Preventive Effects of Zoledronic Acid on Bone Metastasis in Mice Injected with Human Breast Cancer Cells

정준,이경선,최양규,오영주,이희대 대한의학회 2011 Journal of Korean medical science Vol.26 No.12

Bisphosphonates are used routinely to reduce bone-related events in breast cancer patients with bone metastasis. We evaluated the effects of zoledronic acid, a third generation,nitrogen-containing bisphosphonate, to prevent bone metastasis in breast cancer. Zoledronic acid or vehicle alone was administered to nude mice either simultaneously or after intracardiac injection of human breast cancer MDA-MB-231 cells. Nude mice treated with zoledronic acid at early time points showed a lower incidence of bone metastases than did vehicle-treated nude mice, but these differences were not statistically significant. Only 37.5% of mice treated with zoledronic acid at the time of tumor cell inoculation developed bone metastases compared to over 51.8% of mice receiving vehicle alone (P = 0.304). Cell count of apoptosis confirmed by immunohistochemical staining in metastatic bone tissue significantly increased in the zoledronic acid-treated groups compared to non-treated group (1,018.3 vs 282.0; P = 0.046). However, metastatic tumor cells, which invade soft tissue around the bone, did not show extensive apoptosis;there were no differences between the zoledronic acid-treated and control groups. These results suggest that zoledronic acid increases apoptosis of metastatic breast tumor cells in the bone and could therefore reduce metastatic tumor burden. These results support the use of zoledronic acid to reduce the incidence of bone metastasis in breast cancer.

Juxtacortical Osteoma of the Metatarsal Bone: A Case Report

김수지,박희진,이소연 대한영상의학회 2017 대한영상의학회지 Vol.77 No.6

Osteoma is a benign bone-forming tumor composed of compact or mature trabecular bone and is limited almost exclusively to craniofacial bones, especially in the paranasal sinuses and mandible. It is typically a slow growing lesion that is asymptomatic, unless its size significantly increases to cause symptoms such as pain or other neurological symptoms, that happens more often in cases involving craniofacial bones. Radiological appearance of these tumors depends on their location. In cases of juxtacortical osteoma, it is crucial to differentiate between this type of tumor and parosteal osteosarcoma, sessile osteochondroma, and matured juxtacortical focus of myositis ossificans. However, in some cases, it is difficult to differentiate juxtacortical osteoma from above mentioned lesions only with radiologic appearance. We describe a case of an osteoma that arose from the second metatarsal bone, a rare anatomical location for osteoma.

악성 골반 골종양에 의한 천장관절의 경관절 침습

허진도,조길호,김성민,조영덕,Heo, Jin-Do,Jo, Gil-Ho,Kim, Seong-Min,Jo, Yeong-Deok 대한영상의학회 2002 대한영상의학회지 Vol.46 No.3

