eMedicine Specialties > Orthopedic Surgery > Neoplasms

Giant Cell Tumor: Multimedia

Author: Valerae O Lewis, MD, Associate Professor, Chief, Section of Orthopedic Oncology, MD Anderson Cancer Center
Coauthor(s): Terrance Peabody, MD, Professor, Department of Surgery, Chief, Section of Orthopedic Surgery and Rehabilitative Medicine, University of Chicago; A Kevin Raymond, MD, Associate Professor, Department of Pathology, Section Head of Orthopedic Pathology, University of Texas MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: Apr 2, 2009

Multimedia

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Media file 1: Approximately 50% of giant cell tumors are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius.

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Approximately 50% of giant cell tumors are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius.

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Media file 2: Distribution of giant cell tumors according to age and sex of the patient. Six patients had multicentric disease.

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Distribution of giant cell tumors according to age and sex of the patient. Six patients had multicentric disease.

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Media file 3: Giant cell tumor. Anteroposterior radiograph of the distal femur reveals an expansile lytic metaphyseal-epiphyseal lesion.

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Giant cell tumor. Anteroposterior radiograph of the distal femur reveals an expansile lytic metaphyseal-epiphyseal lesion.

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Media file 4: Giant cell tumor. Lateral radiograph of the same distal femur as in Image 2 in Multimedia reveals an expansile lytic metaphyseal-epiphyseal lesion.

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Giant cell tumor. Lateral radiograph of the same distal femur as in Image 2 in Multimedia reveals an expansile lytic metaphyseal-epiphyseal lesion.

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Media file 5: Giant cell tumor. Anteroposterior radiograph of the distal radius reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

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Giant cell tumor. Anteroposterior radiograph of the distal radius reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

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Media file 6: Giant cell tumor. Lateral radiograph of the same distal radius as in Image 4 in Multimedia reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

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Giant cell tumor. Lateral radiograph of the same distal radius as in Image 4 in Multimedia reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

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Media file 7: Giant cell tumor. Sagittal MRI of the same distal radius as in Images 4-5 reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.

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Giant cell tumor. Sagittal MRI of the same distal radius as in Images 4-5 reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.

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Media file 8: Giant cell tumor. Anteroposterior radiograph of the distal tibia demonstrates extension of the lesion to the articular surface.

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Giant cell tumor. Anteroposterior radiograph of the distal tibia demonstrates extension of the lesion to the articular surface.

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Media file 9: Giant cell tumor. Lateral radiograph of the same distal tibia as in Image 7 in Multimedia demonstrates extension of the lesion to the articular surface.

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Giant cell tumor. Lateral radiograph of the same distal tibia as in Image 7 in Multimedia demonstrates extension of the lesion to the articular surface.

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Media file 10: Giant cell tumor. Sagittal MRI of the same distal tibia as in Images 7-8 in Multimedia demonstrates extension of the lesion to the articular surface.

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Giant cell tumor. Sagittal MRI of the same distal tibia as in Images 7-8 in Multimedia demonstrates extension of the lesion to the articular surface.

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Media file 11: Anteroposterior radiograph of a wrist arthrodesis performed for a giant cell tumor. Soft tissue recurrence is present. Note the peripheral mineralization about the soft-tissue recurrence (arrow).

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Anteroposterior radiograph of a wrist arthrodesis performed for a giant cell tumor. Soft tissue recurrence is present. Note the peripheral mineralization about the soft-tissue recurrence (arrow).

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Media file 12: Sagittal T1-weighted MRI shows a giant cell tumor with low signal intensity.

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Sagittal T1-weighted MRI shows a giant cell tumor with low signal intensity.

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Media file 13: Sagittal T2-weighted MRI shows a giant cell tumor with intermediate-to-high signal intensity.

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Sagittal T2-weighted MRI shows a giant cell tumor with intermediate-to-high signal intensity.

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Media file 14: Giant cell tumor. CT scan of the distal femur reveals an absence of matrix within the lesion.

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Giant cell tumor. CT scan of the distal femur reveals an absence of matrix within the lesion.

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Media file 15: Intraoperative photograph of giant cell tumor in the distal femur.

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Intraoperative photograph of giant cell tumor in the distal femur.

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Media file 16: Gross specimen of the same giant cell tumor in the distal femur as in Image 14 in Multimedia displays the typical chocolate brown and spongy appearance.

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Gross specimen of the same giant cell tumor in the distal femur as in Image 14 in Multimedia displays the typical chocolate brown and spongy appearance.

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Media file 17: Bisected gross specimen of the giant cell tumor in Image 15 reveals blood-filled cystic areas and inner yellow and orange discoloration.

