Benign Tumors: Giant Cell Tumors

Rebecca Ann Jones Clinical Presentation Fall 12

Giant Cell Tumors

Found in adults ranging from 20-55 years old. Rare if found in children or 65 + They are rare and occur in 1 out of million people per year. Usually located in the epiphyses of boney joints.

Giant Cell Tumors

Named for how they looked under the microscope.

Giant Cell Tumors

These tumors even though they are benign are the hardest to treat because of the amount of bone damage that is caused. 45% recurrence of tumor

Characteristics
Pain in the area of the tumor (may not have any pain in the beginning)

Swelling in and around the tumor site

Local skin temperature is increased

ROM affected depending on the progression of the tumor

Diagnosis

X- ray Biopsy

Bone scan

Etiology
There is no known etiology of Giant Cell Tumors They has been a link to epidermal growth signal receptors.

EGFR
In a research study, it was related to stromal cell proliferation without osteoblastic differen- tiation (Balla, 2001). 276 patients in case study

Treatments
Surgeries and they may be used in combination of each other or by itself
Curettage Cryotherapy Bone Grafting/ Cement Packing Bone resection

Curettage
Scoop, lope, or ring method

Cryotherapy
This is done usually secondary to Curettage. After the tumor has been removed, they blow liquid nitrogen into the empty cavity and unfreeze it one to two times to make sure any left over tumor cells are prevented from growing.

Bone Grafting and Cement Packing

This will reduce the rate of a reoccurrence of the tumor growth.

Bone Resection
o Cut out segment of bone o Replace with cadaver bone

Sacral Reconstruction

HPI
21 yrs. Male Pain in his right femur near the hip socket
Onset was 2 yrs ago, upper right femur, intermittent, sharp pain, worsens with activity and is better when immobile, treatment is currently just observation and the pain is a 5/10.

Scar 10 cm in length that has hypertrophied 0.5 cm in height

PMH
Tumor was found when he fell playing sports and couldnt get back up.

X-ray showed that he had spiral fractured his entire right femur.
They noticed a mass about the size of a large grapefruit on the x-ray and proceeded immediately to a biopsy where it was determined to be benign tumor. Surgery was scheduled the next day in 2008. Curettage, cryotherapy, and cement packing were all performed. After surgery he was put in a double spica cast. The cast was removed 3 months later. Complained of slight hip pain prior to the fall.

FMH/SMH
The only incidence in the family is his mother. Whom has the tumors in both of her knees. She was diagnosis 2012 and she is 45yr.

No smoking or drinking Heterosexual, monogamous

Treatment
Currently the tumor is growing at a slower rate than before, but the doctors refuse to do surgery again until it starts to affect his everyday life or the tumor drains his leg of too much bone marrow again. They believe that puberty is a major effector of this giant cell tumor growth, which is why studies are being conducted on EGFR.

ADL
He can do all daily living activities such as washing the car, doing the dishes, and ambulating with a steady gait. However, he cannot participate in any physical contact sports because his femur will not handle the stress of any impact. This even includes sports such as tennis and diving. Running is a little difficult because with each surgery he loose some length. His right leg is 1in shorter than the other. He wears a shoe lift to make it unnoticeable to others around him.

Nursing Interventions

Continued
Pain relief and comfort is the biggest intervention.
Its not easy to sleep, void, or move around in that cast plus the added pain of bone surgery is very intense. The teaching will not be fully absorbed if the patient is in severe pain.

Teaching is a huge nursing intervention.

You have to instruct the caregivers or patient on how to help the patient transport, ambulate, sleep, and use the bathroom while wearing double spica cast. Physical therapy will also help with some of this teaching.

Continued
Dietary needs.
After a bone break or fracture, the body will need more nutrients and calories to help with the ATP depleting healing process. High fiber diet because when in a double spica cast the last thing you want is watery stools leaking into the cast and staying there.

Bathing is vital.
Young men sweat allot and you do not extra bacteria growing inside that cast.

Medical Interventions
Routine physical examinations with radiographs of the tumor site.

Surgery if needed again.

Radiation (only if surgery is a unavailable option)

Questions???
Your patient is about to have curettage on his left radial epiphyses and is worried about loosing his arm. What is the most appropriate action for you as a RN? A: Tell your patient that they are not at TGH and that accidents dont happen at this hospital.

B: Let the operating room know that the patient is having some concerns about the surgery.
C: Let the patient know that life without an arm has several perks financially. Then wink at him. D: Make sure the correct arm has the marker lines drawn on correctly and point it out to the

Questions???
Why is pain relief and comfort a major concern for the nurse when is giving discharge instructions to this post op patient? A: The patient will sue if pain is not managed B: Pain relief is not a priority when giving discharge instructions C: It doesnt affect the situation, you are just going to tell the caregiver anyways. D: The patient will not be focused on the teaching if he is in a great deal of pain.

References:
Unal C, Eren GG, Isil E, Alponat A, Sarlak A. Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine. Indian J Plast Surg 2012;45:140-3. Balla P, Moskovszky L, Sapi Z, Forsyth R, Knowles H, Athanasou N A, Szendroi M, Kopper L, Rajnai H, Pinter F, Petak I, Benassi M S, Picci P, Conti A & Krenacs T (2011) Histopathology 59, 376389

Questions?