Introduction

• Tumor  abnormal growth of cells that results enlarged in

size but remain immature cell.
• Bone tumors : Benign  65,8%
Malignant  34,2 %
• Most common :
– Benign : osteoma (9,3 %), osteochondroma (32,5 %),
chondroma (9,8 %)
– Malignant : Osteosarcoma (48,8 %), GCT (17,5 %),
chondrosarcoma (10 %)

5-Minute Orthopaedic Consult, 2nd Edition

Textbook Review of Orthopaedics MILLER 4th Ed.
Campanacci Grading System
Based on the radiographic appearance of the tumors

Grade 1 latent well-defined margin and

an intact cortex

Grade 2 active relatively well-defined

margin but no
radiopaque rim, and the
cortex is thinned and
moderately expanded.

Grade 3 aggressive indistinct borders and

cortical destruction

Textbook Apley’s System of Orthopedic And Fracture

Enneking System for the Surgical Staging of
Benign Tumors

Stage Manifestation

Stage 1 Inactive / latent

Stage 2 Active
Stage 3 Aggressive
Enneking System for the Surgical Staging of
Malignant Tumors
Stage Grade Site Metastasis

IA G1 T1 M0

IB G1 T2 M0

IIA G2 T1 M0

IIB G2 T2 M0

III G1 or G2 T1 or T2 M1

Textbook Apley’s System of Orthopedic And Fracture

• Grade
G0 - Benign lesion
G1 - Low-grade malignant lesion
G2 - High-grade malignant lesion
• Site
T0 - A benign tumor that is confined within a true capsule and the
lesion's anatomic compartment of origin (ie, a benign
intracapsular, intracompartmental lesion)
T1 - An aggressive benign or malignant tumor that is still confined
within its anatomic compartment (ie, an intracompartmental
lesion)
T2 - A lesion that has spread beyond its anatomic compartment of
origin (ie, an extracompartmental lesion)
• Metastasis
M0 - No regional or distant metastasis
M1 - Regional or distant metastasis
 Giant Cell Tumor - Definition

• A benign but aggressive neoplasm,

characterized by large numbers of uniformly
distributed, osteoclast like giant cells and a
background population of epithelioid-to-
spindle mononuclear cells
• Also known as osteoclastoma .
• Majority located at end of a tubular bone;
~50% occur in the knee.
5-Minute Orthopaedic Consult, 2nd Edition 2007 p 157
Intraoperative photograph of giant cell tumor in the distal femur.

http://emedicine.medscape.com/article/1255364
 Epidemiology

• 5-10% bone tumors

• 20% benign bone tumors
• Female-to-male ratio of 1.5:1
• Commonly the age 20-40 years old ;
• 84% occurred in patients older than 19 years.

http://emedicine.medscape.com/article/1255364
Epidemiology

http://emedicine.medscape.com/article/1255364
 Frequently involved sites

• Ends of long bones

• >50% about knee

– Distal femur
– Proximal tibia
– Distal radius
– Proximal humerus

7
Textbook Review of Orthopaedics MILLER 4th Ed.
 Clinical features
• Signs and Symptoms
 Pain
Swelling
Lump/mass
Pathologic fracture.

• Physical Exam
Tendernessepiphyseal end of a bone adjacent to a
joint is noted.
restriction of joint motion

5-Minute Orthopaedic Consult, 2nd Edition 2007 p 157

 X-ray Imaging Studies
• Lytic/lucent lesions
• Epipyseal
• Eccentric or central
• Cortical thinning
• ‘Soap bubble' appearance.

Textbook Review of Orthopaedics MILLER 4th Ed.

 Other Modalities
• CT
– Integrity cortical rim
• MRI
– Assess subchondral breakthrough
• Bone Scan
– Suspect multicentri loci
Histopathology

• Multinucleated
giant cells
• Mononuclear
stroma
– Round / ovoid /
spindle
• Indistinct cell
membrane
 Treatment
1. Well-confined, slow growing lesion with
benign histology can safely treated by
curretage.

2. Aggressive GCTs were treated with

amputation or with wide resection and
reconstruction.

Textbook Apley’s System of Orthopedic And Fracture

 Surgery

Textbook Apley’s System of Orthopedic And Fracture

 Complications
• A secondary malignant giant cell tumor results
when a sarcoma develops at the site of a
previously treated giant cell tumor.
• In the past:
– 10-15% of patients treated with radiotherapy
developed postirradiation sarcomas.
– In comparison, 5% of recurrent giant cell tumors
not subjected to irradiation developed
sarcomatous transformation.

Textbook Apley’s System of Orthopedic And Fracture

 Prognosis
• Recurrence may occur in 40-60% of giant cell
tumors treated by simple curettage alone.
• Most recurrences occur within 2 years, and
nearly all occur within 5 years.
• The recurrence rate with modern treatment
(exteriorization, curettage, and adjuvant
therapy) is 10-15%.

Textbook Apley’s System of Orthopedic And Fracture