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

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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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