IS Case 288: Giant cell tumor
Imaging Sciences URMC 2009
Publication Date: 2009-08-05
Giant cell tumor (GCT) accounts for 5 to 9 percent of all primary bony tumors and may be the most common bone tumor in the young adults aged 25 to 40. It is usually found in the long bones, most often the distal femur, proximal tibia, and distal radius. It only occurs after the epiphyseal plates have closed. Most patients present with slowly progressive pain, with or without a mass. Symptoms arise when the lesion begins to destroy the cortex and irritate the periosteum or when the weakening of the bone caused by the tumor causes pain due to imminent pathologic fracture.
Radiographic exam is usually diagnostic and shows an eccentric, lytic bone lesion with poorly to well-defined borders, conspicuous peripheral trabeculae, septations, no sclerotic borders, and periosteal reaction in 10-30%.
Differential diagnosis includes aneurysmal bone cyst, chondromyxoid fibroma and chondroblastoma (which generally affect a younger age group), osteosarcoma (which exhibits an aggressive periosteal reaction with osseous matrix), and intraosseous ganglion (which has sclerotic borders).
The patient's lesion for this case did have sclerotic borders, which is unusual for a GCT. This pattern occurs in 15-20% of cases.
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