• Journal of Yeungnam Medical Science
• /
• v.33 no.1
• /
• pp.64-67
• /
• 2016

We report on a 64-year-old man with leptomeningeal metastasis (LM) from an epidermal growth factor receptor (EGFR)-mutated adenocarcinoma of the lung. He was treated with paclitaxel, cisplatin. After completion of chemotherapy, he complained of headache, nausea, and vomiting. EGFR-mutated tumor cells were identified from the cerebrospinal fluid (CSF). Second-line therapy with gefitinib, methotrexate was started. After receiving gefitinib for 4 weeks, he had no more headaches or vomiting. Eleven months after initiation of gefitinib, he developed headache and nausea. Chest computed tomography showed aggravation of bone metastasis. Third-line therapy was started with gemcitabine and carboplatin. Two weeks later, he experienced disorientation. After a fourth relapse within the central nervous system, the therapy was switched to erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR mutation in CSF and EGFR tyrosine kinase inhibitors are effective for LM from EGFR mutant non-small cell lung cancer.

• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.1
• /
• pp.43-47
• /
• 2007

Sj$\"{o}$gren's syndrome is a systemic, autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands and characteristic of dry eye and mouth. We report a case of Sj$\"{o}$gren's syndrome in which the patient presented systemic symptoms without sicca symptoms and had radiologic findings mimicking multiple skeletal metastasis and was finally confirmed with Sj$\"{o}$gren's syndrome with renal tubualr acidosis.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.2
• /
• pp.1101-1106
• /
• 2013

Background: Osteosarcoma is the most common primary bone tumor in childhood and adolescence. Carboplatin, a platinum-derived agent, is used as neoadjuvant chemotherapy for pediatric osteosarcoma because of its anti-tumor activity and had low toxicity as compared to cisplatin. Objective: To determine demographic data, prognostic factors and outcome of childhood osteosarcoma treated with a carboplatin-based chemotherapeutic protocol at Chiang Mai University. Method: A retrospective analysis was conducted on 34 osteosarcoma patients aged less than 18 years and treated between 2003 and 2011. Results: Overall limb-salvage and amputation rates were 23.5% and 70.6%, respectively. With the mean follow-up time of 29.5 months (1.5-108.9), the Kaplan-Meier analysis for 3-year disease-free survival (DFS) and 3-year overall survival (OS) were $20.2{\pm}7.7%$ and $47.1{\pm}9.5%$ respectively. Patients who had initial pulmonary metastasis were at significantly greater risk for developing recurrence (p=0.02, OR=7; 1.2-40.1) and had a tendency to have lower 3-year OS compared to those without initial pulmonary metastasis ($28.1{\pm}13%$, $63.1{\pm}12.3%$, respectively, p=0.202). On univariate analysis, age at diagnosis >14 years and patients who were declined surgery were significantly associated with lower 3-year OS (p=0.008 and <0.05, respectively). However, age at diagnosis, sex, tumor size and histological subtypes were not found to significantly affect recurrence or survival. Conclusions: In our study, the survival rate was far lower than those reported from developed countries. These might indicate the ineffectiveness of carboplatin in combination with doxorubicin as frontline treatment of pediatric osteosarcoma, especially in those with initial pulmonary metastasis. Refinement in risk and treatment stratification and dose intensification for pediatric osteosarcoma constitutes a future challenge to improve outcomes, especially in metastatic patients who may need a more intensive regimen.

• The Journal of the Korean bone and joint tumor society
• /
• v.8 no.3
• /
• pp.90-95
• /
• 2002

A 42 year old male patient complained of increasing pain and mass around the right ankle with 4 months duration. Simple Roentgenogram and CT showed ill-defined osteolysis and cortical perforation in the neck of the right talus. The pathologic findings showed high grade osteoblastic osteosarcoma. The tumor mass of the ankle increased and pulmonary metastasis was found in spite of administrating of two cycles of preoperative chemotherapy. Below-knee amputation and open wedge pulmonary resection were performed for primary lesion and multiple pulmoanry metastasis, respectively. However, the patient died with multiple pulmonary metastasis in spite of three cycles of postoperative chemotherapy at ten months after the operation.

• The Journal of the Korean bone and joint tumor society
• /
• v.4 no.1
• /
• pp.30-36
• /
• 1998

Squamous cell carcinoma is a neglected disease entity in orthopedic oncology. The purpose of this study was to analyze overall survival and the role of surgery on survival and to evaluate the significance of possible prognostic factors. From Oct, 1986 to Aug, 1996, 57 patients were enlisted and 42 patients ere eligible. Inclusion criteria included more than one year follow-up and no distant metastasis at the first visit. Staging and survival followed AJC classification and Kaplan-Meier plot. Stage II included 17 cases and stage III, 25 cases. Thirty-eight patients underwent operations, chemotherapy, and/or radiotherapy, and the remaining four had operations only. The chemotherapeutic regimen was adriamycin-cisplatin. The average follow-up period was 45 months. The ten-year actuarial survival rate of whole patients was 65.4%. Location of primary lesion, stage, pathologic grading, and intensity of chemotherapy in the same stage showed a significant difference in survival. Nine out of 42 patients had local recurrence. Seven patients had inadequate wide margins and two had intralesional margins. Average period of recurrence from operation was 13(4-35)months. The operation itself had no impact on survival but a surgical margin of no less than 3cm from the lesion was important for local control. Pathological grade and staging were significant variables for long term survival. Acral lesion had a significantly higher chance of regional and distant metastasis but actual survival showed no difference. In stage II, aggressive chemotherapy could delay or reduce the chance of regional or distant metastasis.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.38
• /
• pp.6.1-6.8
• /
• 2016

