Postoperative management.
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In osteogenic sarcomas of the extremities, radical therapy of the primary tumor now seems more precisely delineated. In most cases, especially in large tumors with lytic lesions or fractures, and in children. Irradiation is indicated only in small tumors with condensation, and in tumors of the proximal metaphysis of the humerus. Conservative surgical treatment with carcinologically satisfactory resection of involved bone followed by reconstruction, is currently under evaluation. Such treatment is indicated in specific cases: children in the final stage of growth, and small tumors without major involvement of soft tissues that respond to preoperative chemotherapy.
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A review of the surgical experiences in 42 patients with proximal femoral focal deficiency has led us to propose a new classification system. This simplified system consists of 4 definite classes based on the roentgenographic appearance of the proximal shaft, and includes distinct prognosis and treatment groups. Early and accurate prognostication facilitates rational prosthetic design and appropriate surgical treatment in all degrees of involvement. In the less severely involved classes, emphasis is placed on the utilization of the proximal shaft signs of Fixsen and Lloyd-Roberts to identify those hips with an unfavorable prognosis.
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A case of low grade hemangiopericytoma of three years duration occurring in the upper end of the femur of a 70 year old man is described. Radiologically, the upper third of the right femur showed a destructive expansile osteolytic lesion with soft tissue extension. The tumour was partially encapsulated. Mitoses were 0-1 per 10 high power fields, suggesting the low grade malignant nature of the lesion. It is felt that all hemangiopericytomas occurring in bone should be considered biologically malignant.