"Giant cell reparative granuloma" was introduced into medical literature by Jaffe in 1953. Prior to that time most authors considered this lesion to be a variant of the benign giant cell tumor of the long bones, or a giant cell variant of osteitis fibrosa. Bernier and Cahn established the subdivision between the rare central giant cell reparative granuloma and the common peripheral epulis. In the past, considerable emphasis has been placed on the importance of differentiating the true giant cell tumor from the giant cell reparative granuloma of the jaw bones. Most authors now believe the true giant cell tumor does not appear in the jaw bones except in rare cases associated with Paget's disease of the skull. Developing from membranous, rather than cartilaginous, ossification might account for this. Both peripheral and central intraosseous lesions, parathyroid osteopathy and the pathologic tissue of cherubism show no appreciable histologic difference. These tumefactions are histologically a proliferative fibroblastic lesion with multinucleated giant cells. The histopathology of the giant cell tumor of the long bones is probably identical to the histopathology of the giant cell reparative granuloma of the jaw bones. The diagnosis of giant cell reparative granuloma must be made by physical examination, history, laboratory, X-ray parameters and clinical follow-up. Localized maxillary swelling is the most important clinical feature. The swelling is smooth and palpation can reveal a rubbery, elastic sensation where bone has been thinned. There are no specific radiographic signs. Conservative surgical management is indicated and adequate for giant cell reparative granulomas. Radiation is not indicated because of long term risks. Steroids have not been proven useful.
This study represents an analysis of 450 mediastinoscopies performed at the University of Minnesota Hospitals between July, 1964, and February, 1972.
The complication rate was 1.8 percent and there was no mortality.
The overall positive biopsy rate was 44.0 percent with 93 benign and 105 malignant diagnoses made by mediastinoscopy.
The yield of mediastinoscopy in bronchogenic carcinoma was significantly better than that of bronchoscopy, cytology and scalene node biopsy.
At 19 thoracotomies in patients with positive mediastinoscopy the lesions were found to be unresectable.
Contraindications to mediastinoscopy are few, the only absolute one being a previous mediastinoscopy. Mediastinoscopy is indicated in all cases of bronchogenic carcinoma to determine resectability. Mediastinoscopy is the procedure of choice for the diagnosis of sarcoidosis.
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