Case of the Month     September, 1999

Case summaries taken from the monthly Orthopedic Oncology - Radiology - Pathology Multidisciplinary Conference at the University of Massachusetts Medical School

Case presentation:

An eight year old girl has pain and swelling of he left tibia just below the knee on the medial side. Two radiographs and a biopsy from the lesion are shown.

What is the diagnosis? (Decide, then scroll down)

The plain films show an aggressive, destructive lesion. The biopsy shows bizarre, pleomorphic cells producing osteoid. The lesion is a) granulocytic sarcoma b)Ewing's sarcoma c) osteosarcoma.

(Decide, then scroll down)

The diagnosis is osteosarcoma. The treatment consists of pre-operative (so-called neo-adjuvant) chemotherapy , surgery, and post-operative chemotherapy. What are the surgical treatment options? (Decide, then scroll down)

Surgical choices include amputation, Van Ness rotation-plasty, limb-sparing surgery with an endoprosthesis or an allograft, alloarthrodesis, and resection - autoclaving - reimplantation with or without a free fibular graft.A discussion of pediatric limb salvage is beyond the scope of this month's case. One of the major considerations is the limb length inequality that will develop over time as the patient's other limb grows at the normal rate and the reconstructed limb grows more slowly due to resection of one or more growth plates. American tumor centers use limb-sparing surgery most frequently, while some European centers perform rotation-plasty more frequently. My own experience is that most patients reject rotation-plasty when presented with complete information on the nature of the procedure.

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