Fig. 149.—Central Sarcoma of Lower End of Femur, invading the knee-joint.
(Museum of Royal College of Surgeons, Edinburgh.)
Pathological fracture is more common in central tumours, and sometimes is the first sign that calls attention to the condition. Consolidation rarely takes place, although there is often an attempt at union by the formation of cartilaginous callus.
Fig. 150.—Osseous Shell of Osteo-Sarcoma of Upper Third of Femur, after maceration.
The soft parts over the tumour for a long time preserve their normal appearance; or they become œdematous, and the subcutaneous venous network is evident through the skin. Elevation of the temperature over the tumour, which may amount to two degrees or more, is a point of diagnostic significance, as it suggests an inflammatory lesion.
The adjacent joint usually remains intact, although its movements may be impaired by the bulk of the tumour or by effusion into the cavity.
Enlargement of the neighbouring lymph glands does not necessarily imply that they have become infected with sarcoma for the enlargement may disappear after removal of the primary growth; actual infection of the glands, however, does sometimes occur, and in them the histological structure of the parent tumour is reproduced.
To obtain a reasonable prospect of cure, the diagnosis must be made at an early stage. Great reliance is to be placed on information gained by examination with the X-rays.