Giant cell tumor of bone

Giant cell tumor of bone
Giant cell tumor: Distal part of the femur (Image courtesy of RadsWiki)
ICD-10	C40, C41
ICD-O:	9250/1
DiseasesDB	9337
eMedicine	radio/307
MeSH	D018212

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Overview

Giant cell tumor of the bone (also called giant cell myeloma or osteoclastoma) is a relatively uncommon tumor. It is characterized by the presence of multinucleated giant cells (osteoclast-like cells). These tumors are generally benign. In most patients, the tumors are slow to develop, but may recur locally in as many as 50% of cases. Metastasis to the lungs may occur.

Epidemiology

Giant cell tumor of the bone accounts for 4-5% of primary bone tumors and 18.2% of benign bone tumors (Gamberi et al, 2003). Giant cell tumors are mostly benign, however 5-10% of patients may have a malignant tumor.

Clinical characteristics

Patients usually present with pain and limited range of motion caused by tumor's proximity to the joint space. There may be swelling as well, if the tumor has been growing for a long time. Some patients may be asymptomatic until they develop a pathologic fracture at the site of the tumor.

Imaging

On x-ray, giant cell tumors (GCTs) have a metaepiphyseal location and grow to the articular surface of the involved bone (Murphey et al, 2001). They are distinguishable from other bony tumors in that GCTs usually have a non-sclerotic and sharply defined border. Because giant cell tumors are known to metastasize, when the diagnosis of giant cell tumor is suspected, a chest x-ray or CT may be needed.

MRI can be used to assess intramedullary and soft tissue extension.

Diagnostic Findings

(Images courtesy of RadsWiki)

Patient #1

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  Giant cell tumor: Distal part of the femur
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  Giant cell tumor: Distal part of the femur

Patient #2

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  Giant cell tumor: Distal part of the femur
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  Giant cell tumor: Distal part of the femur

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  Giant cell tumor: Distal part of the femur
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  Giant cell tumor: Distal part of the femur

• 
  Giant cell tumor: Distal part of the femur
• 
  Giant cell tumor: Distal part of the femur

• 
  Giant cell tumor: Distal part of the femur
• 
  Giant cell tumor: Distal part of the femur
• 
  Giant cell tumor: Distal part of the femur

Treatment

Surgery is the treatment of choice if the tumor is determined to be resectable. Patients with tumors that are not amenable to surgery are treated with radiation therapy (Mendenhall et al, 2006). The situation is complicated in a patient with a pathological fracture. It may be best to immobilize the affected limb and wait for the fracture to heal before performing surgery.

Other bone tumors with giant cells

A number of tumors have giant cells, but are not true benign giant cell tumors. These include, aneurysmal bone cyst, chondroblastoma, simple bone cyst, osteoid osteoma, osteoblastoma, osteosarcoma, giant cell reparative granuloma, and brown tumor of hyperparathyroidism.

See also

• Large cell
• Aneurysmal bone cyst

References

• Gamberi G, Serra M, Ragazzini P, Magagnoli G, Pazzaglia L, Ponticelli F, Ferrari C, Zanasi M, Bertoni F, Picci P, Benassi M (2003). "Identification of markers of possible prognostic value in 57 giant cell tumors of bone". Oncol Rep. 10 (2): 351–6. PMID 12579271.CS1 maint: Multiple names: authors list (link)
• Mendenhall W, Zlotecki R, Scarborough M, Gibbs C, Mendenhall N (2006). "Giant cell tumor of bone". Am J Clin Oncol. 29 (1): 96–9. PMID 16462511.CS1 maint: Multiple names: authors list (link)
• Murphey M, Nomikos G, Flemming D, Gannon F, Temple H, Kransdorf M (2001). "From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation". Radiographics : a review publication of the Radiological Society of North America, Inc. 21 (5): 1283–309. PMID 11553835.CS1 maint: Multiple names: authors list (link)
• Springfield, D and Rosen, G. Bone Tumors, in Holland-Frei Cancer Medicine - 6th Ed., Ch. 124, Kufe, DW et al editors, BC Decker Inc, Hamilton, Ontario. 2003.

External links

• "Symposium on Giant Cell Tumor". Indian Journal of Orthopaedics. 41 (2). 2007.