History and Physical Examination

Most giant cell tumors (GCTs) of bone are located within the epiphyses of long bones, but they often extend into the metaphysis. In several published series, only 1.2% of GCTs involved the metaphysis or diaphysis without epiphyseal involvement.^{[36, 37, 38, 39, 40, 41, 42, 43]}

Approximately 50% of GCTs are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius (see the image below). Most commonly, GCTs are solitary lesions; fewer than 1% are multicentric.^{[44, 45, 46, 47, 48, 49, 50, 51]}Multicentric involvement tends to be more clinically aggressive, and, unlike the solitary lesions, multicentric GCT has a propensity for the small bones of the hands and feet. Patients with multicentric lesions tend to be younger than those with lesions elsewhere.^[52]

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

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Pain is the most common presenting symptom. Swelling and deformity are associated with larger lesions. Soft-tissue extension is common. The incidence of pathologic fracture at presentation is 11-37%.^{[37, 53, 54]}

Workup

McDonald SG. Surgery for Bone and Soft Tissue Sarcomas. Philadelphia: Lippincott Williams & Wilkins; 1998. 756.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987 Jan. 69 (1):106-14. [Medline].
Cheng JC, Johnston JO. Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res. 1997 May. (338):205-14. [Medline].
Connell D, Munk PL, Lee MJ, O'Connell JX, Janzen D, Vu M, et al. Giant cell tumor of bone with selective metastases to mediastinal lymph nodes. Skeletal Radiol. 1998 Jun. 27 (6):341-5. [Medline].
Dahlin DC. Caldwell Lecture. Giant cell tumor of bone: highlights of 407 cases. AJR Am J Roentgenol. 1985 May. 144 (5):955-60. [Medline].
Dahlin DC, Cupps RE, Johnson EW Jr. Giant-cell tumor: a study of 195 cases. Cancer. 1970 May. 25 (5):1061-70. [Medline].
Fitz GR, Carter HK. Giant cell tumor of bone: review and presentation of two unusual cases. J Am Osteopath Assoc. 1966 Nov. 66(3):292-302. [Medline].
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am. 1970 Jun. 52 (4):619-64. [Medline].
Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994 May. (302):219-30. [Medline].
Kitano K, Shiraishi T, Okabayashi K, Iwasaki A, Kawahara K, Shirakusa T. A lung metastasis from giant cell tumor of bone at eight years after primary resection. Jpn J Thorac Cardiovasc Surg. 1999 Dec. 47 (12):617-20. [Medline].
Kreicbergs A, Lönnqvist PA, Nilsson B. Curettage of benign lesions of bone. Factors related to recurrence. Int Orthop. 1985. 8 (4):287-94. [Medline].
McDonald DJ, Sim FH, McLeod RA, Dahlin DC. Giant-cell tumor of bone. J Bone Joint Surg Am. 1986 Feb. 68 (2):235-42. [Medline].
Mirra JM, Ulich T, Magidson J, Kaiser L, Eckardt J, Gold R. A case of probable benign pulmonary "metastases" or implants arising from a giant cell tumor of bone. Clin Orthop Relat Res. 1982 Jan-Feb. (162):245-54. [Medline].
MNAYMNEH WA, DUDLEY HR, MNAYMNEH LG. GIANT-CELL TUMOR OF BONE. AN ANALYSIS AND FOLLOW-UP STUDY OF THE FORTY-ONE CASES OBSERVED AT THE MASSACHUSETTS GENERAL HOSPITAL BETWEEN 1925 AND 1960. J Bone Joint Surg Am. 1964 Jan. 46:63-75. [Medline].
Present DA, Bertoni F, Springfield D, Braylan R, Enneking WF. Giant cell tumor of bone with pulmonary and lymph node metastases. A case report. Clin Orthop Relat Res. 1986 Aug. (209):286-91. [Medline].
Riley LH Jr, Hartmann WH, Robinson RA. Soft-tissue recurrence of giant-cell tumor of bone after irradiation and excision. J Bone Joint Surg Am. 1967 Mar. 49 (2):365-8. [Medline].
Shifrin LZ. Giant cell tumor of bone. Clin Orthop Relat Res. 1972 Jan-Feb. 82:59-66. [Medline].
