artery and vein, as well as the major part of the scapula. The clavicle was resected leaving the medial. 2.5 centimetres for attachment of the sternocleidomastoid.
POSTIR
RADIATION
CHONDROBLASTIC A CASE HAKON
From
A case
of chondroblastic
malignancies
treated
osteogenic
well and free of recurrence Surgical
procedures
to be considered quality oflife. history
is reported
irradiation.
treatment
malignant
CASE
A 59-year-old
woman
department
Fifteen
of cancer
was
the
left
a
tumours.
admitted 1980
to the orthopaedic
with
a rapidly
supraclavicular
She
a
resection then had
of an adenocarcinoma a course of irradiation
the
shoulder
examination revealed girdle.
of the radiographs no abnormal bone
During
the
spring
involvement
tumour
masses
from structures
of 1980
she
the clavicle, the subclavian part
of
the
sternocleidomastoid appeared normal. vessels
were
tumour.
scapula.
freed
and
the humerus
on the lateral innervated
the at
which
had
(Fig.
be
was
sheaths
extracted
which
resected of the
attached
freed ever
through
to the
enabling
the
being touched. above the elbow a double
arm, leaving musculocutaneous
to the
and
first rib and the pleura plexus and subclavian
en bloc without 15 centimetres
sutured
found
clavicle
was
aspect ofthe upper and vascularised
could
incision
was
their
respine
first
for attachment
scapula
tumour to be removed The arm was amputated
of the were
The
leaving the
could not be by the tumour.
part of the brachial vein, as well as the
2.5 centimetres muscle. The The brachial
Finally,
2) and deltoid,
pyrophosphate clavicle and the
the lateral artery and
the
medial
(Fig. The
arteries obstruction
possible
and
ribs. At operation
leaving
in the left axilla and had to the upper left thorax.
vessels artery.
the suprascapular which indicated
scapula,
major
Severe skin changes had developed in the supraclavicular region and in the trapezial area, together with oedema of the entire arm and paraesthesia in the hand and arm, which she was unable to use and kept in a sling. Retrospective 1952-66 period
and
tumour
of the
involved plexus,
irradiation. In 1965 she had suffered of the left breast, treated by mastecirradiation. In 1966 she had undergone
a few subclavian
technetium-99m activity in the
second
had
showed
displaced
Scintigraphy using vealed pathological
growing
region.
artery
distally
acromial demonstrated
history of three episodes of carcinoma. In 1952 she had had carcinoma ofthe cervix, treated by total hysterectomy and postoperative an adenocarcinoma tomy and local
Copenhagen
in a patient with a history of three separate after a forequarter amputation she remains
months
axillary
have
REPORT
in September in
sarcoma
Rigshospitalet,
and metastases.
in the
different
LINDENBERG
Surgery,
in the context of life expectancy and the We present a patient who had a remarkable
of three
tumour
SVEND
ofOrthopaedic
by postoperative
SARCOMA
REPORT
KOFOED,
the Department
OSTEOGENIC
margin
incision a normally flap,
of
the
original
3).
discovered a small lump in the left supraclavicular region which had rapidly increased in size. When she was admitted in September 1980 the tumour measured five
Uneventful healing took place. The removed on the twelfth day and the discharged. After four weeks a prosthesis
centimetres by six and structures (Fig. 1). Radiography revealed
the left shoulder and arm. Histological examination of the tumour showed a chondroblastic osteogenic sarcoma. All borders of the resected specimen were free of tumour
involvement of the tensed tomography
lateral of
was
tethered
normal
lungs,
H. Kofoed, S. Lindenberg,
Arteriography
MD,
The Department Requests
© 590
1982
MChOrth, MD, Registrar
British
Editorial
should
tumour Compushoulder
involvement.
the
subclavian
No
supplementary
treatment
has
been
given. Clinical and radiological examination 1 5 months after operation revealed no signs nor of metastasis. The patient well-adjusted to her disability.
and
was
of the chest of recurrence
physically
well
and
Registrar
Surgery, be sent
Society
but
deeper
four by seven centiscapula and reaching lungs could not be
of
Senior
of Orthopaedic
for reprints
the
part of the clavicle. the chest and left
demonstrated a tumour measuring metres, involving the clavicle and the pleura. Metastasis to the demonstrated.
to
sutures were patient was was fitted for
to Dr
of Bone
Rigshospitalet,
University
Hospital
of Copenhagen,
DK-2l00,
Denmark.
H. Kofoed. and
Joint
Surgery
0301-620X/82/Sl
1 1-0590
$2.00
THE
JOURNAL
OF BONE
AND
JOINT
SURGERY
POSTIRRADIATION
Figure 1 photograph. subclavian
CHONDROBLASTIC
Fig. I
-The
tumour
Figure artery.
It is extremely
of the and
acromial
region.
subclavian suprascapular
Such seen
Notice and
malignant
a tumour in itself is very in connection with former
radiation-induced was normal before
such lished
postirradiative (Weatherby
tumours treatment.
changes
tumours
poor.
1981), of former
large
chondrosarcoma have et a!. 198 1 Considering
The
girdle
problem
defect
procedure
line of incision
that with
which was
vessels 3-The
was this
The
affected
patient
would
tried.
has been
result only
marked
(arrows) and a distally result I S months after
skin
was
the
prognosis
how
is
to cover
if a radical area
on the
displaced operation.
the
operative
totally
unaffected
by irradiation was the axillary region and the inside of the upper arm. As the arm was painful and useless, the decision was made to perform this operation, knowing well there was only a small chance of doing a total
in bone 22 cases of
resection.
However,
had
the skin, the quality deteriorated greatly. rather unusual surgical
been pubthat it was
).
shoulder The
rare, but is cancers of
only occurred So far only
in the area.
the axillary arteries showing a few tumour arteries could not be demonstrated. Figure
the breast or of the cervix several years after irradiation therapy (Weatherby, Dahlin and Ivins 1981). This case even fulfilled the criterion of Parker (1972), who claimed that that
Fig. 3
the skin
the
DISCUSSION that three different
develop in the same patient (Prior and Waterhouse even ifthe third tumour was probably the result irradiation. occasionally
591
SARCOMA
Fig. 2
in the left supraclavicular
2-Arteriography The deltoid,
rare
OSTEOGENIC
the
tumour
fungated
of life for the patient So far the result has solution.
would justified
through have this
REFERENCES RP.
Parker Prior
Weatherby
VOL.
Tolerance
P, Waterhouse 623 -31.
64-B.
RP,
ofmature JAH.
Dahlin
No. 5. 1982
DC,
bone
Multiple lvins
and
cartilage
primary JC.
Postradiation
cancers
in clinical
radiation
of breast sarcoma
and
of bone.
therapy.
cervix Mayo
uteri C/in
Front
Radiat
Ther
: an epidemiological Proc
1981 :56:
Onco/
1972:6:312-31.
approach 294-306.
to analysis.
Br J (‘ancer
1981 :43:
