Tehran University Medical Journal

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Background: In this study we evaluated the treatment of giant cell tumor (GCT) of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA) cementing.
Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years) 13 females and 7 males were included in the study. Cortical disruption were presented in 7 patients 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 ).
Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months.
Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

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Background: Juvenile xanthogranuloma is a benign, normolipemic, dendrocytic histiocytosis that usually affects young children. It presents clinically as single or multiple yellow-brown papulonodular lesions in the upper part of the body, especially the head and neck. In adults, xanthogranuloma is not common and usually presents as a single lesion. Multiple xanthogranuloma in adults is rare. For the most part, cutaneous lesions are self-limited and seldom necessitate treatment. Here we report an adult patient with multiple xanthogranuloma.

Case: A 45-year-old woman presented with multiple papulonodular lesions around the eyes and over her breasts and back. Biopsy showed giant cells with a wreath-like arrangement of nuclei (Touton giant cell) and diagnosis of juvenile xanthogranuloma was made.

Conclusion: Although juvenile xanthogranuloma is a disease of children, it can rarely occur in adults. These patients should be evaluated for involvement of other organs to prevent complications. With ocular involvement, the risk of morbidity is high, and complications can include glaucoma, retinal detachment, cataract, vascular occlusion, hyphema, and corneal blood staining.