Outcomes of Treatment for Malignant Peripheral Nerve Sheath Tumors: Different Clinical Features Associated with Neurofibromatosis Type 1 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Malignant peripheral nerve sheath tumors (MPNSTs) are a rare subtype of sarcoma that occur spontaneously or in association with neurofibromatosis type 1 (NF-1). This study aimed to clinically differentiate these types of MPNSTs. MATERIALS AND METHODS: The study reviewed 95 patients diagnosed with and treated for MPNST at Yonsei University Health System, Seoul, Korea over a 27-year period. The clinical characteristics, prognostic factors, and treatment outcomes of sporadic MPNST (sMPNST) and NF-1 associated MPNST (NF-MPNST) cases were compared. RESULTS: Patients with NF-MPNST had a significantly lower median age (32 years vs. 45 years for sMPNST, p=0.012), significantly larger median tumor size (8.2 cm vs. 5.0 cm for sMPNST, p < 0.001), and significantly larger numbers of imaging studies and surgeries (p=0.004 and p < 0.001, respectively). The 10-year overall survival (OS) rate of the patients with MPNST was 52±6%. Among the patients with localized MPNST, patients with NF-MPNST had a significantly lower 10-year OS rate (45±11% vs. 60±8% for sMPNST, p=0.046). Univariate analysis revealed the resection margin, pathology grade, and metastasis to be significant factors affecting the OS (p=0.001, p=0.020, and p < 0.001, respectively). Multivariate analysis of the patients with localized MPNST identified R2 resection and G1 as significant prognostic factors for OS. CONCLUSION: NF-MPNST has different clinical features from sMPNST and requires more careful management. Further study will be needed to develop specific management plans for NF-MPNST.

Incidence and Survival of Pediatric Soft Tissue Sarcomas: Comparison between Adults and Children / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Pediatric-type sarcomas such as rhabdomyosarcoma (RMS), Ewing sarcoma (EWS), primitive neuroectodermal tumor (PNET), and desmoplastic small round-cell tumor (DSRCT) are rare in adults, with limited studies on their prognosis and optimal treatment strategies. We aimed to examine the outcome of children and adult patients with RMS, EWS, PNET, and DSRCT and relevant prognostic factors. MATERIALS AND METHODS: We retrospectively reviewed 220 pediatric-type sarcoma patients at a single institution between 1985 and 2011. Comparisons were made in order to examine differences in demographics, disease characteristics, and survival. Survival analyses were performed using the Kaplan-Meier method with log-rank tests and Cox proportional hazards models. RESULTS: A total of 220 consecutive patients were identified at our institute. Median age was 15.6 years (range, 0 to 81 years) and there were 108 children (49%) and 112 adult patients (51%). According to histological classification, 106 patients (48.2%) had RMS, 60 (27.3%) had EWS, 50 (22.7%) had PNET, and 4 (1.8%) had DSRCT. With a median follow-up period of 6.6 years, the estimated median overall survival (OS) of all patients was 75 months (95% confidence interval [CI], 27.2 to 122.8 months) and median event-free survival (EFS) for all patients was 11 months (95% CI, 8.8 to 13.2 months). No significant difference in OS and EFS was observed between adults and children. In multivariate analysis, distant metastasis (hazard ratio [HR], 1.617; 95% CI, 1.022 to 2.557; p=0.040) and no debulking surgery (HR, 1.443; 95% CI, 1.104 to 1.812; p=0.012) showed independent association with worse OS. CONCLUSION: Metastatic disease and no surgical treatment are poor prognostic factors for OS among pediatric-type sarcomas for both adults and children.

