True giant-cell tumors are quite rare. Solitary bone cysts occur with about the same frequency, while sarcomata of bone are found five times as often as either.
We agree with Geschickter and Copeland that. there is a close clinical kinship between giant-cell tumor and solitary bone cyst., and tlsat they probably have a common origin.
Giant-cell tumors are neoplasms and as such can be expected to recur in sites of incomplete extirpation. Moreover, they may undergo malignant changes, either through trauma or as a result of inadequate treatment.
The number and size of the giant cells, together with the number of nuclei pet cell, furnish the best criterion for determining the prognosis. The small, sparsely nucleated giant cells with a tendency for collection of many cells in each high-powered field indicate more activity and rapid growth. These tumors have a greater tendency to recur or become malignant.
X-irradiation should be reserved for those lesions inaccessible to surgery. The danger of incomplete cures, recurrence, and of an overdosage of roentgen rays are not as important as the hazard of late sarcomatous changes.
Resection of the involved portion of a bone where feasible is the treatment of choice. The distal portion of the radius can be sipplanted successfully by use Proximal end of the fibula. The femoral condyle can be replaced by a section from the ilium.
If resection is not practical, the next best method of treatment is thorough curettage, with or without cauterization, together with multiple bone grafts or chips to fill the cavity. The most important single factor in this method applies to the treatment of solitary bone cyst as well as giant-cell tumor: this is thorough curettage, breaking through and destroying the limiting wall and thus opening into the normal cancellous bone of the shaft. Bone chips or grafts should he inserted when large defects are created.
The so-called giant-cell variants in most instances are probably separate and distinct pathological lesions resembling this tumor only through the presence of giant cells.