• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.37-44
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• 2019

Purpose: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. Materials and Methods: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21-27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12-13). The average range of motion of the 10 CFTR cases was 67° (0°-100°). The mean extension lag of 10 cases was 48° (20°-80°). Conclusion: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.4
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• pp.201-207
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• 1999

Malignant tumors of the hand are very rare. Between 1989 and 1998, 17 patients with malignant tumors of the hand were evaluated for clinical features, prevalence, treatment and results. The mean age was 45 years and median duration of follow-up was 38 months. A painless mass was the most common symptom and the most common lesion was the digit. Fifteen cases of soft tissue and 2 cases of bone tumor were diagnosed. On pathology, soft tissue tumors were comprised of 8 cases of malignant melanoma, 2 cases of angiosarcoma and 1 case each of malignant fibrous histiocytoma, malignant peripheral nerve sheath tumor, extraskeletal chondrosarcoma, and squamous cell carcinoma. Bone tumors were metastatic tumors and each originated from the rectal cancer or lung cancer. Lymph node involvements were noted in 4 cases of malignant melanoma and 1 case of squamous cell carcinoma. Six cases of metacarpo-phalangeal joint disarticulation and 4 cases of phalanx amputation were performed. Wide excision, ray amputation and below-elbow amputation were also performed. Three cases expired due to metastasis and progression of the original lesion. Among the surviving 14 cases, a malignant melanoma had metastasis on the axillary lymph node and 13 cases showed no local recurrence or metastasis during the follow-up.

• The Journal of the Korean bone and joint tumor society
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• v.15 no.1
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• pp.1-6
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• 2009

The usefulness and accuracy of computer-assisted surgery have been evaluated clinically in many orthopedic fields, such as, joint replacement arthroplasty, cruciate ligament reconstruction, and pedicle screw placemen. Recently several preliminary reports have been issued on the application of navigation to bone tumor surgery. The main advantage of navigation-assisted bone tumor surgery is that it provides highly accurate three-dimensional radiological information for intraoperative guidance. In particular, distances from tumors to resection margins can be precisely determined using intraoperative three-dimensional images. Accordingly, the technique allows preservation of function to be maximized by minimizing unnecessary resection. However, surgeons should recognize that the accuracies of navigation systems in bone tumor surgery have some hidden pitfalls. Here, based on our clinical results, we describe the surgical techniques used and include some cautionary notes.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.63-69
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• 1999

Recently we experienced four cases of soft tissue Ewing sarcoma, developed in the calf muscles in two cases, and one case each in the foot and suprascapular region. We also found that the clinical course in all cases was rather rapid, because of local recurrence and metastatic lesions developing within a few months, followed by the patients' death in about 2 years after the primary tumor was excised. These cases were improperly treated initially as some kind of benign soft tissue tumor. The delay led to missed early accurate diagnosis and was thought to be one of the main causes for the rapid local recurrence and metastasis after tumor excision. The pulmonary metastasis was the most common cause of death.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.142-145
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• 2007

Gastrointestinal stromal tumor (GIST) occurring outside the gastrointestinal tract is uncommon. When GIST is found outside the gastrointestinal tract, it has greater possibility to be diagnosed with metastatic lesion from other primary focus. But it rarely occurs in extragastrointestinal tract primarily, and then even outside abdomen. We experienced one case of GIST occurred from right buttock area of 25 year-old man. We could not find out the primary focus in abdomen. The tumor was developed inside gluteus medius and minimus and extended to pelvic inner area destroying iliac bone and adjacent sacrum. Here, we report the case of GIST with terminology of extragastrointestinal stromal tumor (EGIST).

