Sclerosing Osteogenic Sarcomatosis

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Abstract
There have been a few scattered case reports of multiple osteogenic sarcomas occurring simultaneously in numerous bones of the skeleton (1–6). A case of this type, with features unique in our experience, was recently seen in this hospital (Mt. Sinai, New York) and stimulated a review of the available literature. To our surprise, we discovered 3 cases showing radiographic features practically identical with those seen in our patient. These features are striking, bizarre, and easily recognizable. Multiple areas of dense new bone formation are present throughout the skeletal system. In the long and short tubular bones, the sclerotic process has a marked predilection for the metaphyses. There is similar involvement of the ribs, clavicles, numerous round and flat bones, the vertebrae, and several epiphyses. Areas of soft-tissue calcification may be evident. In some regions, the process is limited to the bone, while in others it perforates the cortex and extends into the subperiosteum or adjacent soft tissue. All the patients were young persons whose bones were in an active stage of growth. Biopsies of the lesions showed them to be sclerosing osteogenic sarcomas. In no case could there be demonstrated any underlying disease which might predispose to sarcomatous change. No history of ingestion of any radioactive substance could be elicited. The following case is reported because of the rarity of multiple osteogenic sarcomas and because the roentgen appearance is presumably characteristic for one form of the disease. M. E., a 5-year-old white girl, was admitted to the hospital Dec. 25, 1952. She had been well until about six weeks prior to admission, when a slight hesitation in her gait became apparent. She was given a shoe wedge by her family physician for a “gait disturbance.” About three weeks later a hard, slightly tender swelling was noticed just inferior to the right knee. An x-ray examination made at that time was interpreted as showing a malignant tumor of the upper end of the tibia, and the child was referred to the hospital for biopsy. The patient was in no acute distress and did not appear I11. She weighed 49 pounds. The temperature was 99.6°, pulse 110 and regular, blood pressure 116/70. The family history was essentially negative. The patient had suffered infantile eczema, occasional attacks of tonsillitis, and chicken pox at the age of one and one-half years. The physical examination was negative except for the skull and the findings at the right knee, where there was a ridge-like bony expansion of the upper tibia. This protruded anteriorly and to both sides 3 to 4 cm. inferior to the joint. About this area was moderate soft-tissue swelling, which was without discoloration, only slightly tender, but warm. There was no limitation of motion of the knee. The circumference at the involved site was 37.5 cm., as compared to 35 cm. at the same site on the left.

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