epiphysis of the femur. The spindle-celled tumors grow steadily, but as a rule, slowly. Local infection of the surrounding tissue and neighboring glands occurs late. The skin is frequently ulcerated. Joint invasion is the exception.
In the ossifying or osteoid spindle-celled tumor, metastasis in the distant organs, particularly in the lungs, is exceedingly common, occurring more often than in any other variety of bone sarcoma. Generalization of these tumors occurs early, generally within a few months after the tumor begins to grow.
The diagnosis of sarcoma of the femur, and especially in the early stage of the disease, is often very difficult. In all varieties of sarcomas of the femur, as in other malignant growths, there is a time when the disease is distinctly local. It is in this stage that long local treatment, if it is to be successful, must be instituted. If the true character of the disease is not recognized until generalization has taken place, no treatment known at the present time, can in any way favorably influence its progress.
The most constant symptoms of sarcoma of the femur are pain, enlargement of the bone and spontaneous fracture or fracture from slight trauma.
Pain is the earliest symptom in most forms of sarcoma of the bone. In the periosteal, particularly in the rapidly grown tumors, it is constant and is the first indication of the onset of the disease. Taking all the different forms of sarcoma, it is present in about 85 per cent. of the cases, and is continuous throughout the course of the disease, varying in character and intensity, being most severe in periosteal and less constant, usually less intense in the myelogenic tumors.
In central tumors, particularly in those of slow growth, it is frequently of a neuralgic character, and not always constant, but of an intermittent character. Thickening of the bone is, of course, always a symptom. In many of the slow growing central tumors, considerable time may elapse before the enlargement can be detected. This is often the case when the disease involves the upper epiphysis of the tumor. In periosteal growths, particularly of the diaphysis of the bone, the tumor can readily be recognized.
In central tumors, the bone is uniformly enlarged throughout its whole circumference; usually the thickened part is smooth and regular in outline. As the disease progresses, the capsule of bone enclosing the tumor becomes thinned so that the slightest pressure will break the thin laminated covering and give distinct crepitation.
Perioesteal sarcoma, as a rule, involves the whole circumference
