整形外科腫瘍学ジャーナル

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Secondary Sarcomas Associated with Bone Infarct?The Birmingham Experience

Balko Jan, Fujiwara Tomohiro, Le Nail Louis Romee, Stevenson Jonathan, Jeys Lee, Guy Morris, Botchu Rajesh, Parry Michael, Sumathi Vaiyapuri

The majority of primary bone sarcomas arise de novo, however some develop in association with bone infarction and are only sparsely reported in the literature. The objective of this study was to investigate the 14 cases of secondary sarcoma associated with bone infarct presenting at a single tertiary referral centre at the Royal Orthopaedic Hospital, Birmingham between 1997 and 2019. A retrospective search of our database was carried out for cases of bone infarct-associated sarcomas. The reports of 164 patients with osteonecrosis were retrospectively reviewed. Clinical notes and imaging data were assessed to determine if the underlying bone infarction predisposed the sarcoma. The histological subtype of tumour was determined utilising the WHO classification. Sarcomas and bone infarcts without obvious interconnection, radiotherapy induced osteonecrosis and post- treatment induced tumour necrosis were excluded. 14 patients were identified. Nine cases represented osteosarcoma (64 %) with various differentiations, followed by four cases of chondrosarcoma (29 %). The remaining case was of high grade undifferentiated spindle cell sarcoma, not otherwise specified (NOS). The clinical features (mean age, sex, symptoms, anatomical site, response to treatment and outcome including prognosis) of sarcomas in our cohort correspond to former studies. This is the only study that describes more than ten original cases of secondary sarcomas associated with bone infarct and is the first study to date using the newest diagnostic histopathological criteria in the English-language literature, which allows precise diagnosis of this rare condition.