• Radiation Oncology Journal
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• 제2권1호
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• pp.123-128
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• 1984

To determine the effectiveness of radiotherapy for pain control in metastatic bone disease, we retrospectively analyzed the treatment results in 126 patients who received short-course radiotherapr(2,000 rad/1wk vs 3,000 rad/2wks) in the Department of Therapeutic Radiology, Seoul National University Hospital from Feb. 1979 to July 1983. Pain relief was obtained in $82\%$ of patients and complete Pain relief was obtained in $35.3\%$ of patients. The incidence of metastatic bone tumor was highest in spine and pelvis, $43.7\%\;and\;26.3\%$>, respectively. Primary sites of metastasia were lung, breast, unknown primary, stomach, uterine cervix, in order of frequency. There was no significant difference in the response to treatment between 2,000 rad in 1 week and 3,000 rad in 2 weeks.

• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.230-232
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• 2012

A 31-year-old man presented with acute onset of paraplegia. The patient's history was significant for thyroid carcinoma that had been treated 2 years earlier by thyroidectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T7-8. Patient underwent surgical treatment and a tumor with hematoma was resected via posterior midline myelotomy. Postoperatively, the patient's motor weakness was improved to grade 3. The lesion showed typical histologic features consistent with papillary thyroid carcinoma. Early diagnosis and microsurgical resection can result in improvement in neurological deficits and quality of life of patients with an ISCM.

• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.475-477
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• 2005

The tendency of glioblastoma multiforme[GBM] to metastasize to the cerebrospinal fluidis well documented. However, symptomatic intradural extramedullary metastasis of GBM in the spinal cord are rarely reported. A 31-year-old female with a previously treated supratentorial GBM presented with back pain and lower extremities weakness. Magnetic resonance imaging of the thoracic spine demonstrated an intradural extramedullary mass at levels of T2-T4 and arachnoid membrane enhancement. The patient underwent an operation. Pathologic diagnosis was confirmed as spinal metastases of GBM. We present a case of spinal metastases from supratentorial GBM presented with paraparesis.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.106-113
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• 2019

Objective : The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods : A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results : The average age of 50 males and 29 females was $57.6{\pm}13.5$ years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion : Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.23-28
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• 2005

목적: 위암의 근치적 절제술 후 발생하는 골 전이는 드물며 이에 대한 보고는 산발적인 증례보고에 머물고 있어 그 특징에 대해서는 잘 알려진 바가 없다. 이에 저자들은 위암의 그치적 절제술 후 발생한 골 전이의 형태와 치료의 효과 그리고 예후를 알아보기 위해 연구를 시행하였다. 대상 및 방법: 1989년부터 2002년까지 가톨릭대학교 의과대학 부속 강남성모병원과 성모자애병원에서 위암으로 근치적 절제술을 시행 받은 후 골 전이가 확인된 29명의 환자들의 의무기록을 조사하여 이들의 임상병리학적인 특징을 분석하였다. 결과: 환자들의 성비는 남자는 19명 여자는 10명이었으며 평균연령은 $53\pm12$세였다. 원발암의 병리학적 특징은 Borrmann 3,4형이 많았으며 미분화형이 많았고 병기는 주로 3,4형이 많았으며 미분화형이 많았고 병기는 주로 3,4기였다. 골 전이가 가장 많이 발생한 부위는 척추였고 그 다음으로 골반, 늑골 그리고 두개골의 순으로 나타났다. 재발 후 치료는 16예($55.2\%$)에서 시행하였다. 지발 후 치료를 받은 환자들의 생존기간의 중간값은 7개월($0\∼75$개월)로 치료를 받지 않은 환자들(2개월)에 비해 길었으나(P=0.019) 치료방법에 따른 차이는 없었다(P=0.388). 결론: 위암의 근치적 절제술 후 발생하는 골 전이는 Borrmann 3,4형에서 미분화형에서 그리고 3,4기의 진행된 암에서 많이 발생하였다. 이들의 예후는 매우 불량하나, 재발에 대한 치료를 적극적으로 시행하는 것이 생존율의 향상을 도모하는 길이라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.151-154
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• 2012

