Chapter 92 • More than 2800 new cases of bone sarcoma are diagnosed annually in the United States. • No specific etiologic agents are identified in the majority of cases. • Secondary neoplasms are related to known oncogenic factors. (e.g., ionizing radiation, alkylating chemotherapy agents, combinations of both). • Hereditary cancer syndromes (tumor suppressor genes) are responsible for some cases. • Plain radiographs are recommended. • Magnetic resonance imaging (MRI) scan of primary tumor is the best radiographic study to obtain. • Chest computed tomography (CT) is indicated to evaluate for pulmonary metastases. • Whole-body technetium-99m (99mTc) bone scan is indicated to evaluate for metastases to other bones. • Positron emission tomography (PET) scanning is controversial and has yet to be generally accepted. • Needle or open biopsy is necessary for a tissue-specific diagnosis and to determine histologic grade. • In the pathology review, immunohistochemistry and cytogenetics are important. • Metastasis at presentation is a worse prognostic finding. • Histologic grade is the next most significant prognostic indicator. • Size is less significant, but lesions larger than 10 cm in diameter have a poor prognosis. • Tumor response to neoadjuvant chemotherapy is important in osteosarcoma and Ewing sarcoma.
Sarcomas of Bone
Summary of Key Points
Incidence and Epidemiology
Diagnosis and Radiographic Staging
Prognostic Factors
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Sarcomas of Bone
