치골에 발생한 연골육종 - 증례 보고 -

송원석,안준환,조완형,변우진,전대근,Song, Won-Seok,An, Joon-Hwan,Cho, Wan-Hyeong,Byun, Woo-Jin,Jeon, Dae-Geun 대한근골격종양학회 2006 대한골관절종양학회지 Vol.12 No.2

골반골은 악성 골종양의 원발 병소 중 예후가 가장 나쁜 위치이다. 그 중에서도 치골결합 주위에서 발생한 악성 골종양은 그 자체가 극히 드물며, 이곳에 발생한 연골육종은 크기가 작은 경우에도 해부학적인 위치 때문에 절제에 어려움이 있다. 저자들은 치골에 생긴 골반강내 연골육종을 양측 치골지의 절골술 후 도달법으로 전 절제가 가능하였으며, 술후 양호한 기능적 결과를 보였기에 보고하는 바이다. Pelvic bone is location with the worst prognosis in primary malignant bone tumor. Malignant bone tumor around symphysis pubis is extremely rare, and although small size, it is difficult to excise because of anatomical location. The authors report a case of intra-pelvic chondrosarcoma of the pubic bone with good functional result through resection by both superior & inferior pubic ramus osteotomy.

저등급 중심부 골육종의 진단, 치료 및 예후

송원석,조완형,이광열,공창배,고재수,전대근,이수용,Song, Won Seok,Cho, Wan Hyeong,Lee, Kwang-Youl,Kong, Chang-Bae,Koh, Jae-Soo,Jeon, Dae-Geun,Lee, Soo-Yong 대한근골격종양학회 2014 대한골관절종양학회지 Vol.20 No.2

Purpose: We analyzed the diagnosis and the treatment outcomes of patients with central low grade osteosarcoma. Materials and Methods: We retrospectively reviewed 16 patients with central low grade osteosarcoma were treated at out institution between 1994 and 2011. Results: There were 4 men and 12 women with mean age of 26 years. Eleven patients were correctly diagnosed but 5 patients were misdiagnosed as osteoid osteoma, non ossifying fibroma, aneurysmal bone cyst, desmoplastic fibroma. 15 patients finally received wide margin en bloc excision and one of them treated under neoadjuvant chemotherapy. Final survival status was continuous disease free in 14 and 1 patient died of renal cell cancer. Remaining 1 with multifocal lesions is alive with disease for 7 years only treated radiation therapy on residual tumors. Nine (56%) of 16 tumors showed extra-osseous extension of tumor (56%) and 1 of them showed extra-compartmental tumors. Conclusion: The diagnosis of central low grade osteosarcoma is challenging, however, considering of the clinical suspicion, the typical findings of radiologic and pathologic features, proper diagnosis is needed. This tumor should be treated with wide excision, even after an intralesional excision, to avoid local recurrence or transformation to higher histologic grade. 목적: 저등급 중심부 골육종 환자의 진단, 치료 및 예후에 대하여 알아보고자 하였다. 대상 및 방법: 1994년부터 2011년까지 저등급 중심부 골육종으로 진단받고 본원에서 치료받은 16명의 환자를 대상으로 하였다. 결과: 환자 분포는 남자가 4명 여자가 12명이었으며 평균 연령은 26세였다. 초기 진단은 11명의 환자가 중심부 저등급 골육종으로 맞게 진단되었으나 나머지 5명의 환자는 각각 유골 골종, 비골화성 섬유종, 골모세포종, 동맥류성 골낭종, 결합조직형성 섬유종 등으로 오진되었다. 15명의 환자가 최종적으로 광범위 절제술을 시행하였으며 그 중 한 명은 수술 전 항암치료를 시행하였다. 그 중 14명의 환자가 치료 후 재발 없이 추시중이며, 한 명은 기존에 앓던 신세포암의 악화로 수술 후 21개월 후 사망하였다. 나머지 한 명은 다발성 종양 환자로, 부분적으로만 광범위 절제술을 시행하였으며 잔존 종양에 방사선 치료만을 시행한 후 7년째 생존 중이다. 9명(56%)의 환자가 종양이 피질골 밖까지 파급되어 있는 소견을 보였으며 그 중 한 명은 구획 외로까지의 파급을 보였다. 결론: 저등급 중심부 골육종은 진단이 어려우나 임상적 의심과 함께 조직병리학적, 영상학적인 특징을 고려하여 주의 깊은 감별이 요구된다. 치료에 있어서는 광범위 종양 절제술이 권장되며, 양성 종양으로 오진하여 병소내 절제술만 시행한 경우라도 국소 재발이나 고등급으로의 악성 전환 가능성이 있으므로 광범위 재절제술을 시행할 것을 권고하는 바이다.