Unni KK, Inwards CY. Dahlin's Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Philadelphia: Wolters Kluwer; 2010.
Yang Y, Huang Z, Niu X, Xu H, Li Y, Liu W. Clinical characteristics and risk factors analysis of lung metastasis of benign giant cell tumor of bone. J Bone Oncol. 2017 Jun. 7:23-28. [Medline]. [Full Text].
Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M. Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res. 1988 Dec. (237):275-85. [Medline].
Maloney WJ, Vaughan LM, Jones HH, Ross J, Nagel DA. Benign metastasizing giant-cell tumor of bone. Report of three cases and review of the literature. Clin Orthop Relat Res. 1989 Jun. (243):208-15. [Medline].
Szyfelbein WM, Schiller AL. Cytologic diagnosis of giant cell tumor of bone metastatic to lung. A case report. Acta Cytol. 1979 Nov-Dec. 23 (6):460-4. [Medline].
Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am. 1984 Feb. 66 (2):269-74. [Medline].
Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol. 1992 Feb. 158 (2):331-4. [Medline].
Rosario M, Kim HS, Yun JY, Han I. Surveillance for lung metastasis from giant cell tumor of bone. J Surg Oncol. 2017 Dec. 116 (7):907-913. [Medline].
Nojima T, Takeda N, Matsuno T, Inoue K, Nagashima K. Case report 869. Benign metastasizing giant cell tumor of bone. Skeletal Radiol. 1994 Oct. 23 (7):583-5. [Medline].
Sanerkin NG. Malignancy, aggressiveness, and recurrence in giant cell tumor of bone. Cancer. 1980 Oct 1. 46 (7):1641-9. [Medline].
Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am. 1982 Jun. 64 (5):755-61. [Medline].
Niu X, Xu H, Inwards CY, Li Y, Ding Y, Letson GD, et al. Primary Bone Tumors: Epidemiologic Comparison of 9200 Patients Treated at Beijing Ji Shui Tan Hospital, Beijing, China, With 10 165 Patients at Mayo Clinic, Rochester, Minnesota. Arch Pathol Lab Med. 2015 Sep. 139 (9):1149-55. [Medline].
Frassica FJ, Sanjay BK, Unni KK, McLeod RA, Sim FH. Benign giant cell tumor. Orthopedics. 1993 Oct. 16 (10):1179-83. [Medline].
Schajowicz F, Granato DB, McDonald DJ, Sundaram M. Clinical and radiological features of atypical giant cell tumours of bone. Br J Radiol. 1991 Oct. 64 (766):877-89. [Medline].
Kransdorf MJ, Sweet DE, Buetow PC, Giudici MA, Moser RP Jr. Giant cell tumor in skeletally immature patients. Radiology. 1992 Jul. 184 (1):233-7. [Medline].
Picci P, Manfrini M, Zucchi V, Gherlinzoni F, Rock M, Bertoni F, et al. Giant-cell tumor of bone in skeletally immature patients. J Bone Joint Surg Am. 1983 Apr. 65 (4):486-90. [Medline].
Puri A, Agarwal MG, Shah M, Jambhekar NA, Anchan C, Behle S. Giant cell tumor of bone in children and adolescents. J Pediatr Orthop. 2007 Sep. 27 (6):635-9. [Medline].
Bai WZ, Guo SB, Zhao W, Yu XC, Xu M, Zheng K, et al. Comparison of outcomes of 2 surgical treatments for proximal humerus giant cell tumors: a multicenter retrospective study. J Shoulder Elbow Surg. 2019 Nov. 28 (11):2103-2112. [Medline].
Bogumill GS, Johnson LC. Giant cell tumor: a metaphyseal lesion. J Bone Joint Surg Am. 1972. 54:1558.
Campanacci M, Giunti A, Olmi R. [Metaphyseal and diaphyseal localization of giant cell tumors]. Chir Organi Mov. 1975. 62 (1):29-34. [Medline].
Fain JS, Unni KK, Beabout JW, Rock MG. Nonepiphyseal giant cell tumor of the long bones. Clinical, radiologic, and pathologic study. Cancer. 1993 Jun 1. 71 (11):3514-9. [Medline].
