title: Multifocal primary bone sarcoma in the elderly: a rare case and review of the literature.
abstract: To our knowledge there are no reports of a primary multifocal spindle cell sarcoma affecting both long bones of the lower limb in an elderly patient. An 83-year-old man presented with a progressively painful right ankle, without a history of trauma. Radiographs demonstrated a pathological fracture through a mixed lytic and sclerotic lesion in the distal tibia. Staging investigations, including bone scintigraphy and magnetic resonance imaging, revealed a second lytic lesion in the right distal femur. A provisional diagnosis of metastatic disease was favoured and intramedullary nailing was considered. However, computed tomography of the chest, abdomen and pelvis, and relevant blood tests revealed no evidence of a primary malignancy. Open biopsy of the tibial lesion showed high-grade pleomorphic spindle cells consistent with a primary bone sarcoma. The patient was treated successfully with a right trans-femoral amputation. In conclusion, we recommend early bone biopsy to allow accurate diagnosis and appropriate skeletal management in elderly patients.
authors.affiliation: Department of Orthopaedic Surgery, New Royal Infirmary, Edinburgh EH16 4SU, Scotland, UK. andrew.duckworth@yahoo.co.uk
authors.forename: A D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: I
authors.initials: I
authors.lastname: Beggs
authors.forename: D M
authors.initials: DM
authors.lastname: Salter
authors.forename: J T
authors.initials: JT
authors.lastname: Patton
authors.forename: D E
authors.initials: DE
authors.lastname: Porter
mesh_terms: D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001706:Biopsy; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome