Abstract

One of the earliest suggestions that reticulum-cell sarcoma could arise from the reticulo-endothelial structures of bone was made by Oberling (17) in 1928. In 1939, Ewing (13) accepted primary reticulum-cell sarcoma of bone as a distinct entity for inclusion in a revised classification of bone tumors for the Bone Sarcoma Registry of the American College of Surgeons. In the same year, Parker and Jackson (18) presented a complete study of 17 cases of this disease; 13 of the cases were from the Bone Sarcoma Registry material and the remainder from their personal experience. Since then only a few reports of small series of cases have appeared in the world literature (15, 19, 22, 23). In the majority of the more recently reported cases the disease was generalized, there were multiple bone foci, or histologic confirmation of the primary focus in bone was not obtained. Definition: Primary reticulum-cell sarcoma of bone is a malignant tumor histologically identical with reticulum-cell sarcoma elsewhere in the body. It arises in a single focus in bone and is capable of regional and distant metastasis. It occurs most commonly in the earlier decades of life, is characteristically accompanied by a striking absence of general debility, and runs a relatively long natural course. The tumor is remarkably radiosensitive and exhibits a high degree of radiocurability. Memorial Hospital Series: At Memorial Hospital (New York), since 1925, a clinical diagnosis of primary reticulum-cell sarcoma of bone has been made in 58 patients. In some of these cases the histologic interpretation of the pathologic material was in doubt; in others there was reason to question whether or not the bone lesion was metastatic from a general form of reticulum-cell lymphosarcoma. Accordingly, a set of criteria for inclusion in this series was adopted as follows: (1) Clinically a primary focus in a single bone on admission. (2) Unequivocal histologic proof3 from the bone lesion (not from a metastasis). (3) Metastases present on admission only if regional, or if the onset of symptoms of the primary tumor preceded the appearance of the metastases by at least six months. Final analysis elicited a total of 37 cases which were acceptable under these criteria, and these form the basis for this study. The cases are summarized in Table I. Etiology General Incidence: Between the years 1925 and 1949 a total of 1,091 cases of malignant bone tumors of all types were seen in Memorial Hospital. Of these, 58 (5.3 per cent) were primary reticulum-cell sarcoma of bone. Vieta, Friedell and Craver (24) found the incidence of metastatic bone lesions in 213 cases of lymphosarcoma to be 7 per cent. On the other hand, Coles and Schulz (4) have reported an incidence of 32 per cent bone involvement in a series of 58 cases of reticulum-cell sarcoma. Age and Sex Incidence: The combined age and sex incidence is summarized in Chart I.