Bradley L. Coley

Primary reticulum-cell sarcoma of bone; summary of 37 cases.

One of the earliest suggestions that reticulum-cell sarcoma could arise from the reticulo-endothelial structures of bone was made by Oberling (17) in 1928. In 1939, Ewing (13) accepted primary reticulum-cell sarcoma of bone as a distinct entity for inclusion in a revised classification of bone tumors for the Bone Sarcoma Registry of the American College of Surgeons. In the same year, Parker and Jackson (18) presented a complete study of 17 cases of this disease; 13 of the cases were from the Bone Sarcoma Registry material and the remainder from their personal experience. Since then only a few reports of small series of cases have appeared in the world literature (15, 19, 22, 23). In the majority of the more recently reported cases the disease was generalized, there were multiple bone foci, or histologic confirmation of the primary focus in bone was not obtained. Definition: Primary reticulum-cell sarcoma of bone is a malignant tumor histologically identical with reticulum-cell sarcoma elsewhere in the bod...

Giant cell tumor of bone

1. The giant-cell tumor is usually benign, but malignant forms are encountered and may result from the transformation of a tumor that is histologically benign at the outset. 2. Surgical extirpation (curettage, resection, and, on rare occasions, amputation) and radiation have been established as successful methods of treatment. Surgery is preferable for accessible tumors, and radiation for inaccessible or extremely advanced tumors. 3. Caution should be exercised when using the roentgen-ray without histological confirmation of the diagnosis, for one may be dealing with an osteolytic sarcoma which bears a close resemblance, roentgenographically, to the giant-cell tumor. 4. Radiation should not be used in conjunction with surgery. Each method should bear the full responsibility of its employment in the individual case. 5. The roentgen-ray in large doses destroys the regenerative powers of the bone; in small doses, it may fail to arrest the disease; therefore, the exact dosage for the individual case is a matter of profound judgment or of fortuitous circumstance. 6. Inexpert radiation is probably less hazardous than surgery in the hands of one unfamiliar with technical operative details. Loss of limb may ultimately result in either instance. 7. Surgical attack should envisage thorough removal of all tumor tissue through adequate exposure, careful wound closure without packing or drainage, and primary wound healing. 8. Protection during the regenerative phase is essential, regardless of the treatment employed, for a pathological fracture usually spells functional impairment and a painful neighboring joint.

The treatment of osteogenic sarcoma by irradiation

Abstract Seventy patients with osteogenic sarcoma have been treated by irradiation. Of these, 64 are dead. Of the 6 patients known to be alive, 4 have fibrosarcomas; one a sarcoma developing on an old osteitis fibrosa cystica. The remaining case is by radiographic appearance a sclerosing osteogenic sarcoma, but it lacks histologic confirmation. Of the 6 patients, only one has survived more than five years. At present we feel that irradiation should be offered in preference to amputation only: 1. 1. When of doubtful operability. 2. 2. When the histologic picture suggests definite radiosensitivity. 3. 3. When a small periosteal lesion affords opportunity for combined external and interstitial irradiation. 4. 4. In medullary osteogenic fibrosarcomas of low malignancy. All inoperable cases and those in which amputation is refused should receive thorough, well-planned irradiation. If improvement is noted, it should be an indication for further use of irradiation up to limits of skin tolerance. At present we favor prolonged treatment by the fractional dose method. With few exceptions our results in the treatment of pulmonary metastases have not been encouraging.

Epidermoid (epithelial) cyst of the phalanx.

Abstract A case of epidermoid (epithelial) cyst of the terminal phalanx of a finger is described. The clinical and radiologic features are briefly discussed. It is believed that in view of the definite signs and symptoms the correct diagnosis of the lesion should not be as difficult as the existing literature seems to indicate.

Malignant tumors of bone in children

Summary Malignant bone tumors in children constitute an unusual, a difficult, and an extremely discouraging problem. Early recognition and careful study are necessary prerequisites to proper therapy. The services of a well-trained radiologist are indispensable both in arriving at the diagnosis and often in assisting in the actual treatment. The pathologist also is an invaluable member of the team. The surgeon should avail himself freely of their assistance, and the selection of treatment should follow a decision in which each has had a voice. While an earlier diagnosis is one of the goals for which we are striving, it should be realized that the earlier the patient is seen, the greater the difficulties of establishing a correct diagnosis. In this connection it is, perhaps, needless to stress the importance of laboratory data which should include a Wassermann test, serum phosphatase determination, and complete blood count as well as urinalysis for Bence-Jones bodies. Until the happy millennium is reached when the ideal treatment, based on a knowledge of the underlying etiology of malignant tumors of bone, has been discovered, we must strive for earlier recognition and more prompt and thorough treatment. In this effort, the part played by the pediatrician is necessarily an important one. He must be conscious of the need for following up with care the slightest suspicion of the presence of sarcoma of bone. The help of an orthopedic surgeon and radiologist should be enlisted promptly, for the earlier the correct diagnosis is made, the more likelihood there is that treatment may be successful.

