Primary reticulum-cell sarcoma of bone, with emphasis on roentgen aspects.

Abstract

Primary reticulum-cell sarcoma of bone is a malignant tumor histologically indistinguishable from reticulum-cell sarcoma arising in other regions of the body. It originates at a single site in bone and, when metastasis occurs, it is usually by way of the lymphatics. Pain and swelling are the chief symptoms, and characteristically there is lack of constitutional reaction. The prognosis is relatively good, the five-year survival rate approaching 50 per cent following operation or proper irradiation. The importance of distinguishing between this tumor and other similar, but more malignant, conditions, such as osteogenic sarcoma and Ewing's tumor, is apparent. Several articles make mention of the roentgen findings in primary reticulum-cell sarcoma of bone, but the only paper in the English or American literature devoted specifically to evaluation of the roentgenologic appearance is that of Sherman and Snyder (1), whose study was based on a review of 17 cases. It seemed, therefore, that further study of this problem in as large a number of cases as possible would be of value. It was thought desirable to determine whether there are certain characteristic roentgen signs of this lesion and, if not, whether there are any suggestive findings. In the final analysis, it would be most important to know whether primary reticulum-cell sarcoma of bone can be recognized unmistakably as a malignant neoplasm and thus distinguished from a benign tumor or an inflammatory process. Background Data Oberling (2) in 1928 and Oberling and Raileanu (3) in 1932 were among the first to call attention to the fact that reticulum-cell sarcoma can develop in the reticulo-endothelial tissues of bone. Ewing (4), however, stated that, even prior to this, Kaufman had reported a case of what appears to have been primary reticulum-cell bone sarcoma. According to Parker and Jackson (5) the diagnosis was first suggested in this country in 1931 (Bone Sarcoma Registry No. 1059). Primary reticulum-cell sarcoma of bone was recognized as a distinct entity in 1939, when Ewing reviewed all the material from the Bone Sarcoma Registry of the American College of Surgeons and assigned it a place in his revised classification of bone tumors. Prior to 1939, it had been erroneously identified as Ewing's tumor, lympho-sarcoma, osteogenic sarcoma, Hodgkin's disease, leukosarcoma, or inflammatory changes. Parker and Jackson, also in 1939, reported the first series of primary reticulum-cell sarcoma of bone, consisting of 17 cases. They pointed out that, whereas generalized reticulum-cell sarcoma (a type of malignant lymphoma usually affecting the lymph nodes and spleen predominantly) is a disease of middle and old age, the form which is primary in bone occurs in a younger age group. In their only reference to the roentgen findings, they stated that the appearance was nonspecific. In 1940, Edwards (6) reported a case of primary reticulum-cell sarcoma of the spinal column.