목적: 종양의 위치, 천장관절의 해부학적 구조와 위치, 관절강직증 유무, 그리고 종양이 형성하는 연부 조직 종괴의 양상에 따라 악성 골반 골종양이 천장 관절로 경관절 침습하는 방식을 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 골반골에서 발생한 악성 골종양 환자 중, 영상소견에서 천장 관절을 침범하여 상대편 골(opposing bone)의 골 파괴가 있는 11명의 환자를 대상으로 하였다. 골종양의 발생위치와 크기를 알아보았으며, 천장관절의 침범부위를 위치에 따라 상부, 중간, 하부 침습으로 분류하였고, 해부학적 차이에 따라 활막 유리질 연골 부위(synovial hyaline cartilage portion)와 섬유성 연골 인대 부위(fibrous ligamentous portion)침습으로 나누었다. 관절의 강직증 유무에 따라 경관절 침습 양식을 비교하였다. 천장관절로의 경관절 침습 양식은 연골을 파괴하고 직접적으로 관절을 가로질러 넘어가는 직접 침습(direct invasion)과 연부 조직 종괴가 상대편 골피질에 인접하여 관절 주변부와 상대편 골(opposing bone)을 침범하는 간접 침습(indirect invasion)으로 분류하였다. 결과: 종양은 전예에서 천장 관절 근처에서 발생하였고, 장골이 8예, 천골이 3예였다. 천장관절의 간접 침습은 6예, 직접 침습은 5예였다. 천장관절의 간접 침습에서 종양의 크기는 평균191.8 cm2 이었고, 직접 침습에서는 평균 69.6 cm2이었다. 천장관절의 간접침습은 모든 예에서 큰 연부조직 종괴가 천장관절 주변부에서 관절과 접하고 있었다. 상부에서 발생한 간접 침습의 5예는 모두 관절 후방의 섬유성 연골 인대 부위를 침범하였으나 종양과 인접한 활막 유리질 연골은 침범하지 않았다. 하부에서 발생한 1예에서는 활막 유리질 인대를 유지하면서, 관절강을 우회하여 상대편 골(opposing bone)의 골피질을 파괴하였다. 이중 관절강직증은 1예에서 보였다. 직접 침습 역시 비교적 큰 연부 조직 종괴가 관찰되었으며, 관절 상부에서 발생한 2예와 중간부위에서 발생한 1예는 관절 후방의 섬유성 연골 인대를 침습하였다. 관절 강직증을 동반한 2예만 하부의 활막 유리질 연골을 통하여 직접 침습을 하였다.결론: 악성 골반 골종양의 경관절 침습은 대부분이 섬유성 연골 인대부분을 통하여 천장관절 을 침습한다. 관절강직증이 동반된 경우 활막 유리질 연골 파괴를 통한 천장관절 침습이 가 능하다. 또한 골반 골종양은 천장관절을 가로질러 침습하기 보다는 큰 연부 조직 종괴가 천장관절과 접한 후, 관절 주변부(periphery)로부터 관절 또는 상대편 골(opposing bone)로의 파급되는 것으로 생각된다. Purpose: To describe modes of transarticular invasion, with reference to the size and location of a tumor, the anatomic characteristics of invaded cartilage, and the existence of ankylosis in SI joint. Materials and Methods: Eleven histologically confirmed malignant pelvic bone tumors involving transarticular invasion of sacroiliac joints, were retrospectively analysed. Transarticular invasion of a joint was defined as involvement of its opposing bones. The anatomic site and size of the tumors were analysed, and invaded sacroiliac joint was divided into upper, middle and lower parts on the basis of the anatomic characteristics of the intervening cartilage: synovial hyaline or fibrous ligamentous. The existence of ankylosis was determined, and transarticular invasion directly across a joint was classified as direct invasion. Extension of tumors around a joint from its periphery to the opposing bone were considered as indirect invasion. Results: All tumors were located near the sacroiliac joint, eight at the ilium and three at the sacrum. Six invasions were indirect and five were direct. Average tumor area was larger in indirect cases than in direct: 191.8 cm2 vs. 69.6 cm2. In all indirect invasions, a huge soft tissue mass abutted onto the peripheral portion of the sacroiliac joint. In five of six cases of indirect transarticular invasion, the upper part of the joint posteriorly located fibrous ligamentous cartilage. In the other, the lower part was invaded, and this involved a detour around the joint space, avoiding the invasion of intervening cartilage. Ankylosis occurred in one of the indirect cases. Among the five cases of direct invasion, there was invasion of the posteriorly located ligamentous fibrous cartilage in three without ankylosis. In the other two cases, involving ankylosis, the synovial hyaline cartilage was invaded directly at the lower part of the joint. Conclusion: Transarticular invasions of sacroiliac joint via fibrous cartilage are most common. Ankylosis of the sacroiliac joint facilitates hyaline cartilage invasion. We consider that in transarticular invasion of malignant pelvic bone tumors, indirect invasion is more common than direct.

Feasibility of a Novel In-situ Local Tumor Ablation and Recycling Machine Based on Radiofrequency Dielectric Heating: In-depth Review on Research Background and Preliminary Report of an Experimental Study

Min Wook Joo,Sangrok Jin,Gyeong-Jun Lee,Yong-Suk Lee,Yang-Guk Chung 대한정형외과학회 2024 Clinics in Orthopedic Surgery Vol.16 No.1

