GIANT CELL TUMOR OF BONE

A correlated clinical,roentgenologicand pathologic study of 19 cases ofgiant cell tumor of bone is presented. The authors point out that thesoap bubble appearance in the x-rayfilm,often described as being character-istic of this lesion,is not caused byshadows of the interlocular septa,butis due to superimposition of the shadowsof the ridges on the remnant bony cor-tex.In addition to the usual pattern ofgrowth by expansion,there is frequentlyaxial or subcortical intramedullary ex-tension,sometimes for several centime-ters.This fact has a definite bearing onthe extent of resection curettage whichis necessary and,therefore,carefulpreoperative scrutiny of the x-ray filmis advisable.Aspiration biopsy may give def-inite help in diagnosis.The site ofbiopsy should be properly chosen andthe puncture made in several directions.Surgical treatment was adopted in17 instances;excision en bloc with orwithout bone grafting in 9,of which onewas for a postradiation sarcomatouslesion;curettage in 2,one of which wasfollowed by postoperative irradiation;amputation for late lesions in 6,in oneof which the procedure was necessitatedby failure of the initial radiotherapy.Radiotherapy was employed alone in 2instances.Among the 3 cases reported in de-tail,one had a giant cell tumor of thespine with paraplegia.Curettage andpostoperative irradiation was used inthis case and was followed by practi-cally complete recovery which has sofar lasted for 13 years.Another casewas a tumor involving the upper end ofhumerus and showing typical shaftwardintramedullary extension.The thirdone was a case of postradiation sarcomaarising in a preexisting giant cell tumorof the right ulna.The amount ofradiation which had been given was4,200 r.The latent period between theradiation treatment and clinical mani-festations of sarcomatous change,was 6years.Although resection was promptlyundertaken,both regional lymph nodeand pulmonary metastases developedand the patient died 2 years and 2months after operation.