Giant-cell tumours, osteitis fibrosa, and bone cysts a study of their aetiological relation

Abstract

Summary May I now summarize my impressions gained from a survey of these fifty cases. Localized osteitis fibrosa is most commonly seen in its late stages when its pathological picture is obscured by secondary and complicated changes. The primary and essential pathological process, as in the generalized form, is one of increased osteoclastic activity and filling of the widening intertrabecular spaces by fibrovascular tissue. This process is invasive and for a time spreads in normally developed bone. I find it difficult to believe that this process arises in low-grade fibrous tissue resulting from dysfibroplasia at the epiphyseal plate. Dysfibroplastic foci might quite well be the origin of simple bone cyst. If dysfibroplastic tissue is extensive, secondary changes may supervene just as in the later stages of localized osteitis fibrosa, and the two lesions thus come to resemble each other. The ‘brown tumours” found in local and generalized ostcitis fibrosa, and most of the giant-cell epulides, are merely hyperplastic or granulomatous gian-cell tissue. Many of the giant-cell tumours of the jaws are primarily lesions of localized osteitis fibrosa in which hyperplastic giant-cell tissue has become the dominant feature. The solitary giant-cell tumour of the long and other bones, and some occurring in the jaws, are truly neoplastic, and their origin is just as mysterious as in any other type of tumour. May I add that I heartily agree with Professor McWhirter when he urges closer co-operation between clinician, radiologist, and pathologist for the proper assessment of these lesions. The organizers of the national scheme for radiotherapy were indeed wise to ensure an efficient follow-up service. This now only affords the radiotherapist a ready means of determining the result of treatment, but also provides the clinician, the radiodiagnostician, and the pathologist with the opportunity of reviewing the diagnosis in the light of the further history of the patient. Proper use of these facilities will, I am sure, in due course, throw much light on the problems under discussion.