Giant Cell Tumor of Bone

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Giant Cell Tumor of Bone
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Overview

• Definition
• Epidemiology
• Hx
• Presentation/Exam
• Radiology
• Dx
• Tx
• Outcomes

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Definition

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

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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

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Incidence

• Ends of long bones
• gt50 about knee
• High recurrence rate
• 1-2 benign pulm. Mets
• 10 malignant GCT lt1
• Rare polyostotic form lt1

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Location
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Presentation

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

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Radiology

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

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Imaging

• Occ. Cortical breakthrough
• /- soft tissue mass
• Extend to subarticular cortex
• Typically no host response
• Often large _at_ presentation

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Other modalities

• CT
• Integrity cortical rim
• MRI
• Assess subchondral breakthrough
• Bone Scan
• Suspect multicentri loci
• ie. HAND

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DDx

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

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Histology

• Fibrohistiocytic origin
• Multinucleated giant cells
• Mononuclear stroma
• Round / ovoid / spindle
• Indistinct cell membrane
• Mitoses
• Giant cells 20 fusion stromal cells

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Gross
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Enneking Staging
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Biopsy

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

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Curettings
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Tx

• Controversial
• Traditionally
• Intralesional curettage / resection bone graft
• Recurrence 35-42
• En Bloc resection
• Recurrence 10
• Multiple complications
• Adjuvant

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Curettage

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

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Adjuvant Tx

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

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PMMA

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

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Recurrence
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Subchondral bone grafting
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Cryotherapy

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

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Cryotherapy
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Phenol

• Wash cavity
• Alcohol rinse
• 10-20 recurrence

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Enbloc Resection

• Expendable bones
• Prox fibula / Distal ulna
• High recurrence with other Tx
• Hand / Distal radius
• Recurrence
• Pathologic
• Joint involvement
• Osteochondral allograft reconstruction

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Reconstruction
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Spine

• lt 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

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Sacrum / Pelvis

• Intalesional excision
• Adjuvant
• /- radiation

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Pelvis

• GCT often vascular
• Pre-op angiography
• ? embolization

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Angiography
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Outcome
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