Peison B, Feigenbaum J. Metaphyseal giant-cell tumor in a girl of 14. Radiology. 1976 Jan. 118 (1):145-6. [Medline].
Sherman MA. Giant cell tumors in the metaphysis of a child. J Bone Joint Surg Am. 1961. 43:1225-9.
Wilkerson JA, Cracchiolo A 3rd. Giant-cell tumor of the tibial diaphysis. J Bone Joint Surg Am. 1969 Sep. 51 (6):1205-9. [Medline].
Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev. 2010 Feb. 36 (1):1-7. [Medline].
Karpik M. Giant Cell Tumor (tumor gigantocellularis, osteoclastoma) - epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil. 2010 May-Jun. 12 (3):207-15. [Medline].
Cummins CA, Scarborough MT, Enneking WF. Multicentric giant cell tumor of bone. Clin Orthop Relat Res. 1996 Jan. (322):245-52. [Medline].
Hindman BW, Seeger LL, Stanley P, Forrester DM, Schwinn CP, Tan SZ. Multicentric giant cell tumor: report of five new cases. Skeletal Radiol. 1994 Apr. 23 (3):187-90. [Medline].
Kadir S, Hudson TM. Multicentric giant cell tumors of bone. Rofo. 1978 Jun. 128 (6):769-70. [Medline].
Kaufman SM, Isaac PC. Multiple giant cell tumors. South Med J. 1977 Jan. 70 (1):105-7. [Medline].
Madhuri V, Sundararaj GD, Babu NV, Ponnaiya J, Korula RJ. Multicentric giant cell tumour of bone--a report of two cases. Indian J Cancer. 1993 Sep. 30 (3):135-9. [Medline].
Peimer CA, Schiller AL, Mankin HJ, Smith RJ. Multicentric giant-cell tumor of bone. J Bone Joint Surg Am. 1980. 62 (4):652-6. [Medline].
Sanghvi V, Lala M, Desai S, Chaturvedi P, Rodrigues G. Synchronous multicentric giant cell tumour: a case report with review of literature. Eur J Surg Oncol. 1999 Dec. 25 (6):636-7. [Medline].
Sim FH, Dahlin DC, Beabout JW. Multicentric giant-cell tumor of bone. J Bone Joint Surg Am. 1977 Dec. 59 (8):1052-60. [Medline].
Hoch B, Inwards C, Sundaram M, Rosenberg AE. Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am. 2006 Sep. 88 (9):1998-2008. [Medline].
Enneking W. Musculoskeletal Tumor Surgery. New York: Churchill Livingstone; 1983.
Hudson TM, Schiebler M, Springfield DS, Enneking WF, Hawkins IF Jr, Spanier SS. Radiology of giant cell tumors of bone: computed tomography, arthro-tomography, and scintigraphy. Skeletal Radiol. 1984. 11 (2):85-95. [Medline].
Matsubayashi S, Nakashima M, Kumagai K, Egashira M, Naruke Y, Kondo H, et al. Immunohistochemical analyses of beta-catenin and cyclin D1 expression in giant cell tumor of bone (GCTB): a possible role of Wnt pathway in GCTB tumorigenesis. Pathol Res Pract. 2009. 205 (9):626-33. [Medline].
Salerno M, Avnet S, Alberghini M, Giunti A, Baldini N. Histogenetic characterization of giant cell tumor of bone. Clin Orthop Relat Res. 2008 Sep. 466 (9):2081-91. [Medline].
Frassica FJ, Sim FH, Pritchard DJ, Chao EY. Subchondral replacement: a comparative analysis of reconstruction with methyl methacrylate or autogenous bone graft. Chir Organi Mov. 1990. 75 (1 Suppl):189-90. [Medline].
Seider MJ, Rich TA, Ayala AG, Murray JA. Giant cell tumors of bone: treatment with radiation therapy. Radiology. 1986 Nov. 161 (2):537-40. [Medline].
Hui M, Uppin SG, Kumar KK, Radhika S, Chandrasekhar P, Rao KN. Utility of P63 in Differentiating Giant Cell Tumor from Other Giant Cell-Containing Lesions. Turk Patoloji Derg. 2021 Jun 8. [Medline]. [Full Text].
He SH, Xu W, Sun ZW, Liu WB, Liu YJ, Wei HF, et al. Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review. Orthop Surg. 2017 May. 9 (2):139-144. [Medline].