Background: Intravenous bisphosphonates have been used in metastatic breast cancer patients to reduce pathologic bone fracture and bone pain. However, necrosis of the jaw has been reported in those who received intravenous bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is caused by dental extraction, dental implant surgery, and denture wearing; however, it occurs spontaneously. The purpose of this study was to report BRONJ in metastatic breast cancer patients. Methods: Consecutive 25 female patients were referred from the Department of Oncology from 2008 to 2014 for jaw bone discomfort. Staging of breast cancer, history of bisphosphonate infusion, etiology of BRONJ, and treatment results were reviewed. Average age of the patients was 55.4 years old (38-74). Twelve maxillae and 16 mandibles were involved. Conservative treatments such as irrigation, antibiotic medication, analgesics, and oral gargle were applied for all patients for the initial treatment. Patients who had sequestrum underwent debridement and primary closure. Results: The etiologies of BRONJ were dental extraction (19 cases), dental implant (2 cases), and endodontic treatment (1 case). However, three patients did not have any risk factors to cause BRONJ. Three patients died of progression of metastasis during follow-up periods. Surgical debridement was performed in 21 patients with success in 18 patients. Three patients showed recurred bone exposure and infection after operation. Conclusions: Prevention of the BRONJ is critical in metastatic breast cancer patients. Conservative treatment to reduce pain, discomfort, and infection is recommended for the initial therapy. However, if there is a sequestrum, surgical debridement and primary closure is the key to treat the BRONJ.

• Archives of Plastic Surgery
• /
• v.33 no.3
• /
• pp.383-387
• /
• 2006

Atypical fibroxanthoma is a pleomorphic spindle cell neoplasm characterized by a variable combination of cells with fibroblastic and histiocytic features. It occurs mostly on sun-exposed area of the head and neck of elderly person and is a clinically benign reactive lesion despite apparent malignant histologic features. However, because of its potential for metastasis, it is widely regarded as a low-grade sarcoma. We report a 30-year-old woman with atypical fibroxanthoma developed on the left occipital area. The lesion was $1.5{\times}2cm$ sized papule. There was no skin lesion such as ulcer or eschar. However, mass was involving occipital bone and composed of dense, pleomorphic spindle cells and several bizarre multinucleated giant cells. After wide excision of the scalp and occipital bone, the defect was covered with bone cement, bipedicled local flap and the donor site was covered with STSG. The wound healed completely without complication. It remained free of recurrence for a period of about 1 year follow up.

• Journal of Chest Surgery
• /
• v.30 no.12
• /
• pp.1214-1218
• /
• 1997

The therapeutic results of pulmonary resection for metastatic bone and soft tissue sarcomas were analyzed. From 1986 to 1996, 14 patients(11 male and 3 female) underwent 15 pulmonary resections for metastatic sarcomas. One(7.1%) patient had 2 thoracotomies for recurrences. The number of metastatic tumors were from one to five. The primary malignant tumors were from bone in 4 and from soft tissues in 10. Mean survival time after thoracotomy was 29.2 months, and Kaplan-Meier's 5-year survival rate from the first metastasectomy was 33.2%. Three patients who had the tumor free interval period over 3 years were alive(mean survival period 52.6 months), whereas eleven patients of the less than 3 years were dead with disease(mean survival period 17.3 months). These results suggested that pulmonary. metastasectomy in bone and soft tissue sarcoma may prolong the survival rate.

• The Journal of the Korean bone and joint tumor society
• /
• v.11 no.2
• /
• pp.126-133
• /
• 2005

Purpose: to know the treatment result of squamous cell carcinoma in extremity had poor prognosis with risk factor including burn scar and chronic osteomyelitis. Material and Methods: Between Octorber 1993 and September 2002, 20 patients with squamous cell carcinoma in extremity had no distant metastasis was got operation and followed over 36 months. Amputation was done when it was hard to get enough wide margin or neurovascular structure was involved instead of wide excision. Mean age of patients was 57.2 years old and male to female was 16 to 4. TMN staging and histologic grading were performed. Results: There were 6 metastasis (30%) in 20 cases for mean 48.3 months (36-84 months). 3 metastasis to local lymph node and 3 distant metastasis were happened at lung (in 3 cases) and thorasic vertebra (in 1 case). Survival was 18 cases at last look. 5-year survival rate was 50%. 3 local recurrence was developed at average 11 months (4-18 months). Complication was focal skin defect after wide excision and skin graft in 2 cases. The patients by wide excision got average 1.9 time operation and by amputation got average 1.3 time. Conclusion: Squamous cell carcinoma at extremity in Korea had high metastasis rate due to burn scar and chronic osteomyelitis, and it showed equal treatment result which treated by wide excision compared with amputation.

• Investigative Magnetic Resonance Imaging
• /
• v.15 no.2
• /
• pp.176-180
• /
• 2011

Metastases to the orbit usually affect the intraorbital fat and bone than the extraocular muscles. Metastasis to the extracoular muscles commonly occurs unilaterally, and diffuse enlargement of the bilateral extraocular muscles due to metastasis is extremely rare. In this report, we will describe a case of diffuse metastasis to the bilateral extraocular muscles from nasal rhabdomyosarcoma masquerading as thyroid associated orbitopathy. We will also discuss about the MR imaging findings helpful for differential diagnosis from thyroid associated orbitopathy.