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Bisected gross specimen of the giant cell tumor in Image 15 reveals blood-filled cystic areas and inner yellow and orange discoloration.

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Media file 18: Gross specimen of a giant cell tumor that fills the entire distal radius. Despite cortical disruption, the periosteum remains intact (arrow). Once again, note the blood-filled cystic areas and areas of orange discoloration.

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Gross specimen of a giant cell tumor that fills the entire distal radius. Despite cortical disruption, the periosteum remains intact (arrow). Once again, note the blood-filled cystic areas and areas of orange discoloration.

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Media file 19: Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

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Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

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Media file 20: Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

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Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

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Media file 21: Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

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Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

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Media file 22: Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

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Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

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Media file 23: Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Media file 24: Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Media file 25: Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

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Media file 26: Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

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Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

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Media file 27: Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

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Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

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Media file 28: Photomicrograph of a giant cell tumor with intravascular invasion of the multinucleated giant cells.

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Photomicrograph of a giant cell tumor with intravascular invasion of the multinucleated giant cells.

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Media file 29: Anteroposterior radiograph of a giant cell tumor of the distal radius.

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Anteroposterior radiograph of a giant cell tumor of the distal radius.

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Media file 30: Intraoperative photograph of the resection bed of the same giant cell tumor of the distal radius as in Image 28 after the distal radius is resected.

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Intraoperative photograph of the resection bed of the same giant cell tumor of the distal radius as in Image 28 after the distal radius is resected.

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Media file 31: Intraoperative photograph of the same giant cell tumor of the distal radius as in Images 28-29 shows the wrist arthrodesis with fibular autograft and 16-hole low-contact dynamic compression (LCDC) plate.

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Intraoperative photograph of the same giant cell tumor of the distal radius as in Images 28-29 shows the wrist arthrodesis with fibular autograft and 16-hole low-contact dynamic compression (LCDC) plate.

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Media file 32: Postoperative lateral radiograph of the same giant cell tumor of the distal radius as in Image 30.

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Postoperative lateral radiograph of the same giant cell tumor of the distal radius as in Image 30.

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Media file 33: Giant cell tumor. Intraoperative photograph of the distal tibia reveals the curetted and burred cavity.

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Giant cell tumor. Intraoperative photograph of the distal tibia reveals the curetted and burred cavity.

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Media file 34: Giant cell tumor. Intraoperative photograph of the same distal tibia as in Image 32 reveals polymethylmethacrylate packed into the distal tibial cavity.

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Giant cell tumor. Intraoperative photograph of the same distal tibia as in Image 32 reveals polymethylmethacrylate packed into the distal tibial cavity.

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Media file 35: Giant cell tumor. Anteroposterior radiograph of the distal tibia with polymethylmethacrylate packed in the distal femur after curettage of the lesion.

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Giant cell tumor. Anteroposterior radiograph of the distal tibia with polymethylmethacrylate packed in the distal femur after curettage of the lesion.

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Media file 36: Giant cell tumor. Illustration of the large cavity necessary for sufficient curettage.

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Giant cell tumor. Illustration of the large cavity necessary for sufficient curettage.

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Media file 37: Giant cell tumor. Illustration of the direct pour technique.

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Giant cell tumor. Illustration of the direct pour technique.

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Media file 38: Intraoperative photograph of the distal femur with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

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Intraoperative photograph of the distal femur with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

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Media file 39: Lateral radiograph of the same distal femur as in Image 37 with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

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Lateral radiograph of the same distal femur as in Image 37 with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

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Media file 40: Intraoperative photograph of the distal femur after removal of a giant cell tumor. The cavity has been curetted and treated with a high-speed burr.

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Intraoperative photograph of the distal femur after removal of a giant cell tumor. The cavity has been curetted and treated with a high-speed burr.

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Media file 41: Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 39 obtained while the cavity is undergoing argon laser.

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Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 39 obtained while the cavity is undergoing argon laser.

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Media file 42: Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 40 after argon laser treatment is complete.

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Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 40 after argon laser treatment is complete.

More on Giant Cell Tumor

Overview: Giant Cell Tumor

Workup: Giant Cell Tumor

Treatment: Giant Cell Tumor

Follow-up: Giant Cell Tumor

Multimedia: Giant Cell Tumor

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Keywords

giant cell tumor, GCT, bone tumor, benign bone tumor, giant cell tumor of bone, osteoclastoma, bone grafting, intralesional curettage

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Contributor Information and Disclosures

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Valerae O Lewis, MD, Associate Professor, Chief, Section of Orthopedic Oncology, MD Anderson Cancer Center
Valerae O Lewis, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

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Terrance Peabody, MD, Professor, Department of Surgery, Chief, Section of Orthopedic Surgery and Rehabilitative Medicine, University of Chicago
Terrance Peabody, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

A Kevin Raymond, MD, Associate Professor, Department of Pathology, Section Head of Orthopedic Pathology, University of Texas MD Anderson Cancer Center
Disclosure: Eli Lilly Consulting fee I am a member of an a advisory board.; Novartis Honoraria Speaking and teaching

Medical Editor

Lynn A Crosby, MD, FACS, Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine
Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society
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Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
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Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
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eMedicine Specialties > Orthopedic Surgery > Neoplasms

Giant Cell Tumor: Multimedia

Multimedia

Approximately 50% of giant cell tumors are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius.

