• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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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.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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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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• v.29 no.1
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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.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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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.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.139-147
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• 2003

Purpose: The purpose of this study was to determine if bony union can be obtained when a bone graft substitute is transplanted in order to treat a benign bone tumor and if there is a difference between calcium sulfate and hydroxyapatite in the healing procedure when the degree of the bony union after the bone graft are compared. Materials and Methods: This study selected 20 cases, in which a curettage on the benign bone tumors was conducted and a bone graft substitute was transplanted. The area of the focus, the new bone formation, the recurrence of the focus in the plain radiographs and histological findings were observed. Results: Twenty cases (13 males, 7 females) were evaluated. Their mean age at surgery was 15.8 years (2~45), and the mean follow-up period was 3 years. The mean area of focus was 30.7 $cm^3$ in the radiographs, and 19 cases showed successful results in the ultimate visit, while 1 case has a recurrence of the focus. Conclusion: Calcium sulfate has osteoconduction and superior bioavailability, and is absorbed in vivo in proportion to the new bone formation. On the other hand, hydroxyapatite has good osteoconduction. It can result in better bone formation when it is combined with an autologous bone graft, autologous bone marrow, and an allogenic bone graft, but is absorbed in vivo more slowly than the former.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.41-45
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• 2014

A femoral bone tumor causing a valgus deformity by affecting the growth plate was found. Long intramedullary diaphyseal tumor was separated by septum at the metapysis. Low grade chondrosarcoma was confirmed diagnosed by pathologists. Progressive limb deformity can be a sign of bone tumor in growing period.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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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%).

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.7-13
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• 2014

Purpose: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. Materials and Methods: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's$^{(R)}$ Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS$^{(R)}$ proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. Results: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. Conclusion: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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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.