IS Case 288: Giant cell tumor

Gurpreet Dhillon, MD


Imaging Sciences URMC 2009
Publication Date: 2009-08-05

History

A 45-year-old male, asymptomatic in his right knee prior to a fall sustained earlier in the year, was treated in an immobilizer followed by a brace for a nondisplaced fracture of his distal femur.

Findings

Lytic lesion in the sub-articular distal femur. Well defined borders around the lesion with a sclerotic margin. Periosteal reaction is seen along the posterior distal femur.

Diagnosis

Giant cell tumor

Discussion

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.

GCT of bone is a benign lesion that is a usually solitary and locally aggressive. Occasionally GCT may metastasize to other areas of the body usually the lungs.

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%.

MRI shows a lesion with low to intermediate signal on T1WI and low to high signal pattern on T2WI. It is used to evaluate intramedullary and extraosseous extension of the tumor.

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.

GCT can undergo sarcomatous transformation, spontaneously or in response to radiation therapy. It is locally aggressive with a 12-50% recurrence rate.

Treatment of GCT is by surgery only. Intralesional excision by extended curettage is the treatment of choice. Recurrence after extended curettage is approximately 10 percent.

References

  1. Dorfman HD, Czerniak B. Bone Tumors. St. Louis: Mosby, 1998:559-606
  2. Manaster BJ, Doyle AJ. Giant cell tumors of bone. Radiol Clin North Am. 1993 Mar;31(2):299-323.PMID: 8446751 [PubMed]

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