A Case of Chondro-Osteo-Sarcoma

Robert W. Lovett
1914 Boston Medical and Surgical Journal  
From the Orthopedic Clinic of the Children's Hospital.] C. P., a boy IIV2 years old, was admitted to the hospital on February 24, 1913. The family history was good, and the personal history showed measles, pertussis and diphtheria seven and six years previously. There had been no known exposure to tuberculosis. In the fall of 1911, that is, about eighteen months prior to admission, while playing football his right leg had been hurt near the hip. Off and on since then he had limped. He had never
more » ... imped. He had never had any acute pain, he had eaten and slept well, and there had been no loss of weight. The parents had noticed that the upper part of the right thigh was larger than the left. Chondro-OBteo'sarootna of Femur. Physical examination showed that the boy was well developed and nourished, the pupils were equal and reacted to light and distance, the throat was normal, the heart and lungs were normal, the abdomen was soft with no masses or tenderness, the in-guinal glanda on the right side were enlarged, and a few glands felt in the left inguinal region. Just below and anterior to the right trochantor there was a swelling about three inches in diameter, not reddened but hard and apparently connected with the bone. There was some Blight tenderness on pressure over the middle of the tumor. The legs were of equal length, and there was no difference in the circumference of the calves. Tho thigh was 1% inches more in circumference over the tumorous mass than at a corresponding point on the other thigh. There was no distinct limitation of motion of cither hip, although the movements in tho right hip were perhaps a little less free than those in the other. Examination of the urine showed that it was acid, with little sediment, no albumin, sugar or acetone. Microscopic examination showed no casts, blood, white blood corpuscles, but a few mucous shreds. The von Pirquet skin test was positive, the leucocyte count was 6,500, the Wassermann reaction was negative. The x-ray showed a thickening of the upper Ohondro-osteo-sareoma. four inches of the shaft, of the femur, and a rounded curve from the neck to the shaft on the outside replaced the normal angle of the trochanter. In the interior of tho bone the normal structure was replaced by a somewhat globular homogeneous area both in the cortex and in the medulla. It appeared to be fairly sharply limited, and the suggestion was of a more or less encysted tumor about 2[ > inches in length from above downward. The diagnosis was a troublesome one, and we considered a malignant growth, bone cyst and syphi-
doi:10.1056/nejm191404021701408 fatcat:aiqmqo5x6vb7tm4cbr4vu3l664