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Giant Cell Tumor

  • Author: Valerae O Lewis, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Jul 16, 2015
 

Background

Cooper and Travers first described giant cell tumor (GCT) of bone in 1818.[1]  GCTs of bone have been described as the most challenging benign bone tumors.[2] Although benign, GCTs show a tendency for significant bone destruction, local recurrence, and occasionally metastasis. The natural history of GCTs varies widely and can range from local bony destruction to local metastasis, metastasis to the lung, metastasis to lymph nodes (rare), or malignant transformation (rare).[3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 2, 14, 15, 16, 17, 18, 19]

Approximately 3% of GCTs metastasize to the lung. The metastases appear as clusters of GCTs located within the lung.[20, 5, 21, 22] GCT metastases generally appear an average of 3-5 years after the initial diagnosis of the primary lesion. In some cases, however, they may go undetected for 10 years or longer.[10, 21, 23, 22, 24]  The natural history of these lung metastases is unpredictable. Pulmonary metastases that spontaneously regress, remain stable, continuously grow slowly, or rapidly progress have been reported.[20, 4, 10, 14, 25, 26]

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Epidemiology

In the United States and Europe, GCTs represent approximately 5% of all primary bone tumors and 21% of all benign bone tumors.[19] In China, GCTs account for 20% of all primary bone tumors.[27]  An epidemiologic comparison study between 9200 patients treated at Beijing Ji Shui Tan Hospital and 10,165 patients treated at the Mayo Clinic found that the incidence of GCT was significantly higher among the former.[28]

A female predominance exists, with a female-to-male ratio of 1.3-1.5:1 (see the image below).[29, 30, 19] GCTs occur most commonly in the third decade of life; less than 5% of GCTs occur in patients who are skeletally immature.[3, 19, 31, 32, 33] In the Mayo Clinic series, 84% of the GCTs occurred in patients older than 19 years.[19]

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

The overall prognosis generally is good. However, pulmonary metastases have been cited as the cause of death in 16-25% of reported cases.[10, 21, 23]

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Sean P Scully, MD 

Sean P Scully, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, Society of Surgical Oncology

Disclosure: Nothing to disclose.

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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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 Advisory board; Novartis Honoraria Speaking and teaching

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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.
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 the previous image 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 the previous image 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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