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“Benign” metastasis in giant cell tumor of bone
MEDICAL INTELLIGENCE proven to be effective in reversing iron induced cardiomyopathy, may be a reasonable alternative mode of therapy when phlebotomy is contraindicated. In summary, postshunt hemochromatosis, although infrequently recognized, may be a potentially treatable cause of cardiac or hepatic decompensation in the cirrhotic patient. References 1. Conn, H. 0.: Portacaval anastomosis and hepatic hemosiderin deposition: a prospective, controlled investigation. Gastroenterology, 62:61-72,1972. 2. Schreiber, A. W.: Hemochromatosis and the heart. Ann. Intern. Med., 47:1015-1021,1957. 3. Milder, M. S., et a!.: Idiopathic hemochromatosis, an interim report. Medicine (Baltimore), 59:34-49, 1980.
4. Skinner, C., and Kenmure, A. C. F.: Haemochromatosis presenting as congestive cardiomyopathy and responding to venesection. Brit. Heart].. 3,,:466-468, 1973. 5. Easley, R. M., Schreiner, B. F., and Yu. P. N.: Reversible cardiomyopathy associated with hemochromatosis. N. Engl. J. ivied., 287:866-867, 1972. 6. Buja, L. M., and Roberts, W. C.: Iron in the heart. Am . .J. Med., 51:209-221,1971. 7. Roff, R. S., Go, T. B.. and Oliai, A.: Hepatic hemosiderosis after portacaval shunt surgery in alcoholic cirrhosis: a sometime thing. Gastroenterology, 63 :834-836, 1972. 8. Jefferys, D. B.. et al.: Subcutaneous desferrioxamine infusion for haemochrornatosis. Lancet, 2: 1364- 1365, 1979. Department of Pathology Veterans Administration Hospital Palo Alto, California 94304 (Dr. Strauchen)
Correspondence
"BENIGN" METASTASIS IN GIANT CELL TUMOR OF BONE To
THE EDITOR:
In his case report of a giant cell tumor of bone (Caballes RL: The mechanism of metastasis in the so-called benign giant cell tumor of bone. Hum Pathol 12:762, 1981), Dr. Caballes postulates a possible pathogenesis of "benign" metastasis in this lesion. In order to give this difficult problem a more balanced view I am submitting the following observations: 1. Only about 1 to 2 per cent of all "benign" giant cell tumors will ever show lung "metastases," and this phenomenon is not predictable by histologic examination. To label all giant cell tumors malignant from their very onset, as the author proposes, with a complete disregard for the histologic appearance is a serious disservice to the patient. 2. About one third of all conventional giant cell tumors of bone will have giant cells in intralesional blood vessels, but this occurrence will in no way affect prognosis, either distant spread or increased local recurrence rate.1,2,3 3. The most plausible explanation for a "benign" metastasis in a giant cell tumor of bone is the previous surgical intervention, like curettage, which dislodges small fragments of tumor which may eventually get deposited in the pulmonary parenchyma. With rare exception the history of a previous surgical manipulation is obtained in every "metastatic" pulmonary lesion. The metastases probably represent iatrogenic transport phenomena, and, accordingly, the lung lesions behave in a benign, non aggressive fashion. 4. By the way, other benign tumors of bone, like chondroblastorna, may exhibit such metastases once in a while." 5. The high recurrence rate in a conventional giant cell tumor can be best explained by the apparent inability of the orthopedic surgeons to remove the tumor adequately in the first place. Cryosurgery may prove to be an excellent method to control this tumor." ANDREW G. Huvos, M.D. Attending Pathologist Memorial Hospital for Cancer and Allied Diseases New York City
1. Sladden, R. A.: Intravascular osteoclasts, J. Bone Joint Surg., 39:346, 1957. 2. Hutter, R. V. P., Worcester, J. N., Francis, K. C., et al.: Benign and malignant giant cell tumors of bone. A clinicopathological analysis of the natural history of the disease. Cancer, 15 :653, 1962. 3. Pan, P., Dahlin, D. C" Lipscomb, P, R., et al.: "Benign" gialll cell urmor of the radius with pulmonary metastasis. Mayo Clin. Proc, 39:344, 1952. 4. Huvos, A. G., Higinbotham, N. L., and Marcove, R. C., et al.: Aggressive chondroblastoma. Review of the literature on aggressive behavior and metastases with a report of one new case. Clin. Orthoped., 126:266, 1977. 5. Marcove, R. C., Weiss, L. D., VaghaiwaUa, M., et al: Cryosurgery in the treatment of giant cell tumors of bone, A report of 52 consecutive cases. Cancer, 41:957, 1978.
BOOKS RECEIVED Books for review or listing can be sent to the Editor, Human Pathology, W. B. Saunders Company, West Washington Square, Philadelphia, Pennsylvania 19105. Acknowledgment in this listing of books received must be regarded as sufficient return for the courtesy of the sender. Books of particular interest to our readers will be reviewed as space permits. F. Berti and G. P. Velo (Editors): The Prostaglandin SystemEndoperoxides, Prostacyclin, and Thromboxanes. New York, Plenum Medical Book Company, 1981. 114 illustrations, 427 pages, $49.50. George J. Brewer (Editor): The Red Cell. Fifth Ann Arbor Conference. New York, Alan R. Liss, Inc., 1981. 199 illustrations, 840 pages. $78.00 Jean de Brux, Rodrigue Mortel, and Jean Pierre Gautray (Editors): The Endometrium: Hormonal Impacts. New York, Plenum Medical Book Company, 1981. 51 illustrations, 167 pages. $29.50. Ronald A. DeLellis (Editor): Diagnostic Immunohistochemistry. New York, Masson Publishing USA, Inc., 1981. 200 illustrations, 347 pages. $59.50. Douglas W. Huestis, Joseph R. Bove, and Shirley Busch: Practical Blood Transfusion. Ed. 3. Boston, Little, Brown and Com pany, 198 I. 62 illustrations, 489 pages. $25.00 Meir H. Kryger (Editor): Pathophysiology of Respiration, New York, John Wiley & Sons, Inc., 1981, 146 illustrations 352 pages. $17.50.