Analysis for Usefulness of Arterial Embolization on Sacral and Pelvic Giant Cell Tumors / 대한골관절종양학회지

PURPOSE: The purpose of this study is to determine the usefulness of arterial embolization on sacral and pelvic giant cell tumor (GCT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 9 patients who had undergone serial arterial embolization between December 1996 and May 2008. We analyzed the clinical outcomes and therapeutic responsiveness of arterial embolization on sacral and pelvic GCT. RESULTS: Six of 9 cases showed progression of disease (PD) status, even if 5 cases showed PD status despite of additional treatments including surgery and radiation, implying that serial arterial embolization on sacral and pelvic GCT is not effective. Three of 9 cases showed stable disease (SD) or continuous disease free (CDF) status and we analyzed associated factors with these good responses for embolization by chi2 test. The number of feeding vessels under six (p=0.048) and the number of collateral arterial supply under three (p=0.048) in the first angiogram showed significant relationships with good response for embolization, while remaining tumor staining by contrast after the first embolization and repeated embolization times were not significant. CONCLUSION: Although serial arterial embolization is not an effective modality on sacral and pelvic giant cell tumors, it may be a pilot modality under narrow indication of tumors with poor vascularity at first angiogram.

Intraosseous Ganglion of the Scapular Glenoid: A Case Report / 대한골관절종양학회지

Intraosseous ganglion is a benign cystic lesion. It is composed of fibrous tissue with mucoid changes located in the subchondral bone adjacent to a joint. Intraosseous ganglion has been reported in various skeletal sites and most commonly in the lower end of the tibia and femur. However reports of intraosseous ganglion of the glenoid are rare, with only 14 cases in the literature. We repot 2 cases of intraosseous ganglion of the glenoid with literature reviews.

Unplanned Excision of Soft Tissue Sarcoma: Patient Profile and Treatment Outcomes / 대한골관절종양학회지

PURPOSE: Unplanned excision of a soft tissue sarcoma is defined as the operation performed for gross removal of a soft tissue sarcoma without regard for preoperative imaging or the necessity to removal a margin of normal tissue covering the cancer. We report our experience of treating primary soft tissue sarcoma after an unplanned excision. MATERIALS AND METHODS: We retrospectively reviewed 31 patients referred to our hospital after unplanned excision at other hospitals for treatment of a STS. The clinical information was reviewed with a focus on the patient's age, gender, tumor location, tumor size, tumor depth, presumptive diagnoses at the previous surgery, refer hospital, definitive diagnosis, interval between the initial and additional surgery and local recurrence. RESULTS: There were 19 males and 12 females with a median age of 48 years (range, 17-75 years) at the time of referral. Seventeen patients (54.8%) had tumors in their lower limb, 6 (19.4%) had tumors in their upper limb, and 8 (25.8%) had tumors in their trunk. Tumor depth could be determined for 8 patients (25.8%), with superficial and 22 deep tumors (71%). The medial interval between unplanned excision to re-excision ranged from 2 weeks to 1 year (median, 5 weeks). Local recurrence was detected in 2 patients. All patients were alive without metastasis at last follow up. CONCLUSION: Even in upper class general hospital, many unplanned excision had been performed, which is considered to be avoided. When the relatively huge mass located in deeper layer it requires enough preoperative imaging studies and biopsy.

Conservative Management in Simple Bone Cyst / 대한골관절종양학회지

PURPOSE: This study evaluated the results of conservative treatment for simple bone cyst. MATERIALS AND METHODS: We studied 126 cases of simple bone cyst, which were treated by observation or steroid injection from February 1990 to May 2010. Their mean age at diagnosis was 14 years (+/-9 years, 2-60 years) and the mean follow-up duration for this study were 41 months (+/-37 months, 12-159 months). Observation and steroid injection was applied for conservative management of simple bone cyst and results was scored by modified Neer classification. RESULTS: 31 cases (24.6%) were treated by observation and 95 cases (75.4%) were treated by steroid injection. The 95 patients were treated by a mean of 1.1 (+/-0.9, 0-4) steroid injections and a single steroid injection was given in 65 cases (51.6%). The 102 cases (80.9%) were resulted in modified Neer classification I and II which could be considered as healing of simple bone cyst. CONCLUSION: Conservative management can be considered as an initial treatment for simple bone cyst with good result.

Outcomes of Diffuse-Type Pigmented Villonodular Synovitis (PVNS) after Open Total Synovectomy / 대한골관절종양학회지

PURPOSE: Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy. MATERIALS AND METHODS: Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications. RESULTS: Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular follow-up period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recur rence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery. CONCLUSION: After the open total synovectomy with electrocautrization, a low recurrence rate and satisfactory clinical outcome was achieved, observed in a minimum of 3 years of follow-up.

