한국인 골종양과 유종양 병소에 대한 임상 및 병리 조직학적 연구

Abstract

[한글]

우리나라 골종양의 실태를 파악하기 위하여 연세대학교 의과대학 병리학교실에서 1965년 1월 부터 1975년 6월까지 10년 6개월간 경험한 골종양 및 유종양 병소 232례에 대하여 조직학적 분류, 방사선 및 임상소견들을 조사검토 하였다.

총 232례중 양성종양이 109례로서 총매수의 47%를 차지하였고 이중 골연골종이 30.4%, 양성거대세포종이 14%, 연골종과 섬유성 골형성부전증이 각각 12.9%등의 순위였다. 총 123례의 악성종양중전이성암이 34.1%로 가장 많았고 골육종이 28%, 연골육종이 10.8%, Bwing씨의 육종 7.2% 였고 다발성 골수종은 6.3%에 불과했다. 방사선소견과 병리조직학적 진단을 비교검토한 결과 양성종양은 77%에서 악성종양은 86%에서 진단이 일치하였다. 이상의 소견을 종합하여 보면 대체로 외국에서 보고된 것과 유사하였으나 다발성 골수종이 우리나라의 원발성 골종양중에서 낮은 비율을 차지하고 있었으며, 골종양진단에 임상적·방사던 소견 및 조직학적 소견의 종합이 중요한 것은 잘 알려져 있는 사실이지만 본 연구에서 골종양의 진단상 조직학적 소견외에 가장 도움이 되는 것은 방사선 소견이 있음은 본 연구의 중요한 결과의 하나로 생각되었다.

Clinico-Pathologic Studies on Tumors and Tumor-like Lesions of Bone and Cartilage

Among Koreans

Yang Ok Huh

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor, Dong Sik Kim, M.D.)

Many of the major advances in present-day understanding of bone tumors have been

in the last two decades. Neoplasms of bone occur sporadically and the management of

certain malignant tumors of bone remains among the most perplexing problems of

clinical medicine despite all the bold therapeutic measures including ablative

surgery, with or without adjunctive radiotherapy and chemotherapy.

Much has been written in recent years about diagnostic difficulties and pitfalls

for the diagnosis of bone tumors X-ray finding alone are sometimes misleading. The

pathologist's diagnosis is still the crucial determining factor in planning

appropriate treatment.

It has become a cliche to emphasize the necessity for the close liaison between

surgeon, radiologist and pathologist to arrive at a correct diagnosis of a lesion

suspected of being a bone tumor.

This collective review includes classification of bone tumors, their incidence

among Koreans, and also emphasizes the importance of cooperation among pathologist,

radiologist and surgeon in diagnosis of bone tumors.

Materials abd Methods

A total of 232 cases of tumors and tumor-like lesions of bone observer during the

ten years and six months period from January, 1965 to June, 1975 was clinically,

roentgenog raphically, and pathologically.

Age, sex, locations of lesions, chief complaints and dration of symptoms were

analysed by clinical records. Correlation of the radiologic appearances and

microscopic features has been possible in 109 cases in which and X-ray films were

available.

Histologic preparation was made by the ordinary technique with hematoxylin and

eosin and decalcification was done by nitric acid method, if necessary. The

classification of bone tumors was based largely on the one advocated by Spjut, et

al.(1971).

Results and Summary

Clinical and histopathological studies were made on 232 cases of benign and

malignant tumors and tumor-like lesions, which were submitted to the Department of

Pathology, Yonsei University, College of Medicine during the period of 10 years and

6 months, from Jan.,1965 to June, 11975, and the results are as follows.

1. Among 232 cases, 109 cases(47%) were benign and 123 cases(53%) were malignant.

2. Osteochondroma was the most frequently encountered benign bone tumor(30.4%),

followed by giant cell tumor(14%), enchondroma and fibrous dysplasia(12.9%, each).

3. Among the 123 cases of all malignant bone tumors, metastatic carcinoma was

most frequent(34.1%), followed by osteogenic sarcoma(28.0%),

cholndrosarcoma(10.8%), Ewing's sarcoma(7.2%) and multiple myeloma(6.3%).

4. The 78% of all beenign tumors developed during the first 3 decades of life,

and the peak age incidence of osteogenic sarcome was second decade and most cases

of multiple myeolma and metastatic carcinoma arised above 40 years of age.

5. The sex distribution of benign bone tumor shows slightly male

predominence(1.3:1), and males are twice as commonly affected as females in

malignant bone tumors.

