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. 2009 Jul;467(7):1820-5.
doi: 10.1007/s11999-009-0744-7. Epub 2009 Feb 20.

Infarct-associated bone sarcomas

Gregory F Domson  1 , Amir Shahlaee, John D Reith, Charles H Bush, C Parker Gibbs
Affiliations

Infarct-associated bone sarcomas

Gregory F Domson et al. Clin Orthop Relat Res. 2009 Jul.

Abstract

Sarcoma associated with bone infarct is a rare condition sparsely reported in the literature. Sixty percent of cases arise about the knee and most are malignant fibrous histiocytomas. We report 15 patients; 12 of 15 presented with a tumor around the knee. Treatment was limb salvage in seven patients, amputation in six, and biopsy alone in two. For patients without metastatic disease at presentation, the 2-year disease-free survival rate was 63% (seven of 11). Two patients received chemotherapy and both were continuously disease-free at last followup. When we combined our 15 patients with the 52 previously reported in the literature, 38 of the 67 (57%) died of their disease at an average of 19.2 months after diagnosis; 21 patients (31%) were continuously disease-free for 24 months. Of 13 patients who received chemotherapy, eight (62%) were continuously disease-free at 24 months compared with 24% (13 of 54) of those who did not receive chemotherapy. Overall, prognosis for these patients is poor, but survival in patients without metastatic disease at diagnosis approaches that of other bone sarcomas. There is a trend suggesting adjuvant chemotherapy combined with appropriate surgery may improve patient outcomes.

Level of evidence: Level IV, therapeutic study.

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Figures

Fig. 1A–C
Fig. 1A–C
An (A) anteroposterior radiograph, (B) coronal T2-weighted fat saturation MR image, and (C) coronal gross section show a proximal tibial malignant fibrous histiocytoma arising in an infarct. Curvilinear radiodensities of the underlying mature bone infarct (narrow arrows) can be seen blending into the permeative destructive areas (wide arrow) of the malignancy associated with a soft tissue mass and pathologic fracture.
Fig. 2A–B
Fig. 2A–B
(A) Low-power (×10) and (B) high-power (×20) photomicrographs show the interface between necrotic bone from an infarct (arrows) and malignant fibrous histiocytoma (Stain, hematoxylin and eosin).
Fig. 3
Fig. 3
Kaplan-Meier survival curves (with 95% confidence intervals) show disease-free survival of Musculoskeletal Tumor Society Stage IIB and Stage III tumors. Survival rates for patients at our institution with Stage IIB disease approached that of other bone sarcomas. Patients with Stage III disease fared extremely poorly.
See this image and copyright information in PMC

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