• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.86-94
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• 2008

$^{18}F$-FDG PET/CT has led to advancement in diagnostic imaging, providing correlation of both physiology and anatomic information, and to new and innovative ways to utilize PET/CT imaging for the evaluation of musculoskeletal tumors. Recently, the most widely utilized musculoskeletal application of PET/CT imaging is for the detection and characterization of bone metastases, staging and restaging of primary malignant bone tumors and soft tissue sarcomas. And it is also useful in evaluating response to therapy for malignant musculoskeletal tumors and in detecting local recurrences or distant metastases during follow up. The future likely holds even more unique and potentially quite useful applications of PET/CT imaging for primary bone and soft tissue tumors. This article will review the useful applications of $^{18}F$-FDG PET/CT imaging for evaluating musculoskeletal tumors.

• 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.

• Proceedings of the KSMRM Conference
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• 2002.11a
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• pp.137-137
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• 2002

목적： 동시획득 T1/T2 강조 경사자장 펄스열을 이용하여 근골격계의 종양 관류 평가를 하고자 한다. 대상 및 방법： 근골격계 양성 및 악성 종양을 대상으로 동시획득 T1/T2 강조 경사자장 펄스열을 이용하여 시간해상도를 1.2초로 하여 1000회(약20분)를 반복하여 역동적 영상을 얻는다. 각각의 TR/TE1/TE2는 10/2/8 msec이다. 각 시기에서 서로 다른 TE를 가지고 있는 두 개의 영상을 이용하여, 수학적으로 분리하여 T1과 T2 값을 얻고, 이를 시간에 따라 배열한다. 이를 통하여, T2의 경우에는 일차효과를 이용하여 조직관류량(tissue blood volume)을 측정하고, T1에서는 2구획모델을 이용하여 투과도(permeability)를 측정한다.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.6
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• pp.553-560
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• 2007

Purpose: We evaluated the standard uptake value (SUV) of F-18 FDG at PET/CT for differentiation of benign from malignant tumor in primary musculoskeletal tumors. Materials and Methods: Forty-six tumors (11 benign and 12 malignant soft tissue tumors, 9 benign and 14 malignant bone tumors) were examined with F-18 FDG PET/CT (Discovery ST, GE) prior to tissue diagnosis. The maxSUV(maximum value of SUV) were calculated and compared between benign and malignant lesions. The lesion analysis was based on the transverse whole body image. The maxSUV with cutoff of 4.1 was used in distinguishing benign from malignant soft tissue tumor and 3.05 was used in bone tumor by ROC curve. Results: There was a statistically significant difference in maxSUV between benign (n=11; maxSUV $3.4{\pm}3.2$) and malignant (n=12; maxSUV $14.8{\pm}12.2$) lesions in soft tissue tumor (p=0.001). Between benign bone tumor (n=9; maxSUV $5.4{\pm}4.0$) and malignant bone tumor (n=14; maxSUV $7.3{\pm}3.2$), there was not a significant difference in maxSUV. The sensitivity and specificity for differentiating malignant from benign soft tissue tumor was 83% and 91%, respectively. There were four false positive malignant bone tumor cases to include fibrous dysplasia, Langerhans-cell histiocytosis (n=2) and osteoid osteoma. Also, one false positive case of malignant soft tissue tumor was nodular fasciitis. Conclusion: The maxSUV was useful for differentiation of benign from malignant lesion in primary soft tissue tumors. In bone tumor, the low maxSUV correlated well with benign lesions but high maxSUV did not always mean malignancy.

• The Journal of the Korean bone and joint tumor society
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• v.8 no.3
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• pp.69-75
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• 2002

Werner's syndrome is a rare autosomal recessive disorder manifesting as premature aging. It is also known to be characterized by a high frequency of malignant tumors, especially sarcomas. However, Werner's syndrome may be not only a premature aging disease but also a cancer syndrome, because the malignant tumors in these patients are different from those of normal population with respect to involved site, histological type, and age of onset. Recent studies found Werner's syndrome was caused by a mutation of Werner helicase suggesting that WRN helicase may participate in metabolism and repair of DNA. And a dysfunction of WRN helicase may induce the genomic instability causing somatic mutations. Further studies of Werner's syndrome associated with sarcoma might give much informations about the normal aging process and the pathogenesis of sarcomas.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.509-518
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• 2019

