Professional Documents
Culture Documents
TUMOUR
OSTEOCLASTOMA
GIANT CELL TUMOUR
SWELLING
-eccentric
Clinical features
JOINT SYMPTOMS
Weakness
limitation of motion
Pain when there is pathological fracture
Tenderness with EGG SHELL CRACKING
Due to jt invovement disuse atrophy ,jt
effusion,
RADIOLOGY
ECCENTERIC expansible
osteolytic lesion
Well demarcated or merges
with metaphysis
Trabeculae- SOAP BUBBLE
APPEARANCE
No periosteal new bone
formation
Pathological fracture
Subchondral bone
involvement
Closed physis will be seen
CAMPANACCI GRADING
According to Radiology
Stage I-Normal bony contour
Stage II- Expansile lytic lesion but no break in cortex
Stage III-Destructive radiolucent lesion, cortical break
and soft tissue involvement
BETTER PROGNOSIS-
Outer border-intact
Inner margin-sharp
AGGRESSIVE –
Cortical break
Soft tissue involvement
MRI AN CT
MULTINUCLEATED GIANT
CELLS
TYPICAL HISTOLOGY
Multinucleated
giant cells
Round
mononulear
cells
Spindle shaped
cells
SPINDLE
SHAPED
CELLS
ATYPICAL HISTOLOGY
Giant cells with
predominance of
spindle cells and this
can be mistaken for
FIBROSARCOMA
Tumour in blood
vessels
MONONUCLEAR CELLS
Phenotypically
resembles
connective tissue
stromal cells
Receptors for
parathyroid hormone
Produce collagen
Don’t express
macrophage surface
antigen
MULTINUCLEATED GIANT
CELLS
Multinucleated giant cells
(50-150nuclei,10-15
microns) are formed from
mononuclear cells
PREDOMINANT TYPE-
Large multinucleated cells
where individual nuclei are
identical to stromal cells
MINORTY-Small size, dark
pyknotic nuclei ,bright
eosinophilic cytoplasm
MULTINUCLEATED GIANT
CELLS
STROMAL CELLS DERIVED
FROM
TYPE I-Fibroblast or undifferentiated
bone marrow mesenchymal cells
TYPE II-monocyte –macrophage
osteoclast lineage
Rarely contain foci of reactive bone so
not to confuse with OSTEOSARCOMA
PATHOLOGY
Giant cells are not diagnostic
They are also seen in
ABC,UBC
Nonossifying fibroma
Chondroblastoma
Brown tumour
Fibrous dysplasia
Osteogenicsarcoma
These are variant of GCT
STAGE
EVING
STROMA
and JAFFE
GIANT CELLS
GRADING
I CONSPISIOUS PLENTY
Chen-chen 2005
-when residual
subchondral bone
after an extended
curretage is
<5mm then
multilayer
reconstruction
technique is
recommended
REINFORCEMENT PINS
Allograft is expensive
Pamidronate, zoledronate
It induces apoptosis in osteoclast like
giant cells
Help in limiting tumour progression
AMPUTATION
Malignant tumour
Fungation
Recurrence after surgery and irradiation
Deep seated associated infection
Extensive destruction of bone
Severe disability
RECCURENCE
PATHOLOGICAL
Benign malignant