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The case of a 28-year-old male patient with a locally aggressive lesion of the distal tibia is presented. Following the diagnosis of giant cell tumor of bone (GCT) on biopsy and curettage, a rapid malignant course was observed with recurrence 2.5 months later. Multiple metastases appeared 6 months after initial presentation. Following initial chemotherapy according to the COSS protocol and later with carboplatin and VP-16, therapy was changed to Adriamycin and later gemcitabine due to progressive disease. Good palliation was achieved, and the patient felt well with less shortness of breath on exertion and was ambulatory with walking aids. The malignant nature of the tumor was not detected in the initial pathologic examinations. Review of the pathologic material provided histologic clues permitting the diagnosis of a primary malignant GCT with a fibrohistiocytic/fibrosarcomatous component. Malignancy in a giant cell tumor is a much debated diagnostic dilemma when a frank sarcomatous component is lacking. Cytologic atypias and flame-like tufts of infiltration of soft tissue are important clues. Surgical treatment should be commensurate. Monotherapy with Adriamycin or gemcitabine can be considered in order to inhibit the disease progression.

Throughout history, certain religious images and symbols often have been uncritically used to legitimate the dominance of men over women. This uncritical use has had lasting effects upon our culture, and these images and symbols often continue to be used as rationale for subordinating women today. Since the nursing profession has been, and continues to be, a predominantly female occupation, nurses are especially impacted by this inherited imagery. In their role as primary health care givers, nurse practitioners often care for women who have been victimized by a pattern of male domination that culturally is bound up in and perpetuated by certain religious imagery. This article describes and analyzes the power of religious sex-role imagery to maintain the public and professional order of female subordination to the male. Practical ideas are suggested for the nursing profession that will help to reconstruct this imagery along more equitable and humane lines. Through such efforts, nurses can justly achieve more reciprocity and equality for themselves, and can take active steps to prevent the victimization of many of the women they care for.