Liposarcoma in the Extremity / 대한골관절종양학회지

PURPOSE: We analyzed disease free survival and the prognostic factors of liposarcoma in the extremity. MATERIALS AND METHODS: Between 1994 and 2005, of 44 patients who were diagnosed and treated for liposarcoma of the extremity, 40 patients were restrospectively analysed. 13 out of 40 patients got postoperative radiotherapy. We examined local recurrence, distant metastasis and disease free 5-year survival rate. We also analyzed clinical prognostic factors, such as age, gender, size of tumor, prior unplanned excision, histologic type, surgical excision margin and postoperative radiotherapy respectively. RESULTS: There were 3 cases of local recurrence and 4 cases of distant metastasis. The disease free 5-year survival rate was 85.0%. 26 patients presented with myxoid, 8 well differentiated, 4 round cell, 1 pleomorphic and 1 dedifferentiated histology. The disease free 5-year survival rate of mixoid, well differentiated and round cell liposarcoma were 100.0%, 84.6% and 75.0% (p=0.419). The 5-year disease free survival rate was 90.6% in negative surgical margin (n=25) and 62.5% in positive surgical margin (n=15) (p=0.003). CONCLUSION: Our study suggests that surgical excision margin is significant prognostic factor for 5-year disease free survival rate.

Mass of the Distal Phalanx of the Finger with Bony Lesion

PURPOSE: Previous study revealed that 90% of benign bone tumor of hand is enchondroma. In soft tissue tumor, 36% of glomus tumor and less than 5% of giant cell tumor of tendon sheath are revealed as bone involving lesions. However, primary bone tumor and soft tissue tumor are not reported frequently at the distal phalanx. We aimed to assess the specific characters of the distal phalangeal mass. MATERIALS AND METHODS: Fourteen cases of distal phalangeal masses with bony lesions were included, and clinical and radiologic review were done. RESULTS: Fourteen cases out of eighteen distal phalangeal mass cases were bony lesions of the distal phalanx. Chief complaints of patients were pain (ten cases), palpable mass (four cases), and both (one case). Six cases were benign bone tumor, eight were soft tissue tumor involving the bone. In eight soft tissue mass, four glomus tumors, two epidermoid cysts, two giant cell tumors of tendon sheath were diagnosed. Nail involvement was found in four cases, and three of them were diagnosed as glomus tumor. CONCLUSIONS: The high rates of bone involvement and nail deformity of the distal phalangeal mass must be considered.

Hibernoma of Right Shoulder :A Case Report

PURPOSE: Hibernoma is a very rare benign soft tissue tumor of the hypervascularized brown fat tissue with no malignant potential. MATERIALS AND METHODS: However, it is difficult to differentiate a hibernoma from other malignant tumors, such as liposarcoma using computed tomography and magnetic resonance imaging, and a surgical resection with histological confirmation is the treatment of choice. RESULTS: Histopathologically, hibernoma is composed of brown adipose cells that are polygonal and multivacuolated with a centrally located nucleus and granular cytoplasm, unlike white adipose cells. CONCLUSION: This article describes a patient with a histologically-confirmed hibernoma of the right shoulder.

Subungual Squamous Cell Carcinoma of the Toe: A Case Report / 대한족부족관절학회지

Nail bed malignancies are rare entities. Most nail bed malignancies are squamous cell carcinoma (SCC)s. Less than 10% of subungual SCCs occur in the foot. Fifty percent occurred on the hallux and approximately 25% on both the fourth and fifth digits. The correct diagnosis is often delayed because nail bed malignancies are frequently mistaken for benign or infectious processes. SCC on extremities is hard to distinguish from the benign lesion like chronic ulcer, fistula caused by chronic osteomyelitis, and abscess fistula. Attention should especially be paid in diagnosing the subungual lesion because paronychia is a common disease. SCC is the most common carcinoma second to malignant melanoma as a soft tissue malignant tumor in the West, and it involves mainly the head, neck and upper extremities but rarely involves lower extremities, particularly the toes. The authors emphasize the importance of a biopsy for chronic nonhealing lesions by presenting this case.

