Results of giant cell tumor of bone treated with intralesional excision.

Treatment of giant cell tumor of bone ranges from intralesional curettage to en bloc resection. We think that intralesional treatment can be done with low recurrence and complication rates and that these patients have good functional results. The results for 40 patients treated by one surgeon with one technique for giant cell tumor of bone between 1985-1999 were reviewed. All patients were treated with intralesional excision of the tumor with adjunctive cautery, phenol, and methylmethacrylate. All patients had been followed up for a minimum of 2 years with the mean followup of 76 months (range, 26-178 months). In addition, recent functional evaluations were done on 23 patients at a mean followup of 90 months (range, 28-175 months). The local recurrence rate was 12.5%. The nononcologic complication rate was 7.5%. Using the Musculoskeletal Tumor Society functional evaluation, 93% of the patients had excellent results. This long-term followup study on patients treated with intralesional excision and methacrylate showed a low recurrence rate similar to those cited in the literature. Additionally, the complication rate was low and the function results were excellent.

Blastomycosis of long bones.

The presentation of blastomycosis clinically and radiographically is nonspecific and often mistaken for a neoplasm. Delay in diagnosis is common. Patients with osseous blastomycosis present with pain and swelling. Radiographs usually show an eccentric lucency in the distal ends of long bones. These patients frequently are referred for a neoplastic workup and a diagnosis is made only after biopsy. We review the cases of five patients diagnosed with a bone tumor who had blastomycosis osteomyelitis. The time to diagnosis from original symptoms was 4.7 months (range, 3-8 months). The average age of the patients was 45.6 years (range, 20-59 years). A Musculoskeletal Tumor Society functional assessment was done. Early radiographs of the current patients ranged from normal to showing faint osteopenia in the involved location. As the disease progressed, the area of lucency appeared with either diffuse or well-marginated borders. Treatment included surgical debridement with antifungals. The mean functional score was 93.3%. All patients are disease-free. Blastomycosis, similar to tuberculosis, often is mistaken for a neoplasm. Blastomycosis osteomyelitis can be treated with excellent results. The key is diagnosis and including endemic fungal infections in the differential diagnosis of bone tumors. In addition, every potential neoplasm should include cultures of specimens obtained at biopsy.