Discovery of biliary bile acids as metabolic biomarkers in Cholangiocarcinoma by LC-MS/MS

송원석,김윤곤,김성민,조성현,이재승,전효진 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.1

Unlike other biologic fluids such as serum or urine, bile is located near bile tumors, increasing the detection of Cholangiocarcinoma (CCA)-specific biomarkers. Conventional CCA biomarkers can be used to distinguish between CCA and healthy controls, but it is not easy to distinguish them from benign biliary diseases (BBD). In this study, we analyzed 15 biliary bile acids in CCA patients and BBD patients by targeted metabolomics using LC-MS/MS and discovered metabolic biomarkers that can distinguish two diseases. First, the total bile acid concentration of patients with BBD was significantly higher than that of CCA patients. Secondary bile acid levels were also higher in patients with BBD than in patients with CCA. Comparing the composition ratios of 15 biliary bile acids, it was found that 7 species of bile acids showed a significant difference. We could analyze various biliary bile acid differences between BBD and CCA through targeted metabolomics using LC-MS / MS.

Clinical Outcome of Parosteal Osteosarcoma

송원석,전대근,조완형,공창배,조상현,이광열,이수용,Song, Won Seok,Jeon, Dae-Geun,Cho, Wan Hyeong,Kong, Chang Bae,Cho, Sang Hyun,Lee, Kwang Ryul,Lee, Soo-Yong The Korean Musculoskeletal Tumor Society 2013 대한골관절종양학회지 Vol.19 No.1

목적: 방골성 골육종 환자의 치료 결과와 국소 재발 후의 결과에 대해서 알아보고자 하였다. 대상 및 방법: 22명의 방골성 골육종 환자의 치료 결과를 후향적으로 분석하였다. 평균 추시기간은 114개월(범위; 36-235개월)이었다. 22명 중 7명은 국소 재발 후에 전원 되었다. 병기는 17명에서 IB였고, 5명은 IIB (G2, 2명; 역분화, 3명)이었다. 종양의 위치는 대퇴골(11명), 기타 부위(11명)이었다. 최초 절제연은 광범위 절제연 10명, 변연 절제연 5명, 병소내 절제가 7명이었다. 여러 임상 및 병리인자와 국소 재발과의 연관성, 그리고 국소 재발 후의 임상 경과를 조사하였다. 결과: 10년 생존율은 85.7%이었다. 3명(14%)에서 원격 전이를 보였고 이들은 모두 사망하였다. 9명(41%)에서 국소 재발이 있었다. 종양의 위치, 절제 방법 및 절제연이 국소재발과 관련이 있었다. 국소 재발 후 수술 한 환자 9명 중 최종 추시 시 7명에서는 무병 상태였다. 결론: 방골성 골육종의 오진의 가능성이 높으며 특히 대퇴골 이외에 발생한 경우 오진이 많았다. 대부분의 재발성 종양에 대한 재 절제는 가능하나 공격적 성향을 보이며 재발한 경우에는 주의가 필요할 것으로 생각된다. Purpose: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). Materials and Methods: The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. Results: The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. Conclusion: A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.