Repeated Pulmonary Metastasectomy in Patients with Osteosarcoma / 대한흉부외과학회지

BACKGROUND: Surgical resection is a standard treatment for pulmonary metastases in patients with osteosarcoma, but the role of performing repeated resections is not clear. This study was designed to clarify the feasibility of performing a repeated pulmonary metastasectomy and the prognostic factors for pulmonary metastases in patients with osteosarcoma. MATERIAL AND METHOD: Between January 1990 and July 2005, 62 patients with osteosarcoma were diagnosed with pulmonary metastases and 36 patients underwent pulmonary resection. We reviewed the patients retrospectively. RESULT: The total number of pulmonary metastasectomies was 62 in 36 patients. Among 36 patients, 18 had a second metastasectomy, 7 had a third metastasectomy, and one patient had a fourth metastasectomy. There was no distinctive difference between the first and second metastatectomy in terms of median survival time, and the 3-year and 5-year survival rate (first resection: 20.5 months, 32.6% and 29.4%; second resection: 11.3 months, 34.9% and 34.%). However, the median survival time (7.1 months) was shorter in patients with a third metastatectomy than in patients with one metastatectomy (p=0.01). In long-term survivors, the number of female patients, patients with a disease free time longer than 12 months, patients with a single metastasis and patients with anatomic resection was larger when compared to non-long term survivors, but showed no statistical significance. CONCLUSION: Repeated pulmonary metastasectomy is expected to prolong survival time in patients with osteosarcoma, and is expected to increase long-term survival in selected cases. Further studies with a large number of patients are necessary.

Tumors in the Foot and Ankle (185 Cases) / 대한족부족관절학회지

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.

Multiple Glomus Tumors of the Ankle with Prominent Intranuclear Pseudoinclusions

Glomus tumors are neoplasms that are composed of modified smooth muscle cells of the glomus body. Here, we report a case of multiple glomus tumors of the ankle that showed various histologic types, including the solid type (glomus tumor proper) and angiomatous type (glomangioma). The tumor cells observed in this case also showed prominent intranuclear inclusions, which has not yet been reported in glomus tumors. Ultrastructural examination demonstrated that the nuclear inclusions were not true inclusion bodies but were intranuclear cytoplasmic pseudoinclusions formed by cytoplasmic invaginations that formed as a result of the deep and complex nuclear contours.

Limb Salvage with Low and Heat Treated Autobone

Limb salvage surgery for treatment of malignant bone tumors is an acceptable alternative to amputation in most patients as marked improvement has been achieved in diagnostic imaging, neoadjuvant chemotherapy, and operative techniques. There are several options for limb salvage: endoprosthesis, allograft, treated autobone, etc and each has its own advantages and disadvantages. Prosthetic replacement is an option for limb salvage surgery, but loosening, breakage, and wear are encountered during long-term follow up. Allografts require a large scale bone bank system, and there are concerns of immunologic responses, transmission of disease, religious and social circumstance, and high complication rate. Low heat treated autobone graft are reasonable option of treated autobone. Multiple studies and clinical application of heat treated bone proved the superiority of low heat treated bone(pasteurization, heating at 60 degrees ... to 65 degrees ... for 30 minutes) over other methods of heat treatment such as autoclaving or boiling. Low heat treatment has a lethal effect on malignant cells while preserving sufficient biomechanical strength and bone inducing property. Low heat treatment showed satisfactory results of bone remodeling and union, function, complication (fracture, infection and bone resorption). Several studies suggest that low heat treatment(pasteurization) may be superior to other cell-lethal treatment for autologous bone graft used for limb salvage surgery.

