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Giant Cell Tumor

Definition. 10 bone neoplasmGenerally benignPotential for :RecurrencePulmonary metastasisFrank malignancy. Epidemiology. 5 to 9 percent of all primary bony tumors20% benign bone tumors 70-80% age 20-40F : M 1.5 : 1Rare skeletally immatureEpiphyseal metapysial Monostotic. Incidence.

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Giant Cell Tumor

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    1. Giant Cell Tumor Dr Neffati

    2. Definition 10 bone neoplasm Generally benign Potential for : Recurrence Pulmonary metastasis Frank malignancy

    3. Epidemiology 5 to 9 percent of all primary bony tumors 20% benign bone tumors 70-80% age 20-40 F : M 1.5 : 1 Rare skeletally immature Epiphyseal metapysial Monostotic only occur after the epiphyseal plates have closedonly occur after the epiphyseal plates have closed

    4. Incidence found in the long bones: distal femur, proximal tibia, and distal radius. >50% about knee. 10 malignant GCT <1% High recurrence rate 1-2% benign pulm. Mets Rare polyostotic form <1%

    5. Clinic presentaion slowly progressive pain,swelling with or without a mass. Symptoms arise when the lesion begins to destroy the cortex and irritate the periosteum or pathologic fracture. Incidental

    6. Radiology Finding eccentrically long axis of the bone radiolucent destruction of the medullary cavity and adjacent cortex Intact borders and a sharp inner margin may expand into the soft tissue Expansil

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

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

    11. Gross appearance homogeneous, with foci of hemorrhage or necrosis Firm

    13. Microscopically Fibrohistiocytic origin Multinucleated giant cells Mononuclear stroma Round / ovoid / spindle Indistinct cell membrane

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

    16. Treatment 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 Curettage:Wide decortication (windowing) Curettage / high speed burr Aggressive Choice of adjuvant

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

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

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

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

    21. Phenol Wash cavity Alcohol rinse 10-20% recurrence

    22. Enbloc Resection Expendable bones Prox fibula / Distal ulna High recurrence with other Tx Hand / Distal radius Recurrence Pathologic # Joint involvement Osteochondral allograft reconstruction

    23. Following surgery patients should be made aware of the ongoing risk of local recurrence regular basis for the first 2 years at least workup including CXR.

    24. Take home points Thanks

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