Giant Cell Tumour

Jaffe 1940
- AKA Osteoclastoma
- Common
- 18% of benign tumours
- Occurs in 2 Oss centre ie epiphysis
- Occ multicentric (rare) ~ MCQ
- Can behave in malignant fashion
F:M = 1.5:1 (most tumours M>F)
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Location
- 50% at knee
Distal femur
Proximal tibia
- Remainder
Distal radius
Sacrum
Vert bodies like EG Cf ABC/OO which occur post
Bullough says include jaw or spine but look for pre-existing
PAGETS
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Clinical
- Us after skel mature
- More common Females
- 3% < epiphyseal closure
- Peak incidence in 20's
- Involved joint has:
Dull ache
Effusion
Muscle atrophy
- Pathol # common
- Occur com Hyperparathyroidism
But Brown tumours mimick GCT
Sounds like bullshit I cant find a reference for this
- Can be pulsatile
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XR
XR
- Us Dx
Well defined defect In Epiphysis & Metaphysis
NO sclerosis around lesion
- Subarticular extension into subchondral bone
- May extend into articular cartilage
Unique ability ***
- Min periosteal R'n
- Cortical breach & ST extension
CT / MRI
- Show cortical destruction & ST extension
Bone Scan
- Us shows inc uptake
- Screens for other lesions
Bloods
- Ca++ & Se PO4 to rule out Brown's tumour
- ESR inc OM & EG
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PATH
- Grossely resemble Scrambled eggs
Two Cell Types
1 Multinucleated Giant Cells - Sim to Osteoclasts
2 Small Stromal Cells - ?The actual tumour ~ Enneking-yes
are probably osteoblast derivatives
Grade = Appearance of these
- Background of fibrous tissue
- N mitoses us seen
- Areas of spont necrosis - Rare for B9 tumours
- Giant Cell Ghosts
- Thin cortical shell

Aetiol
Tumour of stromal cells
Giant cells are osteoclast in nature and are reactive
Staging
Proposed by Enneking ?? Campanacci
Stage I Latent
- 15% of patients
- Asymptomatic
- Sclerotic Rim
- Inactive on bone scan
- Histol benign
Stage II Active
- 70% of patients
- Symptomatic
- Often have pathological fracture
- Expanded cortex but no breakthru
- Active on Bone Scan
- Histol benign Stromal cells
Stage III Aggressive
-15% of patients
- Symptomatic
- Rapidly growing mass
- Cortical peforation ST mass
- Extensive activity on Bone Scan
- Histol benign
Malignant
- Rare form
- Sarcomatous lesion contiguous Benign GCT
Previously said 10% metastasize
But many of these would now be called MFH
For it truly to be Giant cell have to see typical appearance of
GCT in met
1 malignant GCT better prognosis then malignant change in
recurrence
DDx
Synovial cyst of OA = Geode
OCD
- Chondroblastoma/Clear Cell Sarc
- Internal derangement of knee
- EG
- OM
- Enchondroma
- NOF
- Unicameral Cyst
Mx
Stage
- Bx us performed
1 Excise the lesion
2 Sterilize the cavity
3 Reconstruct the defect
Traditional Rx
- Bone graft & curettage
- High recurrence rate (>35%)
- Difficult to do intralesional excision without leaving tumour
cells behind because of prox to articular cartilage
Modern Adjuvant Rx
- Adjuvant Rx dev to dec recurrence
1 Extended Curettage high speed burr & PMMA packing
- Recommended
- Works by thermal necrosis
- Bone graft for 1cm under subchondral plate ? Beneficial
- Waterpick+++
2 Irrigation of Cavity Phenol
- High comp rate
- OK if touch it with cotton bud
3 CryoRx Liquid N2

- Imp principle is visualisation of whole cavity thru large

cortical window & thorough curretage
Coffee Cup Theory
Wide Resection & Osteochondral allograft for :
- Expendable bones
- Recurrences
- Unsalvagable bones
Grade III lesions
Hence:
Grade I & II
- Extended currette high speed burr & bone graft &/or
adjuvant PMMA
- saucerisation is key word - ie to get good view & not miss
any
- long term studies suggest that
<5mm subchondral then 30% chance of OA
>10mm then no OA
Grade III & Recurrence
- Wide resection & Osteochondral allograft
Unresectable
- RadioRx
Outcome
- McDonald 1986 ~ 23% reccurrence 3 yrs
- Histol predictive ~ Enneking
Enneking
Grade 1 = negligible recurrence
Grade 2 = 20%
Grade 3 = 70%
Grade 3 + adjuvant = 20%
Metastases
- Lung metastases occur in 2%
- Lesions slowly progress ie benign in nature
- Us Rx surgical resection
- Consider GCT Benign if Pulmonary Met histologically
benign
- Regular CXR in pts GCT
Dicko says need to know GCT well bc a lot of general ortho
surgeons operate on GCTs and reasonable that we know how
to do it well