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Among 56 cases of a giant cell tumor of bone (GCT) and 52 cases of chondrosarcoma (CSA) in our series, four patients were discovered to have a tumor in the pelvic bone that grew in size during pregnancy. These four rare cases are described here. They include three cases of a GCT in the sacrum and one case of a CSA in the innominate bone. The dextran-coated charcoal assay and immunohistochemical techniques demonstrated the independence of these tumors from hormonal regulation despite the growth stimulated during pregnancy. It was concluded that the delay in detection of these tumors in the pelvis was just related to the opportunity afforded for unexpected growth during pregnancy. Surgical management was difficult due to the delay in tumor detection. The initial complaints such as pain, discomfort, or numbness around the pelvis were misinterpreted as symptoms of pregnancy. It should be kept in mind that during pregnancy, any pain or numbness in the pelvic region could be the direct result of a tumor in the pelvic bone.

Cryotherapy is an increasingly popular mode of therapy adjunctive to surgical curettage in the treatment of certain skeletal neoplasms, such as giant cell tumors or chondrosarcomas. The magnetic resonance (MR) findings following cryotherapy have not been previously reported. We reviewed the MR findings in seven patients with skeletal neoplasms following curettage and cryotherapy. In six cases we found a zone of varying thickness extending beyond the surgical margins, corresponding to an area of cryoinjury to medullary bone. This zone displayed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, consistent with the presence of marrow edema. This zone of edema almost certainly reflects underlying thermal osteonecrosis. This zone may vary in size and intensity over time as the area of cryoinjury evolves or resolves. MR is currently the imaging procedure of choice for follow-up of most musculoskeletal neoplasms. Knowledge of the MR findings following cryotherapy should help prevent confusion during the interpretation of follow-up MR examinations.

An analysis of 26 patients with giant cell tumor of bone was carried out to determine the clinical and pathological factors affecting the prognosis of the tumor, with a follow-up program of more than 3 years. The physical characteristics of the pathological features were measured objectively using an image analyzer. A significant correlation between the therapeutic procedures and recurrence of the tumor was found, but no pathological variables were significantly correlated. Excision or resection en bloc should be performed for the initial treatment of the tumor. Local recurrence could not be predicted on the basis of histological grading. Stromal cell atypia was significantly correlated with metastasis, but multinucleated giant cells bore no correlation to either recurrence or metastasis. The use of a modified histological grading system based not on variations of the stroma and giant cells but only on the atypia of mononuclear stromal cells, either malignant or classical, is recommended for the clinical assessment of the tumor.

The ischium represents one of the rarest sites of giant cell tumor of bone. Two additional cases are presented here. The unusual site, aggressive appearance and occurrence in older individuals are suggestive of other primary and secondary malignancies. Characteristic features of giant cell tumor and current treatment options are reviewed.