This study of 195 patients with giant‐cell tumor reemphasizes the female predominance, the predilection for the region of the knee, and the extreme rarity of the tumor in patients with immature skeletons. One of the tumors occurred in a patient with Paget's disease of bone. There were 2 patients with 2 giant‐cell tumors each. Surgical treatment short of complete resection or amputation was followed by recurrence of benign giant‐cell tumor in 44.6% of cases. Adjunctive radiation or cautery did not decrease this rate. Primary en bloc resection or amputation was uniformly curative. Primary radiation therapy had very limited value. Sarcomas developed in 17 patients (8.7%) of the total; these lesions we have called malignant giant‐cell tumors. In 4 instances, zones of anaplastic sarcoma were found in otherwise typical giant‐cell tumors. The remaining 13 sarcomas were found in recurrent tumors, and in 11 of these, the primary treatment had included radiation. The evidence indicates that surgical removal is the best treatment and that radiation should be employed only for tumors that are unresectable because of their location.

No abstract

After nodal metastasis from malignant melanoma, approximately 80% of patients die from disseminated disease. To clarify the role of radiation therapy (XRT) following node dissection. 56 patients with biopsy-proven nodal metastasis participated in a randomized, prospective clinical trial which compares radiation therapy to the regional lymph node area following lymphadenectomy (27 patients) with lymphadenectomy alone (29 patients). Interesting differences in the survival curves (p = 0.09) and in the disease-free interval curves (p = 0.08) for the two treatment groups proved to be attributable to imbalances in the age and nodal distributions in the treatment groups. Covariate analysis identified age and sex as the factors having the most significant (p less than 0.04) effect on survival and identified the number of positive nodes as the covariate having the most significant (p less than 0.02) effect on disease-free interval. Treatment did not have a significant effect upon survival or disease-free interval.

No abstract

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.