Plain Radiologic Findings and Chronological Changes of Incipient Phase Osteosarcoma Overlooked by Primary Physicians

송원석,전대근,조완형,공장배,조상현,이정욱,이수영 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2

Background: We assessed the plain radiographic characteristics of 10 cases of osteosarcomas during the initial painful period that had been overlooked by a primary physician. In addition, we evaluated chronologic changes in radiographic findings from initial symptomatic period to the time of accurate diagnosis. Methods: The clinical records were reviewed for clinical parameters including age, sex, location, presenting symptoms, initial diagnosis, duration from initial symptoms to definite diagnosis, and initial and follow-up plain radiographic findings of the lesion. Results: Initial clinical diagnoses included a sprain in 6, growing pain in 2, stress fracture in 1, and infection in 1 patient. Initial plain radiographic findings were trabecular destruction (100%), cortical disruption (60%), periosteal reaction (60%), and soft tissue mass (10%). Intramedullary matrix changes were osteosclerosis in 6 and osteolysis in 4 patients. On progression, 4 cases with minimal sclerosis changed to osteoblastic lesion in 3 patients and osteolytic lesion in 1. Four cases with faint osteolytic foci transformed into osteolytic lesion in 3 and mixed pattern in 1. Conclusions: Notable plain radiologic findings of incipient-stage osteosarcoma include trabecular disruption along with faint osteosclerosis or osteolysis. In symptomatic patients with trabecular destruction, additional imaging study including magnetic resonance imaging should be performed to exclude osteosarcoma in the incipient phase, even without radiologic findings suggesting malignant tumor, such as cortical destruction or periosteal reaction.

원위 경골 골육종의 역행적 골수내 정과 저온 열처리 골을 이용한 재건 - 증례 보고 -

송원석,안준환,이수용,박종훈,조완형,고한상,전대근,Song, Won-Seok,An, Joon-Hwan,Lee, Soo-Yong,Park, Jong-Hoon,Cho, Wan-Hyung,Ko, Han-Sang,Jeon, Dae-Geun 대한근골격종양학회 2006 대한골관절종양학회지 Vol.12 No.2

원위 경골에 발생하는 악성 종양은 드물고 치료에 있어서도 절단술이 많이 시행되어왔다. 최근 사지 구제술이 많이 시행되고 있지만 발목 관절이 포함 되는 경우 재건 방법이 용이치 않다. 저자들은 원위 경골에 발생한 골육종 1례에 대해서 역행성 골수내 정과 저온 열처리 자가골을 이용하여 치료하였기에 문헌 고찰과 함께 보고하고자 한다. Malignant bone tumor in distal tibia is a rare condition which has been treated by amputation. Although widely accepted, limb salvage surgery in this area poses difficulties with respect to reconstruction. We present one patient with distal tibial osteosarcoma treated by performing limb salvage and reconstructing with retrograde IM nail and pasteurized bone.

LC-MS/MS based targeted metabolomics analysis of bile acids from malignant and benign gallbladder cancer patients

송원석,박한규,황철환,김윤곤,김병기 한국공업화학회 2016 한국공업화학회 연구논문 초록집 Vol.2016 No.1

Gallbladder cancers can be difficult to detect because they are located deep inside the body and sometimes they may be no symptoms at all. To find the association between malignant gallbladder cancer and bile acids, this study analyzed the bile acid concentration and composition in bile of malignant and benign gallbladder cancer patients. We quantified major unconjugated bile acids in bile (cholic acid, chenodeoxycholic acid, deoxycholic acid, lithocholic acid and ursodeoxycholic acid) as well as their glycine- and taurine-conjugates by liquid chromatographytandem mass spectrometry (LC-MS/MS). Malignant and benign gallbladder cancer bile could be distinguished by quantification of their major bile acids. Therefore, this diagnostics could be valuable for detecting a malignant gallbladder cancer.

