Giant cell tumor
Objectives- Describe symptoms and physical signs associated with giant cell tumor
- Describe the radiographic features of giant cell tumor
- Discuss the prognosis of giant cell tumor
- Discuss initial management of giant cell tumor
Discussion point
- How common is giant cell tumor in skeletally immature patients?
Discussion
Giant cell tumor is uncommon, and is generally classified as a benign bone tumor, although its behavior can be more aggressive than any other benign tumor of bone. Giant cell tumors of soft tissue have also been reported. About 50% of all giant cell tumors occur about the knee, the distal radius and proximal humerus are also frequent sites. Symptoms are swelling and pain. It is predominately a tumor of young adults, only 1.8% of 326 giant cell tumors studied at the Instituto Rizzolo in Bologna occurred in skeletally immature patients. Radiographically, giant cell tumors have a juxtaarticular location, typically involving both epiphysis and metaphysis. Cortical penetration and soft tissue masses are not rare. Treatment of giant cell tumor is generally by curettage, supplemented with high speed burr and/ or phenol application to the wall of the tumor; packing with cement may lower the rate of recurrence. Marginal or side en bloc resection is more effective, but carries more morbidity. "Benign" pulmonary metastases have been reported at a rate of 3%. A genetic marker that appears to predispose to metastases has recently been identified. Treatment of giant cell tumors is best performed at a center experienced with its management.
References
- Gamberi G, Benassi MS, Bohling T, Ragazzini P, Molendini L, Sollazzo MR, et al. Prognostic relevance of C-myc gene expression in giant-cell tumor of bone. Journal of Orthopaedic Research 1998; 16( 1): 1-7.
- Khan DC, Malhotra S, Stevens RE, Steinfeld AD. Radiotherapy for the treatment of giant cell tumor of the spine: a report of six cases and review of the literature. Cancer Investigation 1999; 17( 2): 110-3.
- 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. Journal of Bone & Joint Surgery -American Volume 1994; 76( 12): 1827-33.
- Oliveira AM, Dei Tos AP, Fletcher CD, Nascimento AG. Primary giant cell tumor of soft tissues: a study of 22 cases [see comments]. American Journal of Surgical Pathology 2000; 24( 2): 248-56.
- Picci P, Manfrini M, Zucchi V, Gherlinzoni F, Rock M, Bertoni F, et al. Giant-cell tumor of bone in skeletally immature patients. Journal of Bone & Joint Surgery - American Volume 1983; 65( 4): 486-90.
- Waldram MA, Sneath RS. Is bone grafting necessary? Analysis of twenty cases of giant cell tumour of bone treated by curettage without graft. Archives of Orthopaedic & Trauma Surgery 1989; 108( 5): 296-9.
May 16-19, 2012 in Denver, CO