Tumor Volume Change after Chemotheraphy as a Predictive Factor of Disease Free Survival for Osteosarcoma

Change in tumor volume after chemotherapy appears to have a prognostic significance for the outcome of osteosarcoma. A newly developed volume measurement method based on three-dimensional summation with a proved reproducibility was utilized to measure osteosarcoma tumor volume. This retrospective analysis included 38 patients with biopsy- proven, nonsurface, skeletal high-grade osteosarcoma. The treatment was started by using three cycles of preoperative chemotherapy with cisplastin (100 mg/m2) and adriamycin (30 mg/m2). The tumor volume was measured before and after preoperative chemotherapy using three-dimensional magnetic resonance image measurement. The percentage of tumor necrosis was assessed by pathologic exam. After three cycle of postoperative chemotherapy, the patients were followed up at regular interval. For the 23 good responder patients, the mean survival time was 73.2 months (95% confidence interval 61.9 - 84.5 months), and for the 15 poor responder patients, the mean survival time was 50.8 months (95% confidence interval 38.6 - 63.1 months) (p < 0.05). For the 14 patients with increased tumor volume after chemotherapy, the mean survival time was 47.5 months (range: 36.3 - 58.6 months) and for the 24 patients with stable or decreased tumor volume, the mean survival time was 74.3 months (range: 63.79 - 84.88 months) (p < 0.05). Among the various factors, histopathologic response and tumor volume change after chemotherapy predicted disease free survival (p < 0.05). Change in the tumor volume that was measured with a reproducible method and the histopathologic response after chemotherapy were the important predictors of disease free survival for osteosarcoma patients.

The Role of Popliteal Lymph Nodes in Differentiating Rheumatoid Arthritis from Osteoarthritis by Using CE 3D-FSPGR MR Imaging: Relationship of the Inflamed Synovial Volume

OBJECTIVE: We wanted to assess the role of the popliteal lymph nodes for differentiating rheumatoid arthritis (RA) from osteoarthritis (OA), and we also wanted to investigate the relationship between the popliteal lymph nodes and the inflamed synovial volume (ISV) by using contrast enhanced (CE), fat suppressed, three dimensional-fast spoiled gradient echo (3D-FSPGR) MR imaging. MATERIALS AND METHODS: Contrast enhanced 3D-FSGPR MR imaging of 94 knees (21 with RA and 73 with OA) was analyzed. A lymph node was defined as being 'observed' if it could be seen in at least two planes of the three orthogonal reformatted planes. The number of observed lymph nodes, the mean of the smallest dimension of each lymph node and the existence of central fatty change were recorded. The OA group was graded according to the ISV calculated by a segmentation method: grade I was 40 cm3. Statistical analysis of the number and the mean size of the popliteal lymph nodes among the four groups (the RA group and the grade I-III OA groups) was performed. RESULTS: The prevalence of the observed popliteal lymph nodes was significantly different between all the OA groups or between the grade III OA group and the RA group (p < 0.0001, 0.0001, respectively). The popliteal lymph node was observed in 32 out of 73 OA cases, whereas it was visible in all of the 21 RA cases. The number (mean+/-standard deviation) of lymph nodes in the grade I OA group, the grade II OA group, the grade III OA group and the RA group was 1.2+/-0.4, 1.2+/-0.4, 1.3+/-0.5, and 2.7+/-1.1, respectively. The mean size (mean+/-standard deviation) of the lymph nodes was 3.8+/-1.0 mm, 3.6+/-1.1 mm, 4.1+/-0.8 mm, and 5.4+/-1.3 mm, respectively. The incidence of central fatty changes was significantly lower in the RA group than in all the OA groups and the grade III OA group. When differentiating RA from OA, and when the differentiation was confined to the RA group and grade III OA group, respectively, the criteria of the number of lymph nodes, their size, their central fatty change and a combination of all these three criteria showed statistical significance (Az values for the former were 0.869, 0.847, 0.776, and 0.942; Az values for the latter were 0.855, 0.799, 0.712, and 0.916). The number and mean size of the lymph nodes correlated with the ISVs (r = 0.49, p < 0.001; 0.50, 0.001, respectively). CONCLUSION: The number, size and central fatty changes in the popliteal lymph nodes observed on the MR images might serve as simple and useful markers in differentiating RA disease from OA disease. These markers would be particular helpful in cases of severe synovial enhancement where the ISVs of both RA and OA overlap. The number and mean size of the lymph nodes also correlated well with the ISV.

