Cryosurgery combined with routine "second look" biopsy has been previously reported in our initial series of 25 cases and has been demonstrated to be a promising modality in the treatment of giant cell tumors of bone. Further refinement of this surgical technique by more careful preliminary curettage has now significantly improved the rate of local tumor control and has markedly reduced the incidence of associated complications. While the problems of infection, fracture, delayed bone healing and local tumor recurrence have not been completely eliminated, our experience with 27 additional cases shows that it has been possible to develop a highly reliable procedure for the eradication of tumor while usually preserving joint motion and avoiding arthrodesis or amputation. The 1.9% malignancy rate is much lower than the previously reported papers by Hutter and Jaffe.

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Increased signal on T2-weighted magnetic resonance (MR) images has been demonstrated in skeletal muscle adjacent to neoplasms. Clinical significance of this sign was evaluated by reviewing MR images of 50 patients with musculoskeletal disorders. Increased signal in adjacent muscle was present in 22 patients, including 13 of 25 with primary or secondary malignancies of the musculoskeletal system. Biopsy specimens from the affected area in 11 of these 13 patients revealed edema (n = 8) more often than tumor invasion (n = 3). Nine of 25 patients with nonneoplastic processes had increased signal intensity in skeletal muscle because of infection, myositis, or hematoma. In patients who have not undergone previous surgery or radiation therapy and are without an inflammatory mass, increased signal intensity may be a useful indicator of malignancy.