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Journal of Bone and Joint Surgery, 1938;20:870-884.
© 1938 by The Journal of Bone and Joint Surgery, Inc

GIANT-CELL TUMOR OF BONE

BRADLEY L. COLEY M.D. and NORMAN L. HIGINBOTHAM M.D.

1. The giant-cell tumor is usually benign, but malignant forms are encountered and may result from the transformation of a tumor that is histologically benign at the outset.

2. Surgical extirpation (curettage, resection, and, on rare occasions, amputation) and radiation have been established as successful methods of treatment. Surgery is preferable for accessible tumors, and radiation for inaccessible or extremely advanced tumors.

3. Caution should be exercised when using the roentgen-ray without histological confirmation of the diagnosis, for one may be dealing with an osteolytic sarcoma which bears a close resemblance, roentgenographically, to the giant-cell tumor.

4. Radiation should not be used in conjunction with surgery. Each method should bear the full responsibility of its employment in the individual case.

5. The roentgen-ray in large doses destroys the regenerative powers of the bone; in small doses, it may fail to arrest the disease; therefore, the exact dosage for the individual case is a matter of profound judgment or of fortuitous circumstance.

6. Inexpert radiation is probably less hazardous than surgery in the hands of one unfamiliar with technical operative details. Loss of limb may ultimately result in either instance.

7. Surgical attack should envisage thorough removal of all tumor tissue through adequate exposure, careful wound closure without packing or drainage, and primary wound healing.

8. Protection during the regenerative phase is essential, regardless of the treatment employed, for a pathological fracture usually spells functional impairment and a painful neighboring joint.


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