Daniel Vanel MD, Presenter: Nothing to Disclose

Piero Picci, Abstract Co-Author: Nothing to Disclose

Marco Alberghini MD, Abstract Co-Author: Nothing to Disclose

Marco Gambarotti, Abstract Co-Author: Nothing to Disclose

Gabriella Sieberova, Abstract Co-Author: Nothing to Disclose

Mario Mercuri MD, Abstract Co-Author: Nothing to Disclose

Bone sarcomas developing in pre-existing lesions are rare but well recognised. When a sarcoma occurs at the site of a previously treated benign tumour (curetted and grafted), it is assumed that the sarcoma is secondary to the benign bone tumour. A different hypothesis suggested by new biological studies implies the consequences of the reparative processes as the cause of the sarcoma. We checked this hypothesis by reviewing cases on our files.

Out of 6807 primary bone sarcomas found in our files from 1900 to 2007, 12 developed after curettage and bone grafting (autoplastic : 4, homoplastic : 3, both :1, unknown source : 4) of a benign bone tumour and without radiation therapy. The benign tumors were nine giant cell tumours, a benign fibrous hystiocytoma, an aneurysmal bone cyst and a simple bone cyst. Age at time of the sarcoma presentation ranged from 33 to 77 years. The time interval between the grafting and the sarcoma was from seven to 28 years. All patients had a histological review of the original tumour and the sarcoma (8 osteosarcomas, 3 MFHs, one fibrosarcoma). Seven radiological examinations of the initial lesions were found and reviewed, and all patients had imaging examinations available after the graft and at the time of the sarcoma (all radiographs, eight CT and/or MR).

All cases showed a lytic lesion in the grafted area, with signs of aggressiveness (cortical destruction, periosteal bone formations, soft tissue involvement). The three patients who had metastases at presentation died from the disease within one year. Seven patients are free of disease, more than four years after the diagnosis of the sarcoma. Amputation in three patients was required due to an inadequate local treatment for a suspected recurrence of the benign lesion.

A lytic lesion appearing late after previous grafting with bone chips for a benign bone tumour should be regarded as a sarcoma arising from the grafts, and not as a recurrence of the benign lesion. A better knowledge of this rare pathology should lead to an early diagnosis, and an adequate treatment.

A lytic lesion late after a bone grafting of a benign bone tumor may indicate a sarcoma developped from the graft.

Vanel, D, Picci, P, Alberghini, M, Gambarotti, M, Sieberova, G, Mercuri, M, Imaging 12 Sarcomas Which Developed on Bone Grafts Used in the Surgical Treatment of Benign Bone Tumours.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004645.html