Curettage of biopsy-diagnosed grade 1 periacetabular chondrosarcoma.

Intralesional excision of intraosseous grade 1 periacetabular chondrosarcoma may seem an attractive alternative to the current recommendation of joint-sacrificing, en bloc resection. We report eight patients who initially underwent this treatment to identify if local tumor control can be achieved consistently. All patients had a percutaneous biopsy that was interpreted as grade 1 chondrosarcoma. The final histology after curettage indicated Grade 1 chondrosarcoma in five patients, Grade 2 in two, and dedifferentiated chondrosarcoma in one. Three of the five patients with true grade 1 chondrosarcoma have been free of disease at a median followup of 108 months. The other two patients with grade 1 chondrosarcoma on the curettage specimen recurred as higher-grade tumors. Three patients died of high-grade chondrosarcoma at a median of 23 months (range 17-72 months). Overall, the majority of patients in this cohort had either a misdiagnosis or recurrence of higher-grade disease. Based on these observations, in the absence of a predictable method to identify the true intraosseous grade 1 chondrosarcomas of the pelvis, curettage must be undertaken with the understanding that a percutaneous biopsy may misrepresent the histologic grade and that curettage may result in a higher risk of recurrence.

Primary tuberculosis of bone mimicking a lytic bone tumor.

Causes of lytic bone lesions in children include benign, malignant, and infectious processes. Here, we present the case of a 3-year-old boy presenting with a lytic bone lesion and surrounding soft tissue mass sent for evaluation of possible malignancy versus osteomyelitis. Biopsy revealed granulomatous osteomyelitis, and subsequent purified protein derivative resulted in 20-mm induration. Lesion cultures eventually identified pan-sensitive Mycobacterium tuberculosis. We emphasize that tuberculosis can cause primary lytic bone lesions in children in the United States, even in the absence of pulmonary symptoms or known exposure, and advise clinicians to include mycobacterial cultures when analyzing biopsies of lytic bone lesions.

Periosteal margin in soft-tissue sarcoma.

BACKGROUND: Soft-tissue sarcomas frequently rest in contact with bone. The purpose of the study was to evaluate the risk of local recurrence for sarcomas adjacent to bone and to determine whether the periosteum provides an adequate margin of resection. METHODS: Fifty patients with soft-tissue sarcomas abutting bone were treated at a single institution between 1990 and 2004. All patients had high-grade, T2 (>5 cm), nonmetastatic disease in the lower extremity. Bone contact was verified by preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) scans. Forty-three of 50 patients received preoperative radiation with a mean dose of 50 Gy. In 11 cases a composite resection of bone and soft tissue was performed. In 39 cases the excision involved only soft tissue. RESULTS: True bone invasion was verified by histopathologic examination in 3 of 50 cases (6%). Local recurrence in the soft tissues developed in 8 of 50 (16%) patients. In no case did the recurrence involve destruction of cortical bone or erosion into bone. The recurrent tumor resided against the region of previous bone contact in 1 of 8 cases. There was no statistically significant difference in local recurrence between patients who had composite bone resection and patients who had soft-tissue resection only (P = .87). CONCLUSIONS: Relatively few sarcomas are able to penetrate cortical bone. Composite bone and soft-tissue resections are indicated primarily for frank bone invasion. In the absence of this, the periosteum is an adequate surgical margin for sarcomas treated with wide excision and radiation.