Introduction and Objectives: Extraskeletal osseous sarcomas are very rare high-grade tumours. They include osteosarcoma, chondrosarcoma, and Ewing’s soft tissue sarcoma and their respective variants. We present a retrospective study of 25 cases covering the period from December 2002 to January 2003.

Materials and Methods: This study of 25 cases shows that this heterogeneous group of soft tissue sarcomas primarily affects adults (mean age 50.68; range 17 to 70 years). The thigh (36.60%) and the elbow-forearm (18.18%) are the most common locations for these tumours. In these cases, 14 chondrosarcomas, 8 osteosarcomas, and 3 Ewing’s sarcomas were diagnosed. Mean follow-up time was 48.9 months with a range of 16 to 197 months. There were 16 surgeries performed with wide or compartmental margins, while in the 5 remaining cases, amputations were performed, and one case of Ewing’s sarcoma of the pelvis was treated by means of chemotherapy and radiation therapy, as it was considered non-resectable. All cases of osteosarcoma and Ewing’s sarcoma were treated by means of pre- and postoperative chemotherapy and postoperative radiation therapy.

Results: The postoperative duration of symptoms ranged from 2 weeks to 6 years with a mean of 6 months. Local recurrence following surgery with wide or compartmental margens occurred in 8 cases, representing 35.45% (3 chondrosarcomas, 4 osteosarcomas, and 1 Ewing’s sarcoma). The total number of cases surviving without recurrence is 14 (63.6%), surviving cases with one or more recurrences is 5 (22.72%), one case is alive with metastasis (4.59%), and 3 sarcomas (2 ulcerated upon admission) had disseminated and the patients died (10.05%).

Discussion and Conclusions: All these tumours were high-grade sarcomas. The most common metastatic localizations were lungs, regional ganglia, and skeleton. The recommended treatment is surgery with wide or compartmental margins, if possible in the early stages, in conjunction with chemotherapy and radiation therapy. The worst prognosis corresponds to the osteosarcoma.

Introduction and Objectives: Giant cell tumour (GCT) of the bone is an “aggressive tumor characterized by highly-vascularized tissue consisting of ovoid or fusiform cells and the presence of numerous gigantic osteoclast-like cells distributed uniformly throughout the tumor tissue” (WHO). The aim of this report is to present our experience over the past 19 years (1983–2002) with GCT of the bone treated in our unit.

Materials and Methods: From January 1983 to January 2002, we have treated 67 cases of GCT of the bone, excluding all cases with less than 12 months of follow up. Age at presentation ranged 10 to 17 years. There was a higher incidence from 20 to 40 years of age. There was a moderately higher rate in women compared to men (1.5:1). The most common locations were the distal epiphysis of the femur, proximal epiphysis of the tibia, and the distal end of the radius. This type of tumour generally localises to the epiphysis and subsequently invades the metaphysis. Localization to the axial skeleton is rare. Radiologic diagnosis was achieved by simple local radiology, CT scan, and MRI. Histopathologic diagnosis was done by means of biopsy using a trocar guided by an image intensifier. In cases of central localization, we obtained the sample by CT-guided biopsy. The treatment of choice is aggressive curettage (high-velocity burr) and filling with frozen cancellous chips. Radiation therapy is useful in cases of localization that are not accessible by surgery.

Results: GCT of the bone possesses several unique characteristics, which make it different from other intermediate tumors: a high rate of recurrence (up to 50%), the possibility of sarcomatous degeneration, and the possibility of pulmonary metastasis (even in non-malignant cases). We believe the ideal treatment is resection of the bone where the tumour is located (useful on the head of the fibula, distal end of the ulna, ribs, some bones of the hand and feet, and the patella). In view of its usual localization near the knee (50%), our usual treatment is aggressive curettage (high-speed burr) and filling with frozen cancellous chips. We have treated 26 recurrent cases out of 67 patients treated in our unit (38.8%). Of these, approximately 50% were referred from other centres. Treatment of recurrence has generally been aggressive curettage and addition of allografts. Sarcomatous degeneration occurred in 3 cases (4.5%), all of which were high grade sarcomas of the malignant fibrous histiocytoma type. One case survived following amputation of the extremity, and the other 2 cases died as a result of pulmonary metastasis.

Discussion and Conclusions: Alternative local treatment methods exist for GCT of the bone such as cryosurgery, phenolization, and cementing. However, we cannot comment on these methods due to a lack of experience with them. The aim of all these methods is to cauterize the tumour bed. We prefer aggressive curettage and filling with cancellous bone in an attempt to use a more biological treatment.

Introduction and Objectives: From January 1983 to December 2000 we treated a total of 542 intermediate to high-grade primary bone tumours. We present our experience in reconstruction following tumour resection from the hip, excluding cases of pelvic reconstruction and cases of localised benign bone tumours of the hip.

Materials and Methods: This study included 49 cases of primary bone tumours localised to the proximal humerus (9% of the total). Of all cases treated by means of massive structural allograft for femoral reconstruction (44), only 11 cases were in the hip region. We performed 28 hip tumour resections for high-grade bone tumors with the following diagnoses: osteosarcoma (7), chondrosarcoma (9), Ewing’s sarcoma (6), malignant fibrous histiocytoma (2), and selected cases of metastasis-myeloma (4). Limb salvage procedures (22) with reconstruction after the first surgery included: modular megaprosthesis (11), megaprosthesis associated with massive structural allograft of the proximal third of the femur (8), and osteoarticular allografts (3). The remaining cases (6) required immediate agressive surgery including coxofemoral disarticulation (4) and hemipelvectomy (2).

Results: Limb salvage cases treated by means of mega-prosthesis associated with a composite allograft presented the following complications: 1 case of deep infection with local recurrence and immediate postoperative dislocation (12.5%), 3 isolated coxofemoral dislocations (37.5%), and one case of homograft osteolysis (12.5%). Mean follow-up time was greater than 5 years, and two patients died due to dissemination of the primary tumour (1 chondrosarcoma and 1 osteosarcoma). Cases of limb salvage treatment using modular mega-prosthesis had the following complications: 2 isolated coxofemoral dislocations (18%) and 2 cases of recurrence or local tumour progression (18%). Mean follow-up time was greater than 3 years, and two patients died due to progression of the primary tumour. Cases of salvage treatment using osteoarticular allografts had a mean follow-up time of 2 years and showed no significant complications.

Discussion and Conclusions: 1) In cases of disease up to 12 years of age (primarily Ewing’s sarcomas) we prefer osteoarticular reconstruction. 2) In cases of young adults (from 12 to 60 years of age) we prefer reconstruction using a megaprosthesis (Wagner type) with massive structural allograft. 3) In cases of older adults (greater than 60 years of age) we perform reconstruction using a modular megaprosthesis for tumour treatment.