Introduction: Giant cell tumor of bone (GCT), also known
as osteoclastoma, locally aggressive neoplasm that primarily
affects the epiphyseal (end) region of long bones.
5% of all primary tumour,
Uncertain origin,
Appear in mature bone.
Multiple lesion rare and rare before epiphyseal closure.
Classification- 1.Benign G.C.T. (aggressive Locally) ( Enneking staging )
2. Malignant G.C.T.
Common Site-
Distal femur,
Proximal humerus,
Proximal tibia,
Distal radius,
Other bone may be affected.
Clinical Feature-
Young adult,
Pain in end of long bone,
Slight swelling,
H/O-- trauma,
Pathological fracture (10%-15%),
Palpable mass ,
Warmth,
Tender,
Investigation- X-ray, CT, MRI, Biopsy (Histopathology), Laboratory findings.
X-RAY:
Radiolucent area, (Eccentric, epiphyseal, expensile).
Extened Up to subchondral bone(characterstic feature).
Soap bubble appearance in center , (ridging of surrounding bone).
Cortex thin and ballooning (expansile).
Soft tissue extension.
CT, MRI
Extent of tumour,
Breach of articular surface.
Laboratory findings- Exclude D.D (Brown T)
Blood calcium,
S. phosphate,
Alkaline phosphatase,
Parathhormone
Pathology
Macroscopy-
Radish
fleshy appearance,
Comes away in pieces when curettage,
Difficult to remove completely,
More extension in surrounding bone in aggressive lesion.
Microscopy-
Abundance of multinucleated giant cells(Stricking feature)
Scattered
on a
background of stromal
cell with little or no visible
intracellular tissue.
Cellular atypia and abnormal mitotic figure(Aggressive)
Treatment-
Well-confined, slow growing, benign histology—
Through curettage—
Stripping of cavity with burrs and gauges---
Swabbing with hydrogen peroxide
Or application of liquid nitrogen---
Cavity is dealt with bone chips.
Aggressive
lesion,
recurrent lesions—
excision followed by bone grafting or prosthetic replacement.
In awkward site–
Difficult in irradicate,
Curretege
Supplimentary radiotherapy.(Side effect more)
Malignant GCT—
X-ray Features like highly aggressive Benign lesion,
High risk of metastasis, (Lung)
Treatment-
Wide or radical resection
Adjuvant therapy-
Radiation Therapy-
Systemic Therapies -
Denosumab, a monoclonal antibody
(Chemotherapy is generally not a standard treatment for conventional giant cell tumors of
bone, including malignant GCTB)
Complication-
Recurrence (depending on location of the tumor, the success of the initial
treatment, and the completeness of surgical resection) 15%-45%.
Malignant Transformation -Less than 1-2% of all giant cell tumors.
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