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Deep soft tissue sarcomas are frequently in contact with bone. The therapeutic decision of a composite resection strategy may be challenging, which is usually based on clinical and radiological criteria. The aims of the study were to evaluate the overall frequency of bone and periosteal infiltration in these patients in whom composite resection was indicated, and evaluate the role of magnetic resonance imaging and bone scintigraphy in this scenario. Forty-nine patients with a composite surgical resection (soft tissue sarcoma and bone), treated at a single institution between 2006 and 2018, were retrospectively included. Presurgical planning of the resection limits was based on clinical and imaging findings (magnetic resonance imaging and bone scintigraphy). Magnetic resonance imaging was performed in all patients (100%) and bone scintigraphy in 41 (83.7% of the cases). According to magnetic resonance imaging results, patients were divided into two groups: Group A, in which the tumor is adjacent to the bone without evidence of infiltration (n = 24, 48,9%), and Group B, patients with evidence of bone involvement by magnetic resonance imaging (n = 25, 51,1%). BS showed a pathological deposit in 28 patients (68.3%). Histological analysis of the resection specimen was preceded to identify bone and periosteal infiltration. For the analysis of the diagnostic validity of imaging tests, histological diagnosis was considered as the gold standard in the evaluation of STS bone infiltration. Histological bone infiltration was identified in 49% of patients and isolated periosteal infiltration in 14.3%. In terms of diagnostic accuracy, magnetic resonance imaging and bone scintigraphy sensitivity values were 92% and 90%, and their specificity values were 91.7% and 52.4%, respectively. The incidence of bone and periosteal infiltration of soft tissue sarcomas in contact with bone is high. Presurgical bone assessment by MRI has proven to be a sensitive and specific tool in the diagnosis of bone infiltration. Due to its high negative predictive value, BS is a useful test to rule out it. In those cases, in which there is suspicion of bone infiltration not confirmed by MRI, new diagnostic protocols should be established in order to avoid inappropriate resections.

Low-grade myofibroblastic sarcoma (L-G MFS) is a rare tumour that commonly affects the soft tissues of the head and neck. Its location in bone is very rare and there are few cases published in the literature, which sometimes leads to a wrong initial diagnosis. The following report will give an overview of the clinical, radiological and histological findings in two patients with a very unusual bone sarcoma, which are more often found in the soft tissues. Treatment options and outcome will be discussed. On excision of any sarcoma tumor, surgeons should be aware of the potential risk for erroneous management of malignancy. If not, careless surgery may render the treatment protocol complicated and additional bed tumor resection with poor function and prognosis. Low-grade myofibroblastic sarcoma (L-G MFS) requires a wide resection to avoid local recurrence and distant metastases. We present two cases with an initial diagnosis of giant cell tumor and fibrous dysplasia respectively, which were diagnosed as low-grade bone myofibroblastic sarcoma after clinical, radiological y pathological studies.

The ideal treatment of pelvis bone metastases may be complex and involve multimodality treatment approaches to achieve optimal outcomes. The chapter describes the treatments indications of these patients. It is described from nonoperative treatments, through minimally invasive palliative procedures until reaching the surgical treatment, emphasizing types of pelvis resection and indications for surgical reconstruction of the acetabulum.

Background and objectives Ewing sarcoma is the second most common bone sarcoma of childhood. Ewing sarcomas of the scapula are rare, with little known about their characteristics and outcomes. In this study, we describe the demographic characteristics, tumor characteristics, and oncologic outcomes of patients with Ewing sarcoma of the scapula. Methods This is a retrospective case series of thirty-four patients treated at three urban hospitals between 1993 and 2014 for Ewing sarcomas affecting the scapula. Their demographic data, tumor characteristics, and oncologic outcomes are reported and contrasted with data on Ewing sarcoma described in the literature. Results Patients in our case series were 59% male. The average age at diagnosis was 16 years. 44% of patients had metastatic disease at presentation. 26% of patients had a tumor size >8 cm in largest dimension at diagnosis. 9 patients in our series had the t (11; 22) translocation present. Patients had a survival rate of 68% at five years. No patients had local recurrence of disease. Compared with findings reported in the literature concerning Ewing sarcoma affecting other locations, patients with Ewing sarcoma of the scapula were slightly older at time of diagnosis, had a lower percentage of tumors with size > 8 cm in largest dimension at presentation, and more commonly had metastatic disease at presentation. Patients in our cohort had a 5-year survival rate of 68%, which is higher than the rate of approximately 55% as reported in the general literature. Conclusions In this study, we describe a retrospective case series of thirty-four patients with Ewing sarcomas of the scapula. This is the largest case series to date of Ewing sarcoma affecting this location to our knowledge. These results will contribute to the understanding of the clinical profile and oncologic behavior of Ewing sarcomas affecting the scapula.

Background Reconstruction after internal hemipelvectomy resection likely provides better function than hindquarter amputation. However, many reconstruction methods have been used, complications with these approaches are common, and function often is poor; because of these issues, it seems important to investigate alternative implants and surgical techniques.

The optimal surgical treatment of bone metastases may be complex and require multimodality treatment strategies to achieve optimal outcomes. We describe the surgical indications of these patients, mainly in the periacetabular zone.

Bone tumors are commonly located around the knee, in the distal femur and proximal tibia and less frequently in the proximal fibula and patella. Treatment of bone tumors depends on the histological grade, the size and location of the tumor and the characteristics of the patient. Generally, benign bone tumors are adequately treated by either an intralesional or a marginal resection. To reduce the risk of recurrence, the intralesional resection may be extended with mechanical, chemical, and thermal adjuncts. Primary bone sarcomas and some aggressive benign tumors require a wide resection. Limb salvage principles are largely employed if neurovascular structures can be preserved and a level of function maintained. After tumor resection with a wide margin, the defect left poses a reconstructive challenge. In this chapter, we will refer to bone tumors that most frequently arise around the knee and may affect adult population. First, we consider the basic characteristics of these tumors and then the surgical treatment, focusing in those techniques that preserve the joint.

A hemophilic pseudotumor is basically an encapsulated hematoma; it has become rarer over the years with better treatment modalities for bleeding disorders like factor replacement. Its prevention is paramount; this goal can be achieved by primary prophylaxis to avoid muscle hematomas and by adequate and long-term hematological treatment of muscle hematomas in case they appear. There are a number of therapeutic alternatives for this dangerous condition: surgical removal, percutaneous management, exeresis and filling of the dead cavity, irradiation, and embolization. The management of the patient with a hemophilic pseudotumor is complex and with a high rate of potential complications. Surgical excision is the treatment of choice but should only be carried out in major hemophilia centers by a multidisciplinary surgical team. The main postoperative complications are death, infection, fistulization, and pathological fractures (requiring even amputation of the affected limb).