Background: In bone sarcomas, chemotherapy has improved the prognosis with advances in diagnostic and surgical technologies, which has led to attempts to save limbs. As early detection and multidisciplinary treatment have improved the survival rate, curative surgery is considered for selected patients with metastatic bone carcinomas. Limb salvage procedures may vary in relation to the reconstruction method, which is accompanied by different complications. To overcome them, we devised a novel concept, insitu local tumor ablation and recycling machine based on radiofrequency (RF)-induced heating and intended experiments to demonstrate its feasibility. Methods: The fresh femurs of 6-month-old pigs were used after removing the epiphyses; the distal parts were placed in a heating chamber. Fiber-optic temperature sensors were inserted in the metaphysis, meta-diaphysis, and diaphysis. Temperatures were measured six times each during heating at 27.12 MHz at various powers. Additionally, the compressive and bending stiffnesses were measured six times each for the unprocessed, RF-treated, and pasteurized bones, and the results were compared. Results: Under 200 W power output, the temperatures at all measurement sites reached 70 °C or higher in 6 minutes, and the temperatures were maintained. The median compressive stiffness of RF-heated bones was 79.2% higher than that of pasteurized bones, but the difference was statistically insignificant. The median bending stiffness of RF-heated bones was approximately 66.3% of that of unprocessed bones, which was 20% higher than that of pasteurized bones. Conclusions: The feasibility to rapidly attain and maintain temperatures for tumor ablation is shown, which favorably preserves bone stiffness through the in-situ local tumor ablation and recycling based on RF heating. The problem of nonuniform temperature distribution might be solved by an optimal design determined from simulation research and additional experiments.

Implications of Bone-Only Metastases in Breast Cancer: Favorable Preference with Excellent Outcomes of Hormone Receptor Positive Breast Cancer

이수진,박실비아,안희경,이준호,조은윤,선종무,이정언,남석진,양정현,박연희,안진석,임영혁 대한암학회 2011 Cancer Research and Treatment Vol.43 No.2

Purpose The aim of the current study was to determine the incidence, clinical presentation, and treatment outcomes of “bone-only metastases” in patients with breast cancer and to analyze the impact of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)status on prognosis. Materials and Methods Between 1994 and 2007, of 968 patients with metastatic breast cancer who underwent palliative management at Samsung Medical Center, 565 (57%) relapsed with distant metastases. Of the 968, 146 (15%) had bone-only metastases during a median follow-up period of 75 months. Among the 146 patients with bone-only metastases, 122 (84%) were relapsed patients after curative surgery and 24 (26%) were initially metastatic cases. Results The median time from primary surgery to bone-only metastases of the 122 patients was 37months (95% confidence interval [CI], 27 to 46 months). Bone-only metastases were more common in the HR-positive group than in the other subtypes (85% for HR+; 8.2% for HER2+;6.8%for triple negative. Among all 146 patients, 75 (51%) were treated with hormone therapy. The median post-relapse progression-free survival was 15 months (95%CI, 13 to 17 months). The median overall survival was much longer in the HR+ patients than the HER2+ and triple negative breast cancer patients with marginal statistical significance (65 vs. 40 vs. 40months, p=0.077). Conclusion Breast cancer patients with “bone-only metastases” had excellent clinical outcomes. Further study is now warranted to reveal the underlying biology that regulates the behavior of this indolent tumor, as it should identify ‘favorable tumor characteristics’ in addition to ‘favorable preferential metastatic site.’

Giant Cell Reparative Granuloma in the Temporal Bone of a 4-Month-Old Infant

최연주,정종우 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.10

Giant cell reparative granuloma (GCRG) is a rare benign bone disease of unknown causes. Trauma is a suspected cause or contributor to the onset of GCRG, of which only a few caseshave been reported worldwide. We report a case of temporal bone GCRG in a 4-month-oldmale newborn, who was born at full term via spontaneous vaginal delivery with recent presentationof right facial palsy. He had a right temporo-occipital craniectomy due to GCRG 1month earlier. There had been no history of trauma. During the workup of the facial palsycomplaint, we identified a lobulated mass in the right temporal bone by computed tomographyand magnetic resonance imaging. The mass was mainly in the petrous portion of the temporalbone with extracranial extension through the occipital bone. This was consistent with a GCRGrecurrence. The mass was removed via the transcrusal approach, and the final histopathologyreport confirmed it as recurrent GCRG.

골스캔상 음성인 골전이가 FDG - PET 로 진단된 소세포폐암 2 예

송서영(Seo Yonug Song),최준영(Joon Young Choi),이충현(Choong Hyoun Rhee),김원석(Won Seog Kim),윤성수(Sung Soo Yoon),이홍기(Hong Gi Lee),강원기(Won Gi Kang),박찬형(Chan Hyun Park),김병태(Byung Tae Kim),박근칠(Keun Chil Park) 대한내과학회 2000 대한내과학회지 Vol.59 No.4

