SYMPOSIUM: HIGHLIGHTS FROM THE FIRST COMBINED 2011 MEETING OF THE MUSCULO- SKELETAL TUMOR SOCIETY AND CONNECTIVE TISSUE ONCOLOGY SOCIETY The Classic Case of Osteo-Sarcoma of Tibia, Recurring in Stump of Thigh, and Probably Affecting the Lung

This Classic article is a reprint of the original work by Mr. John Ewens, ‘‘Case of Osteo-Sarcoma of Tibia, Recurring in Stump of Thigh, and Probably Affecting the Lung.’’ The case is of interest, because the findings contradicted an existing idea, ‘‘that large malignant growths, springing from the long bones, do not, after amputation, if the whole of the diseased structures be removed, return in the stump, but at some distant part; and, therefore, it is not necessary to amputate above the knee in the case of the tibia, or at the hip-joint in the case of the femur.’’ In Mr. Ewen’s case, an osteosarcoma of the tibia was treated with above-the-knee amputation, but, in fact, it recurred in the stump. The mechanism was unclear but could have arisen from the presence of a multifocal lesion in the femur, seeding at the time of amputation (details of the amputation were not provided, although the site of the tumor was apparently not involved), or perhaps subsequent metastasis from elsewhere to the stump. Mr. Ewens was a surgeon at the Hospital for Sick Children in Bristol, England. (No other information on Mr. Ewens could be located, and we have no accompanying biographical sketch.) The Classic Article is (1878) and is reprinted from Ewens J. Case of Osteo-Sarcoma of Tibia, Recurring in Stump of Thigh, and Probably Affecting the Lung. Brit Med J. 1878; Feb 9;1(893):192–193. The Association of Bone and Joint Surgeons1 2012 Richard A. Brand MD (&) Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19103, USA e-mail: [email protected] THE BRITISH MEDICAL JOURNAL of December 29th, 1877, contains a report of osteo-sarcoma of the femur, with death from subsequent deposit in the lung, read before the annual meeting of the Association in August last, by Mr. Heath of Manchester. As the following case seems to be in some respects somewhat antagonistic to the conclusions arrived at by Mr. Heath, in connection with the opinion of the late Sir W. Fergusson, it will not, I think, be without some practical interest. A boy, aged 8, was admitted into the Hospital for Sick Children, Bristol, in May 1876, with a large tumour of the upper extremity of the left tibia. The history given was that, some weeks before, he had been struck by a stone flung by another boy, and that he had walked some distance in the snow, and got chilled. The very rapid growth and general appearance of the tumour led to the diagnosis of malignant disease, and that nothing but prompt amputation far beyond the limits of disease could afford the least chance of saving life. The inguinal glands, though more distinct than usual on account of the extreme emaciation, did not appear to be diseased. There was no abdominal tenderness, or evidence of any visceral disease. Amputation was performed by the circular method about the middle of the thigh. The wound was dressed with carbolised oil, and the arteries tied with carbolised catgut. Rapid union of the deep structures occurred by first intention, and the patient was discharged quite well in about a month. The whole of the upper third of the tibia was involved in the malignant growth, which also extended into the joint (but did not invade the femur) and for a considerable distance down the cancellous tissue of the bone. The soft parts were also extensively involved. Unfortunately, the hospital cards containing detailed notes as to circumference of the tumour, etc., have been lost or mislaid. 123 Clin Orthop Relat Res (2013) 471:832–833 DOI 10.1007/s11999-012-2732-6 Clinical Orthopaedics and Related Research® A Publication of The Association of Bone and Joint Surgeons®