Giant Cell Tumour

of the Right Proximal Tibia

Nirwana
C 111 07 240

Advisors
dr. Risal
dr. Nasrah

Supervisor
dr. M. Ruksal Saleh, PhD, Sp.OT.

Orthopaedic and Traumatology Department
Hasanuddin University
2011
PATIENTS IDENTITY
Name : Mrs. C
Age : 25 years old
Sex : Female
Date of admission : December 15
th
2011
Chief complaint : Lump at the proximal part of the right
leg
History : Suffered since 7 months before admitted to the
hospital
Initially, lump is a small (as big as a marble) appeared
at that region . The lump gradually becomes bigger . She
also complains pain. The pain is continous, and the
characteristic is sharp. Pain increased by standing or
walking.
Pain at night (+), loss of body weight (+)
Family history (-) , history of trauma (+)
History of irregular menstruation since she used
injecting contraception since 2 years ago.
History of treatment by bone setter (-)

HISTORY TAKING
PHYSICAL EXAMINATION
General Status
Well-nourished/Conciouss

Vital Sign
BP : 120/80 mmHg
HR : 80 bpm
RR : 20 tpm
T : 36,6 C
LOCALIZED STATUS
Right Lower Limb Region

INSPECTION : Lump at the proximal aspect of the
right leg, size about a tennis ball, venous
dilatation (-), the skin colour is same as
surrounding skin, scar (-), wound (-)
PALPATION : : Warmth (-), tenderness (+), smooth
surface, consistency is hard, well
defined margin, sized 12x7 cm, inguinal
lymph node enlargement (-).

AUSCULTATION : bruit (-)


LOCALIZED STATUS (Cont.)
ROM : active and passive motion of the
ankle and knee joint is normal

NVD : sensibility is normal, dorsal pedis
& tibialis posterior artery are
palpable, CRT <2

CLINICAL PICTURE
LABORATORY
WBC : 9.930 /L
RBC : 4. 260.000 /L
HGB : 12,3 g/dL
PLT : 267.000 /L
Ur/Cr : 17 / 0,6 mg/dL
GOT/GPT : 21 / 16 U/L
ALP : 91 U/L
HBsAg : negative


RIGHT LEG X-RAY (AP &
LATERAL)
RIGHT KNEE X-RAY (AP &
LATERAL)
CHEST X-RAY (PA &
LATERAL)
Microscopic :
Smear preparation consists of many cells
with stroma in it, which stromal nuclei are the
same as giant cell nuclei.

Conclusion :
Appropriate for Giant Cell Tumor
FNA FINDING
RESUME
A 25 y.o woman admitted to the hospital due to lump at
her right leg since 7 months ago. Initially, lump is a small
(as big as a marble) appeared at that region . The lump
gradually becomes bigger. Pain (+), it is continous, sharp,
and increased by standing or walking.
History of trauma (+). history of weight loss (+)
In physical examination, lump appears as big as tennis ball at
proximal of the right leg, venous dilatation (-), the skin
colour is same as surrounding skin, tenderness (+), smooth
surface, consistency is hard, well defined margin, sized 12x7
cm.
Radiologic examination shows suspect of giant cell tumour
FNA biopsy shows giant cell tumour

Giant Cell Tumor of the Right
Proximal Tibia
WORKING DIAGNOSIS
TREATMENT
Analgesic
Operative


GIANT CELL TUMOR
Giant cell tumor is one of benign
primary bone tumors which is
aggressive.
Usually found in the long bones
Epidemiology
Most often at the age of 20-40 years.
>
Malignant transformation (5-10%)
Rarely metastasises (<1% to lungs)
Location
Metaphyseal/Epiphys
ealof long bones.
Proximal tibial
Distal femur
Proximal humerus
Distal radius
Pelvis & sacrum

Classification
1 Benign latent GCT
No local agressive activity
2 Benign active GCT
Imaging studies alteration of
cortical bone structure
3 Locally aggressive GCT
Imaging studies a lytic lesion
surrounding medullary & cortical
bone
May be indication of tumor
penetration through cortex into soft
tissues
1 Lesion confined
within bone
2 Lesion expanding
cortex
3 Breach of cortex
1 - involvement of
joint
2 - distant metastases
Campanacci
Ennekings
Symptom
Pain
Lump
Limitation of joint motion
Pathological fracture

Radiology
X-Ray
a well defined radiolucent
(lytic) lesion in
metaphysis/epiphysis
extending up to joint surface
Cortex thinned & sometimes
ballooned
Soap bubble appearance

Histopatology
Numerous
multinucleated giant
cells.
Stromal cells:
homogenous,
mononuclear
round/ovoid with large
nuclei.
Nuclei of stromal cells
identical to nuclei of
giant cells.
Treatment
Well-confined, slow-growing lesions with
benign histology can safely be treated by
thorough curettage and stripping of the
cavity with burrs and gouges, followed by
swabbing with hydrogen peroxide or by
the application of liquid nitrogen; the
cavity is then packed with bone chips.
More aggressive tumours, and recurrent
lesions, should be treated by excision
followed, if necessary, by bone grafting
or prosthetic replacement.
Radiotherapy
Complication
Lung metastases
Sarcomatous transformation