A 14-year-old girl with Ewing's sarcoma of the proximal fibula, Stage IIA, is planned for limb-salvage surgery. The surgical margin achieved should be classified as 'wide' under the Enneking margin classification. What does a 'wide' margin mean?

• A Tumor removed piecemeal with macroscopic residual disease at margin
• B Tumor excised en bloc with a cuff of normal tissue beyond the reactive zone ✓
• C Tumor excised en bloc within its pseudocapsule/reactive zone
• D Entire compartment containing the tumor is removed

Explanation

Enneking surgical margins are: intralesional (through tumor, piecemeal), marginal (through reactive zone/pseudocapsule), wide (en bloc removal with a rim of normal tissue beyond the reactive zone but within the anatomic compartment), and radical (entire compartment excision). A 'wide' margin is the minimum acceptable oncological margin for most high-grade sarcomas when combined with adjuvant chemotherapy/radiotherapy; it means the surgeon excises beyond the reactive zone into normal tissue. A radical margin (compartmentectomy) is ideal but may be impractical. Marginal margins are associated with high local recurrence rates.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.