Osteogenic Sarcoma Arising from a Calcified Hematoma

Case 1. Mrs. S. McG., housewife, aged 68 years, reported to Dr. A. H. Cantril, of the Bodine and Cantril Clinic, in November, 1932. Eleven years prior to this visit, she had fallen and bruised her left thigh. This injury resulted in a hematoma that did not subside but had remained as a palpable tumor. It had caused no pain or other symptoms for ten years. During the year prior to visiting the clinic, she had observed that the tumor was increasing in size, but she was otherwise symptom-free. Her history was negative for other data pertinent to this illness. Physical examination revealed a large, non-painful, immobile mass, lying in the soft tissues anterior to the femur. The patient was referred to the radiographic department and the following interpretation was made: “Radiographic examination of the left thigh reveals a tumor mass, anterior to the middle one-third of the femur, which measures approximately 9 cm. in its anteroposterior depth, and 15 cm. in length. The anterior half of this mass contains dense, well organized calcium deposits which are typical of an ossified hematoma. Underlying this mass, there are calcium deposits of much less density which have the appearance of newer or more recently laid down bone salts. The femur appears to be smooth and regular. “Conclusions.—This examination reveals evidence of an old ossified hematoma, with underlying new bone production strongly suggesting malignancy (osteogenic sarcoma). We are unable to positively state whether the new bone arises from the hematoma or from the femur.” (F. E. B.) An examination of the chest revealed several areas in the left lung that were strongly suggestive of beginning metastases. The patient was admitted to the Emanuel Hospital and submitted to surgery on Dec. 3, 1932. At operation, a tumor measuring 20 × 12 × 10 cm. was shelled out of the soft tissues of the anterior aspect of the thigh without difficulty. It was not attached to the femur, and it did not infiltrate the muscle or fascia, having simply pushed them apart. Dr. H. H. Foskett reported the pathologic examination as follows: “Gross Examination.—Specimen consists of a smoothly encapsulated tumor nodule measuring 20 × 12 × 10 em. The surfaces are lobulated, and the under surface is grooved where it has rested upon the femur. The capsule in this area, as elsewhere, is entirely smooth, and there are a few tags of fat attached to the capsule. The surfaces, made by sectioning, cut with resistance, and reveal the presence of numerous areas of calcium deposit. The surfaces are of a grayish-white appearance, with numerous flecks of yellowish pigmentation. Near the above mentioned surface, which rested upon the femur, there is a slightly different consistency, with a smooth, grayish, cellular tissue, without calcium deposits, and with no evidence of yellowish pigmentation.