Bone infarct-associated osteosarcoma

Abstract

Reported is a patient with an osteosarcoma arising in a medullary infarct of the humerus. Infarct‐associated sarcoma (IAS) of bone is rare. In a collective review of 50 cases reported in the medical literature, only 37 were fully documented. Including our patient, 26 men and 12 women, ranging in age from 18 to 82 years (mean, 53.4 years) have been reported. Black patients appeared to be disproportionately represented, accounting for 36% of the group. In most patients, there was no known cause for the infarct, whereas in the remainder, the most common underlying condition was a prior dysbaric event or alcoholism. Approximately 75% of the patients had multiple bone infarcts. The femur was involved in 21 patients, the tibia in 14, the humerus in 2, and the radius in 1. Among 40 sarcomas in these patients, 7 (18.4%) were os‐teosarcomas, and 29 (72.5%) were malignant fibrous histiocytomas. The survival rate in patients with IAS is poor: 5 of the 7 patients with osteosarcoma (71%) and 20 of the 31 other patients (65%) died of tumor. Eight patients are alive and well, all for longer than 5 years.

Chronic Knee Pain in an 80-year-old Woman

“…Malignant transformation of bone infarctions to MFH, angiosarcoma, fibrosarcoma, osteosarcoma, and mixed pleomorphic sarcoma is rare, although it has been reported [6,9,13]. The earliest report of sarcomas arising in infarcts is from 1960 by Furey et al [6].…”

“…The earliest report of sarcomas arising in infarcts is from 1960 by Furey et al [6]. Most lesions arise in long bones with predominance in the femur and most commonly occur in the sixth decade of life [3,6,9,12,13]. Approximately 2 .…”

“…When associated with MFH, curvilinear radiodensities of the underlying mature bone infarct can be seen blending into areas of permeative and lytic destruction attributable to the malignancy [2]. The osteonecrotic lesion frequently will appear larger than usually is seen, and usually is ill defined with cortical erosion, periosteal reaction, a pathologic fracture, and soft tissue extension [4,5,7,8,10,11,13]. Bone destruction may be present.…”

Infarct-associated Bone Sarcomas

“…3 of the patients are men [17]. Sixty percent of cases arise about the knee and most are malignant fibrous histiocytomas [17].…”

“…Sixty percent of cases arise about the knee and most are malignant fibrous histiocytomas [17]. One-third of patients have an identifiable etiology for their infarct [17].…”