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  • Giant Cell Tumor of Bone

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    Aurelia Tipka
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    Generally benign Potential for : Recurrence Pulmonary metastasis. 5-10% 10 bone tumors 20% benign bone tumors F : M 1. : 1 70-80% age 20-40 rare skeletally immature Epiphyseal Monostotic Incidence Ends of long bones >50% about knee high recurrence rate 1-2% benign pulm. Mets 10 malignant GCT 1% rare polyostotic form 1% Location Presentation Pain x w

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    Generally benign Potential for : Recurrence Pulmonary metastasis. 5-10% 10 bone tumors 20% benign bone tumors F : M 1. : 1 70-80% age 20-40 rare skeletally immature Epiphyseal Monostotic Incidence Ends of long bones >50% about knee high recurrence rate 1-2% benign pulm. Mets 10 malignant GCT 1% rare polyostotic form 1% Location Presentation Pain x w

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    55 views40 pages

    Giant Cell Tumor of Bone

    Uploaded by

    Aurelia Tipka
    Generally benign Potential for : Recurrence Pulmonary metastasis. 5-10% 10 bone tumors 20% benign bone tumors F : M 1. : 1 70-80% age 20-40 rare skeletally immature Epiphyseal Monostotic Incidence Ends of long bones >50% about knee high recurrence rate 1-2% benign pulm. Mets 10 malignant GCT 1% rare polyostotic form 1% Location Presentation Pain x w

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 40

    Giant Cell Tumor of Bone

    Overview
    Definition Epidemiology Hx Presentation/Exam Radiology Dx Tx Outcomes

    Definition
    10 bone neoplasm First described Cooper 1818 Lebert microscopic description 1845 Generally benign Potential for :
    Recurrence Pulmonary metastasis Frank malignancy

    Epidemiology
    5-10% 10 bone tumors 20% benign bone tumors F : M 1.5 : 1 70-80% age 20-40 Rare skeletally immature Epiphyseal Monostotic

    Incidence
    Ends of long bones >50% about knee High recurrence rate 1-2% benign pulm. Mets 10 malignant GCT <1% Rare polyostotic form <1%

    Location

    Presentation
    Pain x wks. mos. Swelling Mass Pathologic # Neuro deficit (spine / sacrum) incidental

    Radiology
    Lytic lesion Epipyseal Eccentric or central Narrow zone transition Cortical thinning expansile No sclerotic margin

    Imaging
    Occ. Cortical breakthrough

    +/- soft tissue mass

    Extend to subarticular cortex Typically no host response Often large @ presentation

    Other modalities
    CT

    Integrity cortical rim Assess subchondral breakthrough

    MRI

    Bone Scan
    Suspect multicentri loci ie. HAND

    DDx
    Consider: Age & Location
    Fibrogenic/Telangiectatic Osteosarcoma MFH Brown tumor Chondroblastoma ABC Chondromyxoid fibroma (rare) Mets / Myeloma

    Histology
    Fibrohistiocytic origin Multinucleated giant cells Mononuclear stroma

    Round / ovoid / spindle

    Indistinct cell membrane Mitoses Giant cells 20 fusion stromal cells

    Gross

    Enneking Staging
    Stage 1 Pt % Symptoms 10-15% asymp Stage 2 ~70% pain Stage 3 10-15% pain cortical perforation benign

    Radiograph sclerotic rim expanded cortex Histology benign benign

    Biopsy
    Necessary for Dx Tumor principles Histologic grade not helpful R/O 10 malignant GCT Occ assoc.
    ABC Pagets

    Curettings

    Tx
    Controversial Traditionally:
    Intralesional curettage / resection & bone graft Recurrence 35-42%

    En Bloc resection
    Recurrence ~10% Multiple complications

    Adjuvant

    Curettage
    Wide decortication (windowing) Curettage / high speed burr Aggressive Choice of adjuvant

    Adjuvant Tx
    Radiation - ~10% sarcomatous degeneration PMMA, Liquid N2, Phenol, CO2 laser, Electrocautery
    Local extension of margin Kill residual foci

    PMMA
    Fill tumor cavity Heat kill of tumor cells? Effect size dependent 8-26% recurrence Easy recurrence detection Degenerative changes

    Recurrence

    Subchondral bone grafting

    Cryotherapy
    3 freeze thaw cycles Irrigate cartilage with cool saline Circumferential necrosis difficult Complications
    Soft tissue injury Late fractures

    Cryotherapy

    Phenol
    Wash cavity Alcohol rinse 10-20% recurrence

    Enbloc Resection
    Expendable bones

    Prox fibula / Distal ulna Hand / Distal radius

    High recurrence with other Tx

    Recurrence Pathologic # Joint involvement Osteochondral allograft reconstruction

    Reconstruction

    Spine
    < 3% vertebrae above sacrum All levels affected equally Affects vertebral body c ext. pedicle Resection with stabilization Often incomplete ?radiation as adjuvant (low dose 3000 Gyc)
    Incomplete excision Local recurrence

    Sacrum / Pelvis
    Intalesional excision Adjuvant +/- radiation

    Pelvis
    GCT often vascular
    Pre-op angiography ? embolization

    Angiography

    Outcome

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