Giant Cell Tumor of Bone

Updated: Sep 26, 2023
  • Author: Valerae O Lewis, MD; Chief Editor: Harris Gellman, MD  more...
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Practice Essentials

First described by Cooper and Travers in 1818, giant cell tumors (GCTs) of bone have been labeled the most challenging benign bone tumors. 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). [1]

A low percentage (1-9%) of GCTs of bone metastasize to the lung. [2] The metastases appear as clusters of GCTs located within the lung. GCT metastases generally appear an average of 3-5 years after the initial diagnosis of the primary lesion; however, in some cases, they may go undetected for 10 years or longer. [3] 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.

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%.

The presence of tumor is the indication for surgery. Radiation therapy (RT) and embolization generally are reserved for cases in which surgical treatment is not feasible.



In the United States and Europe, GCTs represent approximately 5% of all primary bone tumors and 21% of all benign bone tumors. [1] In China, GCTs have been estimated to account for 20% of all primary bone tumors. [4] 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. [5]

A female predominance exists, with a female-to-male ratio of 1.3-1.5:1 (see the image below). [1] GCTs occur most commonly in the third decade of life; fewer than 5% of GCTs occur in patients who are skeletally immature. [1, 6] In the Mayo Clinic series, 84% of the GCTs occurred in patients older than 19 years. [1]

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


The overall prognosis generally is good. However, pulmonary metastases have been cited as the cause of death in 16-25% of reported cases. [7, 8, 9]

In a study comparing the outcomes of two surgical treatments—curettage (n = 14) and segmental resection (n = 13)—in patients with GCTs of the proximal humerus who were followed for more than 2 years, Bai et al found that the recurrence rate was 7.1% in the curettage group and 15.4% in the segmental resection group. [10]  Postoperative upper-extremity function was significantly better in the curettage group than in the segmental resection group.