근위 경골 골육종의 부분 절제술 - 증례 보고 -

송원석,이승준,원호현,전대근,Song, Won-Seok,Lee, Seung-Jun,Won, Ho-Hyun,Jeon, Dae-Geun 대한근골격종양학회 2008 대한골관절종양학회지 Vol.14 No.2

사지 구제술이 보편화된 후 슬 관절 주위 골육종 환자의 재건 방법은 술자의 선호도에따라 차이가 있을 수 있으나 비교적 표준화 되어 있다. 현재 주로 시행되는 사지 구제술 방법으로는 크게 인공관절 치환술, 동종골 이식술이 있다. 인공관절 치환술의 경우 매우 안정적이며 술후 기능적으로도 양호한 방법으로 알려져 있으나, 궁극적으로 파손에 의한 제거술 시행이 필수적인 단점이 있다. 장기적인 관점에서 볼때 이식골을 이용한 재건술은 큰 장점을 갖고 있다. 하지만, 동종골의 사용은 요구되는 크기와 모양을 쉽게 구하기 어렵다는 단점이 있으며, 자가골 이식술은 수술 절제연이 안전하고, 그 적응증이 확립된 경우에만 사용해야 한다는 단점을 갖고 있다. 사지 구제술에 있어 분절 절제법은 골간의 병변에 있어 그 유용성이 확립되어 있으나, 골간단의 병변에 있어서는 시행 적응증이 널리 알려져 있지 않다. 저자들은 17세 환자의 근위 경골 내측과에 국한적으로 발생한 골육종의 증례에서 내측과 절제만으로도 안전한 절제연을 얻을 수 있을 것으로 사료되어 내측과 절제술 및 저온 열처리 자가골 이식술을 시행하였다. 본 술식은 추가적인 성장이 예상되는 소아환자에게 시행하였을 경우, 추후 파손 발생시에도 반측 치환술로 치환 가능한 방법으로 생각되어 보고하는 바이다. After limb salvage operation becomes popular, reconstruction method of epi-metaphyseal osteosarcoma is relatively standardized though it may be operator's matter of preference. Most limb salvage techniques presently used are prosthesis reconstruction and osteoarticular allograft. In the case of prosthesis, it is very stable and shows good postoperative functional score, however, finally, it has a weak point of requirement for removal procedure due to failure. In the long run, allograft reconstruction has a good merit. But, it has a weak point of difficulties in securing the demanded size and shape. Allograft reconstruction should be performed only in the case of safe margin and established indication. In limb salvage operation, intercalary reconstruction is useful method in diaphyseal osteosarcoma, however, in metaphyseal osteosarcoma, the indication is not confirmed. We treated 17 year old osteosarcoma patient with localized in the tibial medial condyle with proximal medial condylectomy and pasteurized bone reconstruction in the conviction of safe surgical margin. We report this case because we guess if this procedure may be applied to premature patients, despite failure hemiarthroplasty can be tried successfully.

Chemical derivatization with Girard's reagent T for the quantitation of gut microbial short-chain fatty acids by LC-MS/MS

송원석,박한규,김성민,조성현,이재승,김윤곤 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.1

Short chain fatty acids (SCFAs) are the end products of fermentation by anaerobic gut microbiota, which are used as beneficial metabolites in regulating host physiological processes. However, SCFAs are difficult to analyze in mass spectrometric technologies due to their thermo-labile property and low molecular weights. Here, we have developed a sensitive and reliable method to quantify SCFAs by LC-MS/MS in the multiple reaction monitoring (MRM) mode. The SCFAs were chemically derivatized by the Girard’s reagent T (GT), which can provide a permanent cationic charge. The technique showed an excellent quantitative capacity, as determined by good linearity and limit of quantification for five SCFAs. The highly sensitive method would be primarily useful and applicable in quantifying SCFAs extracted from stool in an aqueous solution to monitor gut health.

Development of MALDI-TOF-MS based quantitative targeted glycomics technique for total N-glycan analysis (MALDI-QTaG)

송원석,김윤곤,김성민,조성현,이재승,전효진 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.1

In this study, MALDI-MS based quantitative targeted glycomics (MALDI-QTaG) was developed for monitoring the abnormal glycosylation of clinical and biopharmaceutical products. MALDI-QTaG was proposed for sensitive and quantitative analysis of total N-glycans. The derivatization reactions dramatically increased the linearity and sensitivity relative to underivatized glycans. In addition, the analytical strategy was chromatographic purification-free and non-laborious process accessible to the high-throughput analyses. This MALDI-MS based glycomics technology has wide application in many clinical and bioengineering fields requiring sensitive, quantitative and fast N-glycosylation validation.