6. Benign tumors, osteosarcoma and chondrosarcoma arised most commonly in the

femur, tibia, humerus and small bones of hand and most cases of multiple myeloma

and metastatic carcinoma involved vertebrae, rib and calvarium.

7. Clinical symtoms were mass or local swelling, pain nad limitation of motion in

order of frequency.

8. Overall accuracy of radiologic diagnosis was 77% in benign tumors and 85% in

the malignant.

9. Diagnostic accuarcy of bone tumors with only histologic preparation without

clinical and radiologic findings was 75% in the benign tumors and 86% in the

malignant.

In summary, these findings are similar to various reports in other countries

exept low realtive incidence of multiple myeloma among the malignant bone neoplasms

among Koreans and the necessity for the closed cooperation among the pathologist,

radiologist and surgeon in making a correct diagnosis of the bone tumors has been

emphasized again.

[영문]

Many of the major advances in present-day understanding of bone tumors have been in the last two decades. Neoplasms of bone occur sporadically and the management of certain malignant tumors of bone remains among the most perplexing problems of clinical medicine despite all the bold therapeutic measures including ablative surgery, with or without adjunctive radiotherapy and chemotherapy.

Much has been written in recent years about diagnostic difficulties and pitfalls for the diagnosis of bone tumors X-ray finding alone are sometimes misleading. The pathologist's diagnosis is still the crucial determining factor in planning

appropriate treatment.

It has become a cliche to emphasize the necessity for the close liaison between surgeon, radiologist and pathologist to arrive at a correct diagnosis of a lesion suspected of being a bone tumor.

This collective review includes classification of bone tumors, their incidence among Koreans, and also emphasizes the importance of cooperation among pathologist, radiologist and surgeon in diagnosis of bone tumors.

Materials abd Methods

A total of 232 cases of tumors and tumor-like lesions of bone observer during the ten years and six months period from January, 1965 to June, 1975 was clinically, roentgenog raphically, and pathologically.

Age, sex, locations of lesions, chief complaints and dration of symptoms were analysed by clinical records. Correlation of the radiologic appearances and microscopic features has been possible in 109 cases in which and X-ray films were available.

Histologic preparation was made by the ordinary technique with hematoxylin and eosin and decalcification was done by nitric acid method, if necessary. The classification of bone tumors was based largely on the one advocated by Spjut, et al.(1971).

Results and Summary

Clinical and histopathological studies were made on 232 cases of benign and malignant tumors and tumor-like lesions, which were submitted to the Department of Pathology, Yonsei University, College of Medicine during the period of 10 years and 6 months, from Jan.,1965 to June, 11975, and the results are as follows.

1. Among 232 cases, 109 cases(47%) were benign and 123 cases(53%) were malignant.

2. Osteochondroma was the most frequently encountered benign bone tumor(30.4%), followed by giant cell tumor(14%), enchondroma and fibrous dysplasia(12.9%, each).

3. Among the 123 cases of all malignant bone tumors, metastatic carcinoma was most frequent(34.1%), followed by osteogenic sarcoma(28.0%), cholndrosarcoma(10.8%), Ewing's sarcoma(7.2%) and multiple myeloma(6.3%).

4. The 78% of all beenign tumors developed during the first 3 decades of life, and the peak age incidence of osteogenic sarcome was second decade and most cases of multiple myeolma and metastatic carcinoma arised above 40 years of age.

5. The sex distribution of benign bone tumor shows slightly male predominence(1.3:1), and males are twice as commonly affected as females in malignant bone tumors.

6. Benign tumors, osteosarcoma and chondrosarcoma arised most commonly in the femur, tibia, humerus and small bones of hand and most cases of multiple myeloma and metastatic carcinoma involved vertebrae, rib and calvarium.

7. Clinical symtoms were mass or local swelling, pain nad limitation of motion in order of frequency.

8. Overall accuracy of radiologic diagnosis was 77% in benign tumors and 85% in the malignant.

9. Diagnostic accuarcy of bone tumors with only histologic preparation without clinical and radiologic findings was 75% in the benign tumors and 86% in the malignant.

In summary, these findings are similar to various reports in other countries exept low realtive incidence of multiple myeloma among the malignant bone neoplasms among Koreans and the necessity for the closed cooperation among the pathologist,

radiologist and surgeon in making a correct diagnosis of the bone tumors has been emphasized again.