The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment.
We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS.

M. Olcina

B. Merck

M. J. Gim&#233;nez-Climent

S. Almenar

M. F. Sancho-Merle

F. Llopis

C. V&#225;zquez-Albadalejo

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and 
                        TRAM Flap Reconstruction

Extraskeletal mesenchymal chondrosarcoma is extremely rare and, in combination with psoriasis, it has never been described before. We report a case of wide resection of an extraskeletal chondrosarcoma of the thigh and reconstruction with a femoral megaprosthesis in a patient with psoriasis vulgaris. Special emphasis has been laid to postoperative wound healing in psoriatic skin which did not show any problems.

Markus Nottrott

Jendrik Hardes

Winfried Winkelmann

Georg Gosheger

Wound Healing in a Patient with Psoriasis Vulgaris and Femur Megaprosthesis Implantation

Destructive bone lesions occurring in patients who have previously had a malignancy are generally assumed to be a metastasis from that malignancy. We reviewed  60 patients with a previous history of malignancy, who presented with a solitary bone lesion that was subsequently found to be a new and different primary sarcoma of bone. These second malignancies occurred in three distinct groups of patients: (1) patients with original tumours well known to be associated with second malignancies (5&#37;); (2) patients whose second malignancies were likely to be due to the previous treatment of their primary malignancy (40&#37;); (3) patients in whom there was no clearly defined association between malignancies (55&#37;). The purpose of this study is to emphasise the necessity for caution in assuming the diagnosis of a metastasis when a solitary bone lesion is identified following a prior malignancy. Inappropriate biopsy and treatment of primary bone sarcomas compromises limb salvage surgery and can affect patient mortality.

J. T. Patton

S. M. M. Sommerville

R. J. Grimer

Primary Malignant Tumours of Bone Following Previous Malignancy

We have retrospectively analysed the experience of a musculoskeletal oncological unit in the management of adult head and neck soft tissue sarcomas from 1990 to 2005.
Thirty-six patients were seen, of whom 24 were treated at this unit, the remainder only receiving advice. The median age of the patients was 46 years. Most of the sarcomas were deep and of high or intermediate grade with a median size of 
5.5&#x02009;cm. Eleven different histological subtypes were identified. Wide excision was possible only in 21% of the cases. 42% of the patients developed local recurrence and 42% developed metastatic disease usually in the lungs. Overall survival was 49% at 5 years. Tumour size was the most important prognostic factor. 
Adult head and neck soft tissue sarcomas have a high mortality rate with a high risk of local recurrence and metastatic disease. The rarity of the disease would suggest that centralisation of care could lead to increased expertise and better outcomes.

Rabindra P. Singh

Robert J. Grimer

Nabina Bhujel

Simon R. Carter

Roger M. Tillman

Adesegun Abudu

Adult Head and Neck Soft Tissue Sarcomas: Treatment and Outcome

Dedifferentiated liposarcomas may display a variety of &#x201C;heterologous&#x201D; lines of differentiation, including osseous, vascular, skeletal, and/or smooth muscular. There have been six previously reported examples of leiomyosarcomas associated with high levels of serum human chorionic gonadotropin (hCG) production, comprised of cases originating from the retroperitoneum, spermatic cord, small intestine, and uterus. This report describes the first example of a dedifferentiated liposarcoma that combined both of the aforementioned features: extensive heterologous (leiomyosarcomatous) differentiation <i>and </i><svg style="vertical-align:-2.29482pt;width:8.8500004px;" id="M2" height="13.425" version="1.1" viewBox="0 0 8.8500004 13.425" width="8.8500004"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.425)">
		<g transform="translate(72,-61.26)">
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				<tspan style="font-size: 12.50px; " x="0" y="0">𝛽</tspan>
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		</g>
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</svg>-hCG production (maximum serum levels 1046&#x2009;mIU/ml, reference <svg style="vertical-align:-0.30096pt;width:22.987499px;" id="M3" height="11.25" version="1.1" viewBox="0 0 22.987499 11.25" width="22.987499"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.25)">
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			<text transform="matrix(1,0,0,-1,-71.95,63.35)">
				<tspan style="font-size: 12.50px; " x="0" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="12.027886" y="0">5</tspan>
			</text>

		</g>
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</svg>&#x2009;mIU/ml). The tumor, which originated in the retroperitoneum in the region of the right kidney, was rapidly progressive and ultimately fatal within three months of its diagnosis. In addition to characteristic morphologic features, lipogenic and smooth muscle differentiation were confirmed with immunohistochemical stains for MDM2 and smooth muscle actin, respectively. The tumor also displayed diffuse immunoreactivity for <svg style="vertical-align:-2.29482pt;width:8.8500004px;" id="M4" height="13.425" version="1.1" viewBox="0 0 8.8500004 13.425" width="8.8500004"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.425)">
		<g transform="translate(72,-61.26)">
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		</g>
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</svg>-hCG in both primary and metastatic sites. This case further expands the clinicopathologic spectrum of lipogenic tumors.

