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The Korean Journal of Pathology 1976;10(1): 73-90.
한국인 골종양과 유종양 병소에 대한 임상 및 병리조직학적 연구
Clinico-Pathologic Studies on Tumors and Tumor-like Lesions of Bone and Cartilage among Koreans
Many of the major advances in present-day understanding of bone tumors have been made 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 pathologist. In spite of significant advances in the roentgenologic diagnosis of bone tumors X-ray findings 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 and Methods ; A total of 232 cases of tumors and tumor-like lesions of bone observed during the ten years and six months period from January, 1965 to June, 1975 was reviewed clinically, roentgenographically, and pathologically. Age, sex, locations of lesions, chief complaints and duration of symptoms were analysed by clinical records. Correlation of the radiologic appearances and microscopic features has been possible in 109 cases in which 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, 1975, and the results were 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%), chondrosarcoma(10.8%), Ewing's sarcoma(7.2%) and multiple myeloma(6.3%). 4. The 78% of all benign tumors developed during the first 3 decades of life, and the peak age incidence of osteogenic sarcoma was second decade and most cases of multiple myeloma and metastatic carcinoma arised above 40 years of age. 5. The sex distribution of benign bone tumor showed slightly male predominence(1.3:1), and males were 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 and limitation of motion in order of frequency. 8. Overall accuracy of radiologic diagnosis wes 77% in benign tumors and 85% in the malignant. 9. Diagnostic accuanrcy 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 were similar to various reports in other countries except low relative incidence of multiple myeloma among the malignant bone neoplasms among the pathologist, radiologist and surgeon in making a correct diagnosis of the bone tumors has been emphasized again.