Malone S, O'Sullivan B, Catton C, Bell R, Fornasier V, Davis A. Long-term follow-up of efficacy and safety of megavoltage radiotherapy in high-risk giant cell tumors of bone. Int J Radiat Oncol Biol Phys. 1995 Oct 15. 33 (3):689-94. [Medline].
Schwartz LH, Okunieff PG, Rosenberg A, Suit HD. Radiation therapy in the treatment of difficult giant cell tumors. Int J Radiat Oncol Biol Phys. 1989 Nov. 17 (5):1085-8. [Medline].
Hefti FL, Gächter A, Remagen W, Nidecker A. Recurrent giant-cell tumor with metaplasia and malignant change, not associated with radiotherapy. A case report. J Bone Joint Surg Am. 1992 Jul. 74 (6):930-4. [Medline].
Mori Y, Tsuchiya H, Karita M, Nonomura A, Nojima T, Tomita K. Malignant transformation of a giant cell tumor 25 years after initial treatment. Clin Orthop Relat Res. 2000 Dec. (381):185-91. [Medline].
Rock MG, Sim FH, Unni KK, Witrak GA, Frassica FJ, Schray MF, et al. Secondary malignant giant-cell tumor of bone. Clinicopathological assessment of nineteen patients. J Bone Joint Surg Am. 1986 Sep. 68 (7):1073-9. [Medline].
Bennett CJ Jr, Marcus RB Jr, Million RR, Enneking WF. Radiation therapy for giant cell tumor of bone. Int J Radiat Oncol Biol Phys. 1993 May 20. 26 (2):299-304. [Medline].
Chen ZX, Gu DZ, Yu ZH, Qian TN, Huang YR, Hu YH, et al. Radiation therapy of giant cell tumor of bone: analysis of 35 patients. Int J Radiat Oncol Biol Phys. 1986 Mar. 12 (3):329-34. [Medline].
Nair MK, Jyothirmayi R. Radiation therapy in the treatment of giant cell tumor of bone. Int J Radiat Oncol Biol Phys. 1999 Mar 15. 43 (5):1065-9. [Medline].
Harwood AR, Fornaster VL, Rider WD. Supervoltage irradiation in the management of giant cell tumor of bone. Radiology. 1977 Oct. 125 (1):223-6. [Medline].
Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, et al. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol. 2010 Mar. 11 (3):275-80. [Medline].
Branstetter DG, Nelson SD, Manivel JC, Blay JY, Chawla S, Thomas DM, et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res. 2012 Aug 15. 18 (16):4415-24. [Medline].
Ueda T, Morioka H, Nishida Y, Kakunaga S, Tsuchiya H, Matsumoto Y, et al. Objective tumor response to denosumab in patients with giant cell tumor of bone: a multicenter phase II trial. Ann Oncol. 2015 Oct. 26 (10):2149-54. [Medline]. [Full Text].
Traub F, Singh J, Dickson BC, Leung S, Mohankumar R, Blackstein ME, et al. Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone. Eur J Cancer. 2016 May. 59:1-12. [Medline].
Rock M. Adjuvant management of benign tumors; basic concepts of phenol and cement use. Chir Organi Mov. 1990. 75 (1 Suppl):195-7. [Medline].
Kutchemeshgi AD, Wright JR, Humphrey RL. Pulmonary metastases from a well-differentiated giant cell tumor of bone. Report of a patient with apparent response to cyclophosphamide therapy. Johns Hopkins Med J. 1974 Apr. 134 (4):237-45. [Medline].
Ladanyi M, Traganos F, Huvos AG. Benign metastasizing giant cell tumors of bone. A DNA flow cytometric study. Cancer. 1989 Oct 1. 64 (7):1521-6. [Medline].
Stargardter FL, Cooperman LR. Giant-cell tumour of sacrum with multiple pulmonary metastases and long-term survival. Br J Radiol. 1971 Dec. 44 (528):976-9. [Medline].
Stewart DJ, Belanger R, Benjamin RS. Prolonged disease-free survival following surgical debulking and high-dose cisplatin/doxorubicin in a patient with bulky metastases from giant cell tumor of bone refractory to "standard" chemotherapy. Am J Clin Oncol. 1995 Apr. 18 (2):144-8. [Medline].