We report here two cases of primary intraosseous meningioma with aggressive behavior. A 68-year-old man presented with a one year history of a soft, enlarging mass in the right parietal region. Magnetic resonance image (MRI) revealed a 6 cm sized, heterogeneously-enhancing, bony expansi1e mass in the right parietal bone, and computed tomograph (CT) showed a bony, destructive lesion. The tumor, including the surrounding normal bone, was totally resected. Dural invasion was not apparent Diagnosis was atypical meningioma, which extensively metastasized within the skull one year later. A 74-year-old woman presented with a 5-month history of a soft mass on the left frontal area. MRI revealed a 4 cm sized, multilobulated, strongly-enhancing lesion on the left frontal bone, and CT showed a destructive lesion. The mass was adhered tightly to the scalp and dura mater. The lesion was totally removed. Biopsy showed a papillary meningioma. The patient refused adjuvant radiation therapy and later underwent two reoperations for recurred lesions, at 19 and at 45 months postoperative. The patient experienced back pain 5 years later, and MRI showed an osteolytic lesion on the 11th thoracic vertebra. After her operation, a metastatic papillary meningioma was diagnosed. These osteolytic intraosseous meningiomas had atypical/malignant pathologies, which metastasized to whole skull and the spine.

• Radiation Oncology Journal
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• 제19권4호
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• pp.353-358
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• 2001

척수내 전이암은 암환자에서 매우 드문 합병증으로 증상이 있는 척수 전이암 중 $3.4\%$정도를 차지한다고 보고된 바 있다. 척수내 전이암 환자의 생존 기간은 매우 짧아서 2개월 이내인 경우가 대부분인데 그 이유는 신경학적으로 빨리 악화되고 뇌전이를 포함하여 여러 곳에 전이암이 동반되기 때문이다. 국내 문헌상 척수내 전이암에 대한 보고가 거의 없고 저자들이 경험한 두 증례는 서로 다른 임상 경과를 보였기에 문헌 고찰과 함께 보고하는 바이다. 원발암이 접형동암인 환자에서 척수내 전이암으로 인해 이차성 척수공동증을 동반한 증례는 세계 문헌상 세번째 증례이다. 한 증례는 증상이 서서히 진행되었고 척수에 방사선치료를 시행한 후 생존기간이 26개월이었고, 다른 증례는 증상이 매우 빠르게 진행되었고 생존기간이 훨씬 짧았다. 척수내 전이암도 신경학적 증상이 가역적인 상태에서 조기 진단이 내려진다면 더욱 효과적인 증상완화를 기대할 수도 있다.

• 대한핵의학회지
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• 제34권5호
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• pp.433-435
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• 2000

A 6000-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the ether represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.$^{1-4)}$ A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.$^{4)}$ Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.

• Brain Tumor Research and Treatment
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• 제6권2호
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• pp.54-59
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• 2018

Background Leptomeningeal metastasis (LM) is an uncommon, but devastating complication of advanced cancer and has no standard treatment. Herein, we analyzed the clinical characteristics and outcomes of patients with solid tumors who were diagnosed with LM. Methods Between January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM. Results A total of 58 patients were enrolled in this study. The median age of patients was 51 years (range, 27-72 years), and 62.1% had a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (>2). The common types of primary tumor were breast cancer (39.7%), gastric cancer (25.9%), and non-small cell lung cancer (20.7%). Forty-two patients (72.4%) were diagnosed with LM by MRI of the brain and/or spine and cerebrospinal fluid (CSF) analysis, 14 were diagnosed by CSF analysis alone, and 2 were diagnosed by MRI alone. Treatments for LM were performed in 53 patients (91.4%), and best supportive care was provided for 5 patients (8.6%). Intrathecal chemotherapy, radiotherapy, and systemic chemotherapy were administered in 43 (74.1%), 17 (29.3%), and 24 (41.4%) patients, respectively. The median overall survival of the entire cohort was 2.4 months (95% confidence interval, 1.0-3.7). In the analysis of prognostic factors for survival, a good ECOG PS (${\leq}2$), administration of systemic chemotherapy after LM diagnosis, and a prior history of brain radiation were associated with prolonged survival. Conclusion Although the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.

• Clinical Pain
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• 제18권2호
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• pp.88-91
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• 2019

Unexplained pain and weakness, i.e., without obvious predisposing factors, are often encountered by physiatrists and efforts should be made to determine the cause. A 63-year-old male presented with radiating pain in his right arm and mild weakness of the right hand. An electrodiagnostic examination revealed distal symmetric sensory polyneuropathy in the upper and lower extremities, and denervation potentials in the forearm muscles, which were inconsistent with the cervical spine MRI images and symptoms. A predisposing undiscovered disease was revealed, i.e., squamous cell carcinoma in the lung; brain metastasis affecting the left primary motor cortex was also detected. Therefore, we concluded that the pain and weakness were related to paraneoplastic syndrome and brain metastases of the hand knob. The observed denervation potentials were characterized as trans-synaptic changes in the brain metastasis. This case highlights the importance of unexplainable focal pain and weakness in the increasing prevalence of cancer.