BACKGROUND Giant cell tumour is a primary bone tumour. It is benign but locally aggressive neoplasm with a tendency for local recurrence. The aim of treatment is to remove the tumour completely and to preserve the joint. Local recurrence is a well-documented problem. Treatment of recurrent lesions is the same as for primary lesions. This study is aimed at analysing the treatment of the recurrent GCT and aggressive GCT with pathological fracture by adequate curettage using adjuvant like H2O2, liquid nitrogen followed by filling the curetted cavity with bone grafts, bone substitutes and bone cement, thereby preventing the recurrence and to provide structural stability in aggressive GCT with pathological fracture. MATERIALS AND METHODS This is a prospective study of management of 32 cases of Giant Cell Tumour during 2003 to 2007 in Government Kilpauk Medical College, Chennai. Out of the 32 cases, 17 cases were Aggressive GCT with pathological fracture and 15 cases were Recurrent GCT. RESULTS For recurrent GCT, removal of previously applied bone cement, extended curettage with adjuvant Hydrogen Peroxide and reconstruction with bone cement/bone graft/amputation were the treatment methods employed. For Aggressive GCT with pathological fracture, extended curettage with adjuvant H2O2/liquid nitrogen and reconstruction with fibular strut graft/cancellous bone graft, bone substitute and bone cement were the treatment methods employed. CONCLUSION GCT is a locally aggressive benign tumour occurring in young individuals with a normal life expectancy. If inadequately or inappropriately treated, it results in considerable morbidity and recurrence. Careful attention to soft tissue protection while using cryosurgery significantly decreased the previously published reports of high rates of infection and wound healing problem. Hydrogen peroxide is an ideal adjuvant, which gives a comparable rate of recurrence and least local or systemic complications. Free fibular strut graft along with PMMA incorporates in the bone early and the joints can be salvaged with useful function. En bloc resection must also be followed by adjuvant to prevent recurrence due to local tissue contamination.

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Neurofibromatoses Type 1(NF 1) is an autosomal dominant disease characterized by disordered growth of ectodermal tissues, and is part of a group of disorders called Phakomatoses (neurocutaneous syndrome). NF 1 (aka Von Recklinghausen's disease) patients develop both benign and malignant tumors at an increased frequency. Malignant peripheral nerve sheath tumours (MPNST) is a very rare tumor, with an incidence of 1 per 1,00,000 population. MPNSTs occur in about 2% to 5% of neurofibromatosis patients and constitutes between 3 to 10% of all soft tissue sarcomas. Most MPNSTs are considered as high-grade sarcomas originating from tissues of mesenchymal origin and are biologically aggressive tumours with notoriety for recurrence and metastases.In this paper, we present a case of a 64 yr old male, who was diagnosed with NF 1 at the age of 25 yrs. He presented with a local recurrence of MPNST in left thigh, He was previously operated for MPNST (Stage 1) at the same site with a tumor free margin, 3 yrs back. Thereafter patient was disease free but two and half yrs later developed a swelling at the same site. Diagnostic core needle biopsy demonstrated a high grade MPNST. Metastatic work up yielded intracranial and hepatic metastases.