Factors Influencing the Recurrence of a Giant Cell Tumor of the Bone / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the recurrence rates of a giant cell tumor of the bone an determine what, if any, patient factors, tumor characteristics and surgical treatments correlate with the incidence of a local recurrence. MATERIALS AND METHODS: The records of fifty two cases who were diagnosed with a giant cell tumor of the bone between March 1992 and March 2001 and were could be followed up for at least 2 years were analysed retrospectively. This study reviewed the clinical characters, and the treatment method, recurrence, complication, the result of the follow-up. A Fisher' exact test was carried out to analyse the statistics. RESULTS: Sixteen patients (31%)had a local recurrence. The average time to recurrence was 17 months. All but case one recurred within 2 years after receiving surgical treatment. There was no significant differences in the recurrence rates based on the following variables: gender, tumor location, Campanacci grade, the presence of a pathologic fracture, primary versus recurrent tumor at presentation, resection margin, the use of a bone graft, internal fixation or polymethylmethacrylate. CONCLUSION: The clinical characters and methods of treatment were not correlated with a local recurrence. Most recurrences of a giant cell tumor can be expected within the first two to three years. Therefore the patient needs to be followed up in that period and longer for the a late recurrence and pulmonary metastasis.

ERK1/2 Activation Modulates Matrix Metalloproteinase 2 Activity and Ezrin Expression in Osteosarcoma Cell Lines / 대한정형외과연구학회지

PURPOSE: In this study, we aimed to investigate the influence of mitogen-activated protein kinase (MAPK) signal pathway and related factors of metastatic property on the osteosarcoma cell lines. MATERIALS AND METHODS: Osteosarcoma cell lines, MG-63, HOS, U2OS, SAOS-2, and osteoblast-like cell line, MC3T3-E1 were used for evaluating the activation of MAPK signal pathway and the effect of ERK1/2 inhibiton by 15 micrometer U0126 for 6 days. Then we measured the activity of matrix metalloproteinases (MMP) by gelatin zymography analysis. RESULTS: ERK was strongly activated in three osteosarcoma cell lines, MG-63, HOS, U2OS, and was weakly activated in SAOS-2 cell line. MMP2 was strongly activated in MG-63, HOS, U2OS cell lines. However, SAOS-2 cell line, in which ERK1/2 was weakly activated, showed weak activation of MMP2. When the ERK1/2 was inhibited by U0126 for 6 days, the ezrin expression was remarkably suppressed in all osteosarcoma cell lines. These data showed that the suppression of ezrin expression might be dependent on the ERK1/2 activation in osteosarcoma cell lines. CONCLUSION: Our results suggested that the ERK1/2 activation might be related to the activity of MMP2 and the suppression of ezrin expression in osteosarcoma cell lines. We suggest that ERK1/2 activation might be closely related to the ezrin expression and the ezrin expression might play an important role in the activation of MMP2 which is known to involve in the activated MMP2 involves in early metastatic properties in osteosarcoma.

Surgical Treatment of Hemangioma in The Extremities / 대한정형외과학회잡지

PURPOSE: Hemangioma of the extremity is a painful soft tissue tumor. Many treatment modalities (surgical excision, sclerotherapy, radiation, etc) have been used, but results have rarely been reported. This study addressed the efficacy of surgical excision on hemangioma of the extremities. MATERIALS AND METHODS: Eighty cases were analysed, all diagnosed as hemangioma between January 1994 and September 2001, and were followed up for at least 1 year. The male to female ratio was 31: 49, and the mean age 22.1 years. Sixty-one of the cases received surgical treatment, nine cases sclerotherapy, and the other ten cases received both. RESULTS: The main complaint of 54 of the 71 people who received surgery, was pain. After surgery, 49 were completely relieved of pain, and the reminder showed more than 50% pain relief. The mean size of the mass was 6x4 cm, and in 49 cases, it was larger than 5 cm. Hemangioma recurred in 4 patients (5.6%), 3 of the 4 received sclerotherapy and surgical treatment, only one received excision. Complications requiring surgical treatment occurred in only 2 patients (2%). The most common type was cavernous hemangioma which occurred in 51 cases (71.8%). Nineteen patients who received sclerotherapy showed reduced pain to about 50% average. Retreatment was required after a 1.5 years interval. CONCLUSION: Surgical excision is a reliable treatment for pain relief and for removing symptomatic hemangioma.