Bone Infarcts and Tumorigenesis-Is There a Connection? A Mini-Mapping Review

Int J Environ Res Public Health. 2022 Jul 29;19(15):9282. doi: 10.3390/ijerph19159282.


(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012-2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy.

Keywords: avascular necrosis; bone infarct; epidemiology; imaging; infarct associated sarcoma; mapping review; secondary osteosarcoma.

Publication types

  • Review
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone and Bones / pathology
  • Carcinogenesis
  • Humans
  • Infarction / pathology
  • Sarcoma*
  • Soft Tissue Neoplasms*

Grants and funding

Publication was funded by the Medical University of Lodz, Department of Social Medicine (project No. 503/6-029-01/503-61-001-19-00).