Bone scintigraphy is a very sensitive and cost-effective diagnostic method for detecting bony metastases of malignant neoplasm. However it has been reported that bone scan is less sensitive for early bony metastases, especially vertebral metastases. PET is a non-invasive clinical imaging methodology that can be used to assess such biochemical disturbance in tissue in vivo quantitatively with high resolution.We experienced two cases of small cell lung cancer with multiple bony metastases which were detected on PET imaging but not on planar bone scan. This case report suggests that FDG-PET will be a very effective diagnostic tool for bony metastases especially in clinically suspected case despite a normal planar bone scan.(Korean J Med 59:467-471, 2000)

Outcome after Surgery for Metastases to the Pelvic Bone: A Single Institutional Experience

Chandra Kumar Krishnan,한일규,김한수 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.1

Background: The pelvic bone is the most common site of bone metastases following the axial skeleton. Surgery on the pelvic bone is a demanding procedure. Few studies have been published on the surgical outcomes of metastasis to the pelvic bone with only small numbers of patients involved. This study sought to analyze the complications, local progression and survival after surgery for metastasis to the pelvic bone on a larger cohort of patients. Methods: We analyzed 83 patients who underwent surgery for metastases to the pelvic bone between the years 2000 and 2015. There were 41 men and 42 women with a mean age of 55 years. Possible factors that might be associated with complications, local progression and survival were investigated with regard to patient demographics and disease-related and treatment-related variables. Results: The overall complication rate was 16% (13/83). Advanced age (> 55 years, p = 0.034) and low preoperative serum albumin levels (≤ 39 g/L, p = 0.001) were associated with increased complication rates. In patients with periacetabular disease, the complication rate was higher in those who underwent total hip replacement arthroplasty (THR) than those who did not (p = 0.030). Local progression rate was 46% (37/83). The overall median time to local progression was 26 ± 14.3 months. The median time from local progression to death was 13 months (range, 0 to 81 months). The local progression-free survival was 52.6% ± 6.4% at 2 years and 36.4% ± 7.6% at 5 years, respectively. Presence of skip lesions (p = 0.017) and presence of visceral metastasis (p = 0.027) were found to be significantly associated with local progression. The median survival of all patients was 24 months. The 2-year and 3-year survival rates were 52.5% ± 5.9% and 35.6% ± 6%, respectively. Metastasis from the kidney, breast, or thyroid or of hematolymphoid origin (p = 0.014), absence of visceral metastasis (p = 0.017) and higher preoperative serum albumin levels (p = 0.009) were associated with a prolonged survival. Conclusions: Advanced age and low serum albumin levels were associated with high complication rates. Local progression after surgery for metastases to the pelvic bone was affected by the presence of skip lesions, not by surgical margins. Primary cancer type, serum albumin level and visceral metastasis influenced survival.

Application of Biomarkers for the Prediction and Diagnosis of Bone Metastasis in Breast Cancer

Feiqi Liu,Jianji Ke,Yanqiu Song 한국유방암학회 2020 Journal of breast cancer Vol.23 No.6

The most common metastatic site of breast cancer is the bone. Metastatic bone disease can alter the integrity of the bone and cause serious complications, thereby greatly reducing health-related quality of life and leading to high medical costs. Although diagnostic methods and treatments for bone metastases (BM) are improving, some patients with early breast cancer who are at high risk of BM are not diagnosed early enough, leading to delayed intervention. Moreover, whole-body scintigraphy cannot easily distinguish BM from nonmalignant bone diseases. To circumvent these issues, specific gene and protein biomarkers are being investigated for their potential to predict, diagnose, and evaluate breast cancer prognosis. In this review, we summarized the current biomarkers associated with BM in breast cancer and their role in clinical applications to assist in the diagnosis and treatment of BM in the future.

안면신경마비로 발현한 측두골의 전이성 폐 선암종 1예

심형준,전병석,박수찬,김성희 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.11

Metastatic lesions in temporal bones were rare in the past, however, nowadays, they seem to be increasing. The primary sites ofmetastases to the temporal bones are known to be the breasts, lungs, kidneys, gastrointestinal tract, prostate gland, larynx, andthyroid gland. We present a case with peripheral facial paralysis as the only symptom of a metastasis to the temporal bone in a73 year-old woman, and that peripheral facial paralysis was the first and only metastatic symptom in that case. This patient wasinitially diagnosed with Bells palsy. However, based on the pathologic findings, a further study revealed an adenocarcinoma ofthe lungs which spread to the temporal bone. Any metastatic diseases to the temporal bone should be considered as possibleetiology in patients with a clinical history of malignant neoplasms presenting with common otologic or vestibular symptoms,especially with facial nerve paralysis. (Korean J Otolaryngol 2006;49:1130-3)