Michael J. Russell

Frederick L. Flynt

Allyson L. Harroff

Oluwole Fadare

Dedifferentiated Liposarcoma of the Retroperitoneum with Extensive Leiomyosarcomatous Differentiation and 
                        <svg style="vertical-align:-3.56265pt" height="16.6625" version="1.1" viewBox="0 0 10 16.6625" width="10" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"><g transform="matrix(.017,-0,0,-.017,.062,12.162)"><path id="x1D6FD" d="M558 587q0 -32 -14 -61t-40 -53.5t-48.5 -41t-54.5 -36.5q144 -51 144 -174q0 -55 -43.5 -108t-104.5 -87q-77 -42 -131 -42q-31 0 -54 20t-31 47l11 18q48 -29 108 -29q79 0 119.5 43t40.5 109t-44.5 107.5t-119.5 50.5l22 47q34 1 65 21q96 61 96 157q0 42 -24 67.5&#xA;t-62 25.5q-24 0 -43.5 -9t-35 -29.5t-27 -44t-22.5 -63t-19.5 -75.5t-18.5 -91q-57 -294 -68 -380q-26 -190 -35 -200q-26 -31 -97 -37l-4 26q19 9 48 170l77 413q23 121 52.5 187.5t83.5 114.5q70 62 148 62q51 0 88.5 -34t37.5 -91z" /></g></svg>-Human Chorionic Gonadotropin Production

<i>Introduction and aim</i>. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds. <i>Material and Methods</i>. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases). <i>Results</i>. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. <i>Conclusion</i>. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

Haitham H. Khalil

Ahmed El-Ghoneimy

Yasser Farid

Walid Ebeid

Ahmed Afifi

Ahmed Elaffandi

Tarek Mahboub

Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula, deep to serratus anterior, and often attached to the periosteum of the ribs, presenting with long history of swelling and occasionally pain and discomfort. This lesion is usually seen in patients over the age of 50 years and is not uncommonly mistaken as a malignant tumour because of its size and location deep to the periscapular muscles. Review of the orthopaedic oncology database of 17&#x2009;500 patients revealed that  there were 15 patients with elastofibroma dorsi. There were 12 males and 3 females, mean age at diagnosis of 68.4 years range 51&#8211;79 years. The diagnosis was confirmed by MRI in 3 patients, excision biopsy in 3 patients, trucut biopsy in 8 patients and open biopsy in 1 patient. Eight patients had excision of the lesion which was symptomatic. There have been no recurrences. We highlight the clinical and radiological presentation of elastofibroma dorsi to increase awareness of its existence and management.

C. R. Chandrasekar

S. R. Carter

R. M. Tillman

A. Abudu

A. M. Davies

V. P. Sumathi

Elastofibroma Dorsi: An Uncommon Benign Pseudotumour

A 33-year-old woman sought medical attention for a painful swelling of the left
ankle. Plain radiographs revealed an osteolytic lesion involving the left distal tibia.
An excisional biopsy provided the diagnosis of leiomyosarcoma in the tibia. A
staging work-up was performed and an abdominal CT showed 4 liver hypodense
lesions in both lobes with peripheral contrast enhancement. A liver biopsy
confirmed the diagnosis of epithelioid hemangioendothelioma of the liver. No
association between these two entities has been described before. This case
introduces the importance of the pathological confirmation of apparent metastatic
lesions in low grade sarcomas and provides a review of the literature of both
tumours.

E. Gonzalez-Billalabeitia

M. Quintela-Fandino

I. Alemany

G. L&#243;pez-Alonso

A. Ruiz-Ollero

F. Martinez-Tello

R. Hitt

Coexistence of Two Rare Sarcomas: Primary Leiomyosarcoma of Bone and Epithelioid Hemangioendothelioma of the Liver

<i>Introduction and aims</i>. It is well established that soft tissue sarcomas (STSs) are more effectively treated in a specialist centre. However, delays in time taken for a patient to be referred to a specialist centre may lead to a poorer prognosis. This study aims to identify the length of these delays and where they occur. <i>Patients and methods</i>. Patients with a proven STS were included. They were recruited from both outpatient clinics and from the surgical ward of the Royal Orthopaedic Hospital (Birmingham, UK). A structured interview was used to take a detailed history of the patients' treatment pathway, before arriving at the specialist centre. Dates given were validated using the case notes. <i>Results</i>. The median time for the patient to present to a specialist centre from the onset of symptoms was 40.4 weeks. The median delay until presentation to a medical professional (patient delay) was 1.3 weeks. Median delay in referral to a specialist centre (service delay) was 25.0 weeks. <i>Discussion</i>. Medical professionals rather than patients contribute the greatest source of delay in patients reaching a specialist centre for treatment of STS. Adherence to previously published guidelines could decrease this delay for diagnosis of possible sarcoma. Steps should be taken to refer patients directly to a diagnostic centre if they have symptoms or signs suggestive of STS.

G. D. Johnson

G. Smith

A. Dramis

Delays in Referral of Soft Tissue Sarcomas

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<p><em>Sarcoma</em> covers all aspects of connective tissue oncology research. It brings together work from scientists and clinicians carrying out a broad range of research in this field, including the basic sciences, molecular biology and pathology etc.</p>


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Sarcoma covers all aspects of connective tissue oncology research. It brings together work from scientists and clinicians carrying out a broad range of research in this field, including the basic sciences, molecular biology and pathology etc.

Sarcoma