Distribution of giant cell tumors according to age and sex of the patient. Six patients had multicentric disease.

Giant cell tumor. Anteroposterior radiograph of the distal femur reveals an expansile lytic metaphyseal-epiphyseal lesion.

Giant cell tumor. Lateral radiograph of the same distal femur as in Image 2 in Multimedia reveals an expansile lytic metaphyseal-epiphyseal lesion.

Giant cell tumor. Anteroposterior radiograph of the distal radius reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

Giant cell tumor. Lateral radiograph of the same distal radius as in Image 4 in Multimedia reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough and significant soft-tissue expansion.

Giant cell tumor. Sagittal MRI of the same distal radius as in Images 4-5 reveals an aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.

Giant cell tumor. Anteroposterior radiograph of the distal tibia demonstrates extension of the lesion to the articular surface.

Giant cell tumor. Lateral radiograph of the same distal tibia as in Image 7 in Multimedia demonstrates extension of the lesion to the articular surface.

Giant cell tumor. Sagittal MRI of the same distal tibia as in Images 7-8 in Multimedia demonstrates extension of the lesion to the articular surface.

Anteroposterior radiograph of a wrist arthrodesis performed for a giant cell tumor. Soft tissue recurrence is present. Note the peripheral mineralization about the soft-tissue recurrence (arrow).

Sagittal T1-weighted MRI shows a giant cell tumor with low signal intensity.

Sagittal T2-weighted MRI shows a giant cell tumor with intermediate-to-high signal intensity.

Giant cell tumor. CT scan of the distal femur reveals an absence of matrix within the lesion.

Intraoperative photograph of giant cell tumor in the distal femur.

Gross specimen of the same giant cell tumor in the distal femur as in Image 14 in Multimedia displays the typical chocolate brown and spongy appearance.

Bisected gross specimen of the giant cell tumor in Image 15 reveals blood-filled cystic areas and inner yellow and orange discoloration.

Gross specimen of a giant cell tumor that fills the entire distal radius. Despite cortical disruption, the periosteum remains intact (arrow). Once again, note the blood-filled cystic areas and areas of orange discoloration.

Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

Photomicrograph of a giant cell tumor reveals the typical appearance. Multinucleated giant cells are dispersed throughout on a background of mononuclear cells.

Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

Photomicrograph of a giant cell tumor reveals prominent mitotic activity and rare cellular atypia.

Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

Giant cell tumor. Photomicrograph of a multinucleated giant cell. Note the centrally located nuclei.

Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

Photomicrograph of a giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.

Photomicrograph of a giant cell tumor with intravascular invasion of the multinucleated giant cells.

Anteroposterior radiograph of a giant cell tumor of the distal radius.

Intraoperative photograph of the resection bed of the same giant cell tumor of the distal radius as in Image 28 after the distal radius is resected.

Intraoperative photograph of the same giant cell tumor of the distal radius as in Images 28-29 shows the wrist arthrodesis with fibular autograft and 16-hole low-contact dynamic compression (LCDC) plate.

Postoperative lateral radiograph of the same giant cell tumor of the distal radius as in Image 30.

Giant cell tumor. Intraoperative photograph of the distal tibia reveals the curetted and burred cavity.

Giant cell tumor. Intraoperative photograph of the same distal tibia as in Image 32 reveals polymethylmethacrylate packed into the distal tibial cavity.

Giant cell tumor. Anteroposterior radiograph of the distal tibia with polymethylmethacrylate packed in the distal femur after curettage of the lesion.

Giant cell tumor. Illustration of the large cavity necessary for sufficient curettage.

Giant cell tumor. Illustration of the direct pour technique.

Intraoperative photograph of the distal femur with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

Lateral radiograph of the same distal femur as in Image 37 with polymethylmethacrylate and Steinman pins inserted into the cavity after removal of a giant cell tumor.

Intraoperative photograph of the distal femur after removal of a giant cell tumor. The cavity has been curetted and treated with a high-speed burr.

Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 39 obtained while the cavity is undergoing argon laser.

Giant cell tumor. Intraoperative photograph of the distal femoral cavity of the same distal femur as in Image 40 after argon laser treatment is complete.

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