Primary bone tumors in children

Abstract Bone tumors in children constitute an unusual, a difficult and an extremely discouraging problem. Early recognition and careful study are necessary prerequisites to proper therapy. The services of a well-trained radiologist are indispensable both for arriving at the diagnosis and often for assisting in the actual treatment. The pathologist also is an invaluable member of the team. The surgeon should freely avail himself of their assistance and the selection of treatment should follow upon a decision in which each has had a voice. While an earlier diagnosis is one of the goals for which we are striving, it should be realized that the earlier the case is seen, the greater are the difficulties of establishing a correct diagnosis. In this connection it is, perhaps, needless to stress the importance of laboratory data which should include a Wassermann, blood chemistry and complete blood count as well as a urinalysis for Bence Jones bodies. Until the happy millenium is reached when the ideal treatment, based upon a knowledge of the underlying etiology of malignant diseases of bone, has been discovered, we must strive for earlier recognition and more prompt and thorough treatment. In this effort the part played by the radiologist is a major one. It is, perhaps, not beyond the realm of possibility that during the next two decades strides will be made by them in the treatment of malignant lesions of bone comparable to those made in the diagnosis during the same period in the immediate past. This, to my mind, is by no means the least of the many glorious achievements of this honored branch of our profession.

Osteogenic tumors of scapula

Abstract The operative removal of a part, or the whole of the scapula is discussed, (1) from an historical review and (2) from a study of the cases of scapular tumors in the Memorial Hospital records and in the Bone Sarcoma Registry of the American College of Surgeons. The treatment of osteogenic tumors of the scapula in these two series is considered separately with reference to late results obtained by various methods employed. The substitution of subtotal or total excision of the scapula for interscapulothoracic amputation is recommended for a selected group of osteogenic tumors which includes chondromyxosarcoma and osteochondrosarcoma of relatively low grade malignancy; and chondroma and osteochondroma, which though benign are prone to undergo malignant transformation. Five cases personally treated by these conservative surgical measures are abstracted briefly. The careful selection of cases suitable for this type of operation is urged, and technical considerations are given.

The operative treatment of hernia by living sutures

Abstract 1. (1) A series of fifty patients with sixtythree hernias all operated upon by living suture method is reported from the Second Surgical (Cornell) Division of Bellevue Hospital. 2. (2) The majority of these hernias were either direct, recurrent inguinal or ventral in type, and the age of this group averaged a decade above that of simple adult herniotomies. 3. (3) The operation as performed by us is described in full with illustrations. 4. (4) There were six recurrences in 34 traced hernias, the period of observation ranging from three to twenty-one months. 5. (5) Postoperative wound infection was a complicating factor in 14 cases and was undoubtedly responsible for three of the recurrences, but did not seem to affect the end result in the other 11 cases. The presence of fascial sutures renders wound infection more likely to occur. 6. (6) Barring wound infection, the postoperative course does not differ materially from that observed in simple herniotomy. Statistics show an apparent increase in mortality. Whether this would be maintained in a larger series of living suture operations is doubtful. Care should be taken in the selection of cases for this more prolonged operative procedure. 7. (7) The operation is indicated in recurrent inguinal hernia, direct inguinal hernia, and large scrotal hernia associated with poor musculature. It is a valuable aid in dealing with postoperative ventral and large umbilical hernia. We regard it as a major procedure and reserve it for cases in which we feel it is distinctly indicated. The results of the operation should be judged with due consideration to the type of complicated hernia upon which it was used.

Use of bank bone in the treatment of central lesions of bone

and WiIson5 separateIy reported in their experiences in two orthohospitaIs with homogenous bone has been derived aImost entireIy from ribs resected on the Thoracic Service by Dr. WiIIiam L. Watson and his associates. Based grafts-They made use of a deep-freeze to store bone obtained at operation or from amputated specimens. They estabIished the fact that refrigerated bone serves as a useful source of bone transplants and that such bone behaves in the host much as does autogenous materia1. Additional experimental and cIinica1 experience by Bush and Garber3 further established the safety and utiIity of the method and Wilson6 reported an impressive foIIow-up study of 214 patients who were subjected to 27X operations in which steriIe homoIogous bone grafts were used. Wilson6 concludes“ I. With careful technique homoIogous bone grafts may be preserved for Iong periods of time for surgical use. 2. Such grafts are we11 toIerated by human tissues and the risk of infection is no greater than with autogenous grafts. 3. The healing of such grafts takes pIace by a process of invasion, absorption and replacement simiIar to that of autogenous bone grafts. 4. The resuIts obtained are identica1 with those from the use of autogenous grafts except that in some instances the heaIing appears to be a IittIe slower. 5. The operation of the bone bank is safe and practical. It offers great advantages to the patient and the surgeon from the standpoint of availability, abundance and the eIimination of the necessity of secondary operations to obtain bone.” It seems unnecessary to repeat here detaiIs which both Bush and Wilson have given concerning the organization and operation of the bone bank. Instead we wish to describe our experiences with this method during a fifteenmonth period in which it has been in use on the Bone Tumor Service at Memorial Hospital. During this period we have had a bone bank and have kept an ampIe supply on hand which IA IB Frc;. 1. A, typical unicamera1 bone cyst in a six year old boy; B, five weeks after curettage, cauterization and implantation of homologous rib chips.

Filarial funiculitis; report of a case discovered at operation for inguinal hernia.

Abstract 1. 1. A case of asymptomatic filarial funiculitis is presented. 2. 2. An increase in the occurrence of filarial funiculitis in this country seems probable.