후 하지의 기능적 평가를 위해 Musculoskeletal Tumor Society score(MSTS) grading system 을 이용하였다. 결과: 최종 추시 시 20예(19명) 중 11예(10명)가 생존하고 9예(9명)가 사망하였으며 사망한 환자의 술 후 평균 생존기간은 10.1개월(1-38개월) 이었다. VAS 점수는 술 전 평균 8.40점(5-10점)에서 술 후 평균 1.35점(0-3점)으로 호전 되었고, 수술 후 MSTS 기능적 평가는 평균 19.65점(65.50%) (7-28점)이었다. 수술과 관련된 합병증으로는 국소 재발 2예, 혈종 3예, 감염 3예, 음낭 종창 2예, 탈구 1예였고 치환물 주위 골절이나 해리는 없었다. 결론: 대퇴골 근위부에 발생한 악성 골 종양에 의한 통증 또는 병적 골절이 발생한 경우 종양 대치물을 이용한 사지 구제술은 조기의 통증 감소 및 기능 회복을 위한 적절한 치료로 생각된다.

• 대한골관절종양학회지
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• 제2권1호
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• pp.18-26
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• 1996

We investigated the effect of deep-freezed, boiled and autoclaved autogenous long bone graft on the incorporation of the radial diaphyseal reconstruction in 30 rabbits by radiogram and histology for 8 weeks. Immediate histologic changes of 1cm of resected long bone treated by deep freezing, boiling and autoclaving in each 2 rabbits were also observed as control. Resected, boiled ($95^{\circ}C$ for 5 min.) and reimplanted bone was compared with resected, autoclaved ($131^{\circ}C$ for 5 min.) and reimplanted bone, and resected, deep freezed with liquid nitrogen for 5 minutes and thawing in saline and reimplanted bone in the reconstruction of bilateral radial defects in each of 8, and in total 24 adult rabbits. The results were as follows : 1. Immediate histologic changes showed that intracortical osteocytes in lacunae were partially necrotized and the cortex were faintly stained with they Masson trichrome stain in both boiled and deep freezed groups, while they completely necrotized and their cortex stained more weakly with Masson trichrome stain in autoclaved group which means less amount of collagen and protein in cortex of long bone. 2. Radiographies at 8 weeks showed complete union with more marked incorporation and external callus formation in all boiled and freezed groups, whereas there was delayed union in four of sixteen (25%) in autoclaved group. Histologically, at 8 weeks after boiled and freezed, more intense incorporation with new bone formation and neovascularization were observed, whereas transverse clefts consisted with delayed union in 4 cases of autoclaved group (25%) were observed at osteotomy site. Through these studies, the boilod and deeply freezed bones acted as an osteoinductive material as well as osteoconductive, but the autoclaved bone only as osteoconductive. Though boilod and deeply freezed bone showed higher osteogenic potentials than autoclaved bone, the necrotizing effect on cortical and boiled bone was inferior to that of autoclaved. Thus the deeply freezed bone can be used for the treatment of aggressive benign or less malignant bone tumor not involving cortical bone, but the autoclaved bone supplemented with bone graft for the treatment of malignant bone tumor involving cortex of long bone.