Vanel D, Contesso G, Rebibo G, Zafrani B, Masselot J. Benign giant-cell tumours of bone with pulmonary metastases and favourable prognosis. Report on two cases and review of the literature. Skeletal Radiol. 1983. 10 (4):221-6. [Medline].
Benjamin RS. Interferon a2b as anti-angiogenesis therapy of giant cell tumors of bone: implications for the study of newer angiogenesis-inhibitors. Proc Am Soc Clin Oncol. 1999. 18:548a.
Gitelis S, Mallin BA, Piasecki P, Turner F. Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am. 1993 Nov. 75 (11):1648-55. [Medline].
Alaqaili SI, Abduljabbar AM, Altaho AJ, Khan AA, Alherabi JA. Malignant Sarcomatous Transformation of Benign Giant Cell Tumor of Bone after Treatment with Denosumab Therapy: A Literature Review of Reported Cases. Cureus. 2018 Dec 28. 10 (12):e3792. [Medline]. [Full Text].
Abuhejleh H, Wunder JS, Ferguson PC, Isler MH, Mottard S, Werier JA, et al. Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol. 2020 Jan. 30 (1):11-17. [Medline].
Singh S, Rai A, Dinesh Iyer R, Surana R, Sharma D. Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee. SICOT J. 2021. 7:49. [Medline]. [Full Text].
Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008 Sep. 134 (9):969-78. [Medline].
Wysocki RW, Soni E, Virkus WW, Scarborough MT, Leurgans SE, Gitelis S. Is intralesional treatment of giant cell tumor of the distal radius comparable to resection with respect to local control and functional outcome?. Clin Orthop Relat Res. 2015 Feb. 473 (2):706-15. [Medline].
Clohisy DR, Mankin HJ. Osteoarticular allografts for reconstruction after resection of a musculoskeletal tumor in the proximal end of the tibia. J Bone Joint Surg Am. 1994 Apr. 76 (4):549-54. [Medline].
Kocher MS, Gebhardt MC, Mankin HJ. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft after excision of a skeletal tumor. J Bone Joint Surg Am. 1998 Mar. 80 (3):407-19. [Medline].
Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW. Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer. 1982 Aug 15. 50 (4):613-30. [Medline].
Mankin HJ, Fogelson FS, Thrasher AZ, Jaffer F. Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med. 1976 Jun 3. 294 (23):1247-55. [Medline].
Waldram MA, Sneath RS. Is bone graft necessary? Analysis of twenty cases of giant cell tumour of bone treated by curettage without graft. Int Orthop. 1990. 14 (2):129-33. [Medline].
Leeson MC, Lippitt SB. Thermal aspects of the use of polymethylmethacrylate in large metaphyseal defects in bone. A clinical review and laboratory study. Clin Orthop Relat Res. 1993 Oct. (295):239-45. [Medline].
Mjöberg B, Pettersson H, Rosenqvist R, Rydholm A. Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand. 1984 Dec. 55 (6):597-600. [Medline].
Campanacci M, Capanna R, Fabbri N, Bettelli G. Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov. 1990. 75 (1 Suppl):212-3. [Medline].
Persson BM, Wouters HW. Curettage and acrylic cementation in surgery of giant cell tumors of bone. Clin Orthop Relat Res. 1976 Oct. (120):125-33. [Medline].
Quint U, Müller RT, Müller G. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg. 1998. 117 (1-2):43-6. [Medline].
Quint U, Vanhöfer U, Harstrick A, Müller RT. Cytotoxicity of phenol to musculoskeletal tumours. J Bone Joint Surg Br. 1996 Nov. 78 (6):984-5. [Medline].
Wilkins RM, Okada Y, Sim FH, et al. Methyl methacrylate replacement of subchondral bone: a biomechanical, biochemical, and morphologic analysis. Enneking WF, ed. Limb Salvage in Musculoskeletal Oncology. New York: Churchill Livingstone; 1987. 479-86.
Willert HG. Clinical results of the temporary acrylic bone cement plug in the treatment of bone tumors: a multicentric study. Enneking WF, ed. Limb Salvage in Musculoskeletal Oncology. New York: Churchill Livingstone; 1987. 445-58.
Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006 Jan. 37 (1):35-51. [Medline].
Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am. 1999 Jun. 81 (6):811-20. [Medline].
Capanna R, Sudanese A, Baldini N, Campanacci M. Phenol as an adjuvant in the control of local recurrence of benign neoplasms of bone treated by curettage. Ital J Orthop Traumatol. 1985 Sep. 11 (3):381-8. [Medline].
Dürr HR, Maier M, Jansson V, Baur A, Refior HJ. Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol. 1999 Dec. 25 (6):610-8. [Medline].
Gitelis S, Wang JW, Quast M, Schajowicz F, Templeton A. Recurrence of a giant-cell tumor with malignant transformation to a fibrosarcoma twenty-five years after primary treatment. A case report. J Bone Joint Surg Am. 1989 Jun. 71 (5):757-61. [Medline].
O'Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am. 1994 Dec. 76 (12):1827-33. [Medline].
Aboulafia AJ, Rosenbaum DH, Sicard-Rosenbaum L, Jelinek JS, Malawer MM. Treatment of large subchondral tumors of the knee with cryosurgery and composite reconstruction. Clin Orthop Relat Res. 1994 Oct. (307):189-99. [Medline].
Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res. 1999 Feb. (359):176-88. [Medline].
Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop Relat Res. 1991 Jan. (262):42-57. [Medline].
Marcove RC. A 17-year review of cryosurgery in the treatment of bone tumors. Clin Orthop Relat Res. 1982 Mar. (163):231-4. [Medline].
Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, Huvos AG. Cryosurgery in the treatment of giant cell tumors of bone. A report of 52 consecutive cases. Cancer. 1978 Mar. 41 (3):957-69. [Medline].
Pogrel MA. The management of lesions of the jaws with liquid nitrogen cryotherapy. J Calif Dent Assoc. 1995 Dec. 23 (12):54-7. [Medline].
Grogan TJ, Eckardt J. Phenol cauterization versus liquid nitrogen cryosurgery: extent of cellular necrosis in a dog model. Trans Orthop Res Soc. 1984. 9 (291):184.
Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon MA. Argon beam coagulation as an adjuvant for local control of giant cell tumor. Clin Orthop Relat Res. 2007 Jan. 454:192-7. [Medline].
Kumar A, Sinha S, Haider Y, Jameel J, Kumar S. Role of Zoledronic Acid Supplementation in Reducing Post-Surgical Recurrence of Giant Cell Tumor of Bone: A Meta-Analysis of Comparative Studies. Cureus. 2021 Jul. 13 (7):e16742. [Medline]. [Full Text].
Wang X, Su P, Kang Y, Xu C, Qiu J, Wu J, et al. Combination of Melatonin and Zoledronic Acid Suppressed the Giant Cell Tumor of Bone in vitro and in vivo. Front Cell Dev Biol. 2021. 9:690502. [Medline]. [Full Text].
Barnaba A, Colas M, Larousserie F, Babinet A, Anract P, Biau D. Burden of complications after giant-cell tumor surgery. A single-center retrospective study of 192 cases. Orthop Traumatol Surg Res. 2021 Sep 6. 103047. [Medline].
Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011 Feb. 469 (2):591-9. [Medline]. [Full Text].
Tang H, Moro A, Feng W, Lai Y, Xiao Z, Liu Y, et al. Giant cell tumors combined with secondary aneurysmal bone cysts are more likely to develop postoperative recurrence: A retrospective study of 256 cases. J Surg Oncol. 2019 Sep. 120 (3):359-365. [Medline].

Media Gallery

Approximately 50% of giant cell tumors are located around knee. Most common locations are distal femur, proximal tibia, and proximal humerus and distal radius.
Distribution of giant cell tumors according to age and sex of patient. Six patients had multicentric disease.
Giant cell tumor. Anteroposterior radiograph of distal femur reveals expansile lytic metaphyseal-epiphyseal lesion.
Giant cell tumor. Lateral radiograph of same distal femur as in previous image reveals expansile lytic metaphyseal-epiphyseal lesion.
Giant cell tumor. Anteroposterior radiograph of distal radius reveals aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.
Giant cell tumor. Lateral radiograph of same distal radius as in previous image reveals aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.