Purpose: Lymph node metastasis is a very important prognostic factor for all skin cancers and some sarcomas. A sentinel lymph node (SLN) biopsy is the most useful technique for identifying SLNs. Recently, a new generation of diagnostic tools, such as single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/CT (PET/CT) enabled the detection of SLNs. This study compared the efficacy of PET/CT for detecting lymph node metastases with a SLN biopsy in a single medical center. Materials and Methods: From 2008 to 2018, 72 skin cancers of sarcoma patients diagnosed with some lymph node involvement in a whole body PET/CT reading were assessed. Patients suspected of lymph node metastasis were sent to biopsy and those suspected to be reactive lesions were observed. The analysis was performed retrospectively using the medical records, clinical information, PET/CT readings, and pathology results. Results: The age of patients ranged from 14 to 88 years and the mean follow-up period was 2.4 years. Twenty-two patients were suspected of a lymph node metastasis and confirmed. The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT images in sarcoma and non-sarcoma tumors were increased significantly when the expert's findings were considered together. Conclusion: PET/CT is effective in detecting lymph node metastases.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.178-189
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• 2003

Purpose: The current study was designed to investigate the expression pattern of chemokine in musculoskeletal tumors, and between primary osteosarcoma and recurred, and postchemotherapy one. Materials and methods: Ten primary soft tissue and bone tumors, one primary, one recurred, one post-chemotherapy osteosarcoma, and one normal control patients were included in the current study. RT-PCR and RPA were used for the investigation of the expression of cytokines and chemokines. Fisher's exact test in SPSS was used for the statistical analysis. Results: IL-8 and TNF-${\alpha}$ were expressed in all tumor tissues, IFN-${\gamma}$ was in all except two cases, RANTES was in 5 soft tissue tumors and 4 bone tumors, GRO-${\alpha}$was in one soft tissue tumor and 2 bone tumors, and MCP-1 and IP-10 were in two bone tumors and in all the other group. In recurred osteosarcoma all the cytokines and chemokines were expressed, and the degree of the expression was stronger than the primary, except IFN-${\gamma}$. After chemotherapy, RANTES, IFN-${\beta}$ and TGF${\beta}_1$ among the TGF${\beta}$isoforms were expressed. Conclusion: There were differences in the expression of cytokines and chemokines in some different bone and soft tissue tumors, even though it was impossible to support this statistically due to small numbers of cases. The expression pattern of IFN-${\gamma}$and TGF-${\beta}$ isoform in osteosarcoma could be used for the study of tumor recurrence and the changes after chemotherapy.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.208-212
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• 2005

Maffucci syndrome was first reported by Maffucci, an Italian, in 1881. This rare, nonhereditary syndrome is characterized by multiple enchondromas combined with hemangiomas and less commonly lymphangiomas. Maffucci syndrome is sometimes confused with Ollier disease, which was described in 1899 and consists of multiple enchondromas without hemangiomas. Although the prevalence of malignant change in skeletal lesions in Maffucci syndrome and Ollier disease is quite similar, it is important to differentiate between these two conditions because of the greater risk of developing nonmusculoskeletal malignancies in the former. We experienced a case of this rare syndrome and because of it's rarity, we report with review of literature.

• The Journal of the Korean bone and joint tumor society
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• v.8 no.3
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• pp.96-105
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• 2002

Purpose: The purpose of this study was to assess the oncologic results and functional outcomes of limb salvage surgery performed in patients of primary bone tumors of the shoulder girdle. Materials and Methods: Twenty-nine patients who underwent limb sparing resection for shoulder girdle neoplasm between 1982 and 2001 were analyzed. Follow up periods averaged 7 years and 1 month. Mean age of the patients was 35 (11~71) years. There were 14 males and 15 females. Primary malignant bone tumors of shoulder girdle (proximal humerus 21, scapula 3, both 1) were 23 cases; osteosarcomas 7, chondrosarcoma 14, parosteal osteosarcoma 1, hemangioendothelioma 1, and giant cell tumor of proximal humerus were 6 cases. Limb salvage surgery was performed by curettage and cementing in 7 patients, by cement molding arthroplasty in 10 patients, and by tumor prosthesis in 7 patients, by other method such as resection only, bone graft, arthrodesis in 5 patients. The Musculoskeletal Tumor Society functional rating system was used to assess functional outcomes. Results: One osteosarcoma and 2 chondrosarcoma patients died, and the survival of the salvaged limb was 88.6% at the final follow-up. There were 6 local recurrences, 2 lung metastases, 2 local recurrences and lung metastases. The functional outcome was 80%. There was statistically significant difference of functional results among the patients treated by cement filling (86%), cement molding arthroplasty and IM nailing (71%), and tumor prosthesis (83%). (p=0.034) There were three complications including 1 radial nerve palsy and 1 axillary nerve palsy, and 1 wound infection. Dislodgement of vascularized fibular graft in one patient was treated by internal fixation. Conclusion: Limb salvage surgery seems to be useful method to treat bone tumors of the shoulder girdle.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.95-105
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• 2008

Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.