Excision of the shaft: of the tibia for sarcoma; examination of a patient forty-three years after replacement by a fibular graft.

OIl August 4, 1906, I resected tile left tibial diaphysis of a girl aged fourteen years for sarcoma diagnosed clinically and radiologically (Figs. I and 2). Tile segment excised was replaced by a graft of equal length from tile fibula, the soft tissue attacilments of which were disturbed as little as possible durillg mobilisation in order to preserve tile blood supply. My reason for undertaking conservative resection was tilat tile sarcoma was a central one, limited to tile bone and showing no soft tissue invasion. Histological examination of tile tumour showed a uniform structure. It consisted of connective-tissue spindle cells set in several directions, ‘ith an abundant vascular stroma. In se -’eral places, but mostly w’ilere the stroma was abundant and the fusiform cells scanty, there were groups of six or more giant cells. These were similar to the m ’eloplaxes of tile bone marrow, from which tlley were probably derived. There were also some areas of degeneration, where the stroma was granular and its reaction-distinct from the acidopilil reaction of the rest of the tumour-was basophil. Since tile first publisiled report of this case in 1907 it has been referred to by several writers, some of whom have doubted the accuracy of the diagnosis. Cavaillon and Alamartine