We experienced a case of osteogenic sarcoma judged presumably secondary to the occupational injury.
The patient, a workman 21 years old, had got a severe bruise on the medialanterior aspect of the lower left femur, on Nov. 1, 1951, when working, and pain, swelling and dysfunction had occussed subsequently.
The pain had been so much increasing in severity that he came to receive our medical examination on Feb. 1, 1952,
Examination showed the pain and the limitation of motion in the left knee joint. There was a palpable swelling of bony-hardness adherent to the bone in the deep of the part concerned.
The roentgenogram revealed a translecent periosteal shadow above internal condyle of the femur. In the follow-up x-ray study was seen a enlarged tumor with more definite contour.
On Mar. 6, the lesion proved, on open biopsy, to be osteogenic sarcoma, histopathologically. Therefore, deep roentgen therapy was first administered in amount of 150r. each, the total being 750r. Subsequent to this therapy, “Nitromin” (Nitrogen Mustard-N-oxide) was given intravenously in 50mg doses every other day, with the total of 500mg. Then, amputation was performed through the middle of the left femur.
No appreciable reaction to the drug in blood picture, but marked loss of appetite and lassitude were complained of.
Following the administration of “Nitromin”, there occurred much variation in the histopathologic appearance, compared with the biopsy specimen taken before the therapy. In the majority of tumor cells, degenerations were striking, both in the nuclei and in the cytoplasms. The karyolysis and cytolysis were also common finding. The tumor cells were seen dispersed in a more disorderly fashion, and remarkably decreased in number, presenting the appearance of homogeneous hyaline substance among these cells.
Thus, Nitrogen Mustard is in efficacy and decreased in toxicity, in its N-oxide form.
In the review of this case, being agreeable to the criteria described by Thiem or Segond after careful evaluation, the evidence for trauma as a pathogenic factor seems to be convincing.
In our opinion, Workmens' compensation may be awarded for this case. It is thought advisable to make the unbaseded provision how it is handled, based on the sound clinical and statistical evaluation. The problems presented are difficult, but we trust these thought may be of some assistance.
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