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4. Skinner, C., and Kenmure, A. C. F.: Haemochromatosis presenting as congestive cardiomyopathy and responding to venesection. Brit. Heart].. 3,,:466-468, 1973. 5. Easley, R. M., Schreiner, B. F., and Yu. P. N.: Reversible cardiomyopathy associated with hemochromatosis. N. Engl. J. ivied., 287:866-867, 1972. 6. Buja, L. M., and Roberts, W. C.: Iron in the heart. Am . .J. Med., 51:209-221,1971. 7. Roff, R. S., Go, T. B.. and Oliai, A.: Hepatic hemosiderosis after portacaval shunt surgery in alcoholic cirrhosis: a sometime thing. Gastroenterology, 63 :834-836, 1972. 8. Jefferys, D. B.. et al.: Subcutaneous desferrioxamine infusion for haemochrornatosis. Lancet, 2: 1364- 1365, 1979. Department of Pathology Veterans Administration Hospital Palo Alto, California 94304 (Dr. Strauchen)
Correspondence
"BENIGN" METASTASIS IN GIANT CELL TUMOR OF BONE To
THE EDITOR:
In his case report of a giant cell tumor of bone (Caballes RL: The mechanism of metastasis in the so-called benign giant cell tumor of bone. Hum Pathol 12:762, 1981), Dr. Caballes postulates a possible pathogenesis of "benign" metastasis in this lesion. In order to give this difficult problem a more balanced view I am submitting the following observations: 1. Only about 1 to 2 per cent of all "benign" giant cell tumors will ever show lung "metastases," and this phenomenon is not predictable by histologic examination. To label all giant cell tumors malignant from their very onset, as the author proposes, with a complete disregard for the histologic appearance is a serious disservice to the patient. 2. About one third of all conventional giant cell tumors of bone will have giant cells in intralesional blood vessels, but this occurrence will in no way affect prognosis, either distant spread or increased local recurrence rate.1,2,3 3. The most plausible explanation for a "benign" metastasis in a giant cell tumor of bone is the previous surgical intervention, like curettage, which dislodges small fragments of tumor which may eventually get deposited in the pulmonary parenchyma. With rare exception the history of a previous surgical manipulation is obtained in every "metastatic" pulmonary lesion. The metastases probably represent iatrogenic transport phenomena, and, accordingly, the lung lesions behave in a benign, non aggressive fashion. 4. By the way, other benign tumors of bone, like chondroblastorna, may exhibit such metastases once in a while." 5. The high recurrence rate in a conventional giant cell tumor can be best explained by the apparent inability of the orthopedic surgeons to remove the tumor adequately in the first place. Cryosurgery may prove to be an excellent method to control this tumor." ANDREW G. Huvos, M.D. Attending Pathologist Memorial Hospital for Cancer and Allied Diseases New York City
1. Sladden, R. A.: Intravascular osteoclasts, J. Bone Joint Surg., 39:346, 1957. 2. Hutter, R. V. P., Worcester, J. N., Francis, K. C., et al.: Benign and malignant giant cell tumors of bone. A clinicopathological analysis of the natural history of the disease. Cancer, 15 :653, 1962. 3. Pan, P., Dahlin, D. C" Lipscomb, P, R., et al.: "Benign" gialll cell urmor of the radius with pulmonary metastasis. Mayo Clin. Proc, 39:344, 1952. 4. Huvos, A. G., Higinbotham, N. L., and Marcove, R. C., et al.: Aggressive chondroblastoma. Review of the literature on aggressive behavior and metastases with a report of one new case. Clin. Orthoped., 126:266, 1977. 5. Marcove, R. C., Weiss, L. D., VaghaiwaUa, M., et al: Cryosurgery in the treatment of giant cell tumors of bone, A report of 52 consecutive cases. Cancer, 41:957, 1978.
BOOKS RECEIVED Books for review or listing can be sent to the Editor, Human Pathology, W. B. Saunders Company, West Washington Square, Philadelphia, Pennsylvania 19105. Acknowledgment in this listing of books received must be regarded as sufficient return for the courtesy of the sender. Books of particular interest to our readers will be reviewed as space permits. F. Berti and G. P. Velo (Editors): The Prostaglandin SystemEndoperoxides, Prostacyclin, and Thromboxanes. New York, Plenum Medical Book Company, 1981. 114 illustrations, 427 pages, $49.50. George J. Brewer (Editor): The Red Cell. Fifth Ann Arbor Conference. New York, Alan R. Liss, Inc., 1981. 199 illustrations, 840 pages. $78.00 Jean de Brux, Rodrigue Mortel, and Jean Pierre Gautray (Editors): The Endometrium: Hormonal Impacts. New York, Plenum Medical Book Company, 1981. 51 illustrations, 167 pages. $29.50. Ronald A. DeLellis (Editor): Diagnostic Immunohistochemistry. New York, Masson Publishing USA, Inc., 1981. 200 illustrations, 347 pages. $59.50. Douglas W. Huestis, Joseph R. Bove, and Shirley Busch: Practical Blood Transfusion. Ed. 3. Boston, Little, Brown and Com pany, 198 I. 62 illustrations, 489 pages. $25.00 Meir H. Kryger (Editor): Pathophysiology of Respiration, New York, John Wiley & Sons, Inc., 1981, 146 illustrations 352 pages. $17.50.
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