ANGIOSARCOMAS ASSOCIATED WITH BONE INFARCTS

Objective. A bone infarct may occasionally dedifferentiate to osteogen ic sarcoma, fibrosarcoma or malignant fibrous histiocytoma. However, t he association of an angiosarcoma with a bone infarct is extremely rar e. Such an association is presented in three patients. Their clinical course is compared with that of patients with bone infarcts associated with other sarcomas. Design and patients. The three patients were men with a mean age of 43 years. Cases 1 and 3 presented with a pathologi cal fracture at the site of the angiosarcoma. Plain radiography was do ne in the three patients, computed tomography (CT) was performed in ca ses 1 and 3 and magnetic resonance imaging (MRI) in case 3. The femur was the site of the three tumors: midshaft in cases 1 and 3 and distal shaft in case 2. On the basis of the radiographic findings, and clini cal examination, an open biopsy was performed for the three men, which confirmed the diagnosis of a high-grade angiosarcoma associated with a bone infarct. Results. Case 1 was treated with high-above knee amput ation and is still alive after 18 months from the time of operation. S egmental resection of the distal femur with adjuvant chemotherapy and local irradiation was the treatment for case 2, who is still alive wit h no tumor recurrence on metastatic disease 3 years from the operation . Intramedullary redding was done for case 3 who died 6 months later. Conclusion. The association of an angiosarcoma with a bone infarct has been established in only five cases. Although the number of such asso ciations is small, it seems that such an association may be prognostic ally more or less the same as in those cases in which a bone infarct i s associated with either osteosarcoma, fibrosarcoma or malignant fibro us histiocytoma, where the survival rate is unfavorable. A cause-and-e ffect relationship may exist between a bone infarct and subsequent dev elopment of a bone sarcoma.