Giant cell tumor. Sagittal MRI of same distal radius as in previous two images reveals aggressive lesion characterized by extensive local bony destruction, cortical breakthrough, and significant soft-tissue expansion.
Giant cell tumor. Anteroposterior radiograph of distal tibia demonstrates extension of lesion to articular surface.
Giant cell tumor. Lateral radiograph of same distal tibia as in preceding image demonstrates extension of lesion to articular surface.
Giant cell tumor. Sagittal MRI of same distal tibia as in previous two images demonstrates extension of lesion to articular surface.
Anteroposterior radiograph of wrist arthrodesis performed for giant cell tumor. Soft-tissue recurrence is present. Note peripheral mineralization about soft-tissue recurrence (arrow).
Sagittal T1-weighted MRI shows giant cell tumor with low signal intensity.
Sagittal T2-weighted MRI shows giant cell tumor with intermediate-to-high signal intensity.
Giant cell tumor. CT scan of distal femur reveals absence of matrix within lesion.
Intraoperative photograph of giant cell tumor in distal femur.
Gross specimen of same giant cell tumor in the distal femur as in preceding image displays typical chocolate-brown and spongy appearance.
Bisected gross specimen of giant cell tumor in preceding image reveals blood-filled cystic areas and inner yellow and orange discoloration.
Gross specimen of giant cell tumor that fills entire distal radius. Despite cortical disruption, periosteum remains intact (arrow). Once again, note blood-filled cystic areas and areas of orange discoloration.
Photomicrograph of giant cell tumor reveals typical appearance. Multinucleated giant cells are dispersed throughout on background of mononuclear cells.
Photomicrograph of giant cell tumor reveals typical appearance. Multinucleated giant cells are dispersed throughout on background of mononuclear cells.
Photomicrograph of giant cell tumor reveals prominent mitotic activity and rare cellular atypia.
Photomicrograph of giant cell tumor reveals prominent mitotic activity and rare cellular atypia.
Giant cell tumor. Photomicrograph of multinucleated giant cell. Note centrally located nuclei.
Giant cell tumor. Photomicrograph of multinucleated giant cell. Note centrally located nuclei.
Giant cell tumor. Photomicrograph of multinucleated giant cell. Note centrally located nuclei.
Photomicrograph of giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.
Photomicrograph of giant cell tumor with few multinucleated giant cells but abundant swirls of spindle-shaped stromal cells.
Photomicrograph of giant cell tumor with intravascular invasion of multinucleated giant cells.
Anteroposterior radiograph of giant cell tumor of distal radius.
Intraoperative photograph of resection bed of same giant cell tumor of distal radius as in preceding image after distal radius is resected.
Intraoperative photograph of same giant cell tumor of distal radius as in previous two images shows wrist arthrodesis with fibular autograft and 16-hole low-contact dynamic compression (LCDC) plate.
Postoperative lateral radiograph of same giant cell tumor of distal radius as in preceding image.
Giant cell tumor. Intraoperative photograph of distal tibia reveals curetted and burred cavity.
Giant cell tumor. Intraoperative photograph of same distal tibia as in preceding image reveals polymethylmethacrylate packed into distal tibial cavity.
Giant cell tumor. Anteroposterior radiograph of distal tibia with polymethylmethacrylate packed in distal femur after curettage of lesion.
Giant cell tumor. Illustration of large cavity necessary for sufficient curettage.
Giant cell tumor. Illustration of direct pour technique.
Intraoperative photograph of distal femur with polymethylmethacrylate and Steinman pins inserted into cavity after removal of giant cell tumor.
Lateral radiograph of same distal femur as in preceding image with polymethylmethacrylate and Steinman pins inserted into cavity after removal of giant cell tumor.
Intraoperative photograph of distal femur after removal of giant cell tumor. Cavity has been curetted and treated with high-speed burr.
Giant cell tumor. Intraoperative photograph of distal femoral cavity of same distal femur as in preceding image, obtained while cavity is undergoing argon laser treatment.
Giant cell tumor. Intraoperative photograph of distal femoral cavity of same distal femur as in preceding image, obtained after argon laser treatment is complete.

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Giant Cell Tumor of Bone Clinical Presentation

History and Physical Examination

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