• Journal of Veterinary Clinics
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• v.28 no.3
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• pp.310-313
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• 2011

A 6-year-old female Shih-tzu dog was referred with left elbow joint mass associated with weight bearing lameness. Ultrasonography demonstrated an encapsulated hyperechoic mass at the left elbow joint. Radiography was performed on elbow joint, chest, and abdomen, but there was no evidence of metastasis. Clinicopathologic examination revealed the existence of neoplastic cells with anisocytosis, pleomorphism and increased nuclear-cytoplasmic ratio. The left forelimb was amputated for cure. Histopathological examination diagnosed the mass as a malignant peripheral nerve sheath tumor. During the 4 weeks follow-up, the patient showed full remission and adopted to walk with remaining three legs. Thereafter, the tumor recurred after 5 months of first surgery at the operation site and other two cutaneuos regions. Cytology test revealed the mesenchymal originated tumor cells with malignancy. These tumors were surgically removed and histopathological examination of the resected tissue revealed the recurrence of primary tumor and metastasis. Metronomic therapy with cyclophophamide (10 mg/$m^2$, PO, sid) and piroxicam (0.3 mg/kg, PO, sid) had been adopted for 5 months. At 26 months of follow up after the first surgery, the dog alive with satisfactory quality of life. Aggressive surgical resection with metronomic chemotherapy should be the most effective treatment for malignant peripheral nerve sheath tumor.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.96-104
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• 2007

Purpose: The authors investigated whether 35 flexible nail-rotating hinge composite reconstructions around knee joint minimize junctional osteolysis of host bone. Material and Method: The reconstructive technique was as follows: 1) en bloc tumor resection, 2) filling of the host bone marrow cavity with multiple Ender nails, 3) assembling the Ender nails and an Endo-Link type total knee component with wire and bone cement. Result: Mean follow-up was 53 months (ranged 30~79). At final follow-up, 29 patients retained a mobile joint. Resection of more than 40% of bone showed a positive relationship with junctional hypertrophy (p=0.028). Eight patients showed nail breakage and eight prostheses were removed due to early or late infection. The cumulative prosthetic survival rate was 33% at 6 year. Average functional score according to the MSTS criteria was 26.8. Conclusion: Mid-term evaluations showed that results were fair. The revision process was straightforward. Junctional hypertrophy observed appears to give some clues as to how to minimize osteolysis at the prosthesis-host junction after modular prosthesis fixation.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.157-162
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• 2008

Nowadays, most of the malignant bone tumor patient underwent limb salvage operation, however, reconstructive options for skeletally immature group are still controversial. There are three necessary conditions of most ideal reconstructive method in treating the skeletally immature children. As the epiphyseal plate sacrification is usually inevitable in malignant bone tumor around knee joint, ideal reconstructive technique would be as follows; 1)minimal or no damage to theadjacent epiphyseal plate, 2) maintaining mobile joint, 3) index procedure does not disturb subsequent operation such as lengthening. Segmental resection and reconstruction using autogenous pasteurized graft was done for 4 years old meta-diaphyseal osteosarcoma of femur. At 6 months from index operation, plain radiograph showed pasteurized bone resorption and loosening of fixation devise. To overcome the complication, we used allograft reconstruction by impacting the proximal host bone to the fluted portion of allobone. Three months later, proximal bone union was observed and patient showed good functional outcome.

• 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.1 no.2
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• pp.244-248
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• 1995

Glomus tumor is uncommon tumor with an incidence of about 1% in soft tissue tumors and the single most common location is the subungual region of the finger. Many reports have emphasized that glomus tumors were difficult to diagnose and that the result of surgical removal was good, but nail deformity has received little attention. Most of authors removed the entire nail or partially splitted the nail to exposure the nail bed and tumor. Nobody reported whether nail deformity after operation was present or not. But, an abnormal nail is both a cosmetic and a functional problem in that catches on objects. In this study, our attention was postoperative nail deformity as well as the results of surgical removal. Seven patients(eight cases) who were diagnosed as a subungal glomus tumor in the hand were treated by surgical excision without removal of the nail and followed over twenty two months. And then we report on our experience with 8 cases of subungual glomus tumor which were successfully treated by complete excision without nail deformity.