1 / 40

Giant Cell Tumor of Bone

Giant Cell Tumor of Bone. Overview. Definition Epidemiology Hx Presentation/Exam Radiology Dx Tx Outcomes. Definition. 1 0 bone neoplasm First described Cooper 1818 Lebert microscopic description 1845 Generally benign Potential for : Recurrence Pulmonary metastasis

Leo
Download Presentation

Giant Cell Tumor of Bone

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Giant Cell Tumor of Bone

  2. Overview • Definition • Epidemiology • Hx • Presentation/Exam • Radiology • Dx • Tx • Outcomes

  3. Definition • 10 bone neoplasm • First described Cooper 1818 • Lebert microscopic description 1845 • Generally benign • Potential for : • Recurrence • Pulmonary metastasis • Frank malignancy

  4. Epidemiology • 5-10% 10 bone tumors • 20% benign bone tumors • F : M 1.5 : 1 • 70-80% age 20-40 • Rare skeletally immature • Epiphyseal • Monostotic

  5. Incidence • Ends of long bones • >50% about knee • High recurrence rate • 1-2% benign pulm. Mets • 10 malignant GCT <1% • Rare polyostotic form <1%

  6. Location

  7. Presentation • Pain x wks. – mos. • Swelling • Mass • Pathologic # • Neuro deficit (spine / sacrum) • incidental

  8. Radiology • Lytic lesion • Epipyseal • Eccentric or central • Narrow zone transition • Cortical thinning • expansile • No sclerotic margin

  9. Imaging • Occ. Cortical breakthrough • +/- soft tissue mass • Extend to subarticular cortex • Typically no host response • Often large @ presentation

  10. Other modalities • CT • Integrity cortical rim • MRI • Assess subchondral breakthrough • Bone Scan • Suspect multicentri loci • ie. HAND

  11. DDx • Consider: Age & Location • Fibrogenic/Telangiectatic Osteosarcoma • MFH • Brown tumor • Chondroblastoma • ABC • Chondromyxoid fibroma (rare) • Mets / Myeloma

  12. Histology • Fibrohistiocytic origin • Multinucleated giant cells • Mononuclear stroma • Round / ovoid / spindle • Indistinct cell membrane • Mitoses • Giant cells 20 fusion stromal cells

  13. Gross

  14. Enneking Staging

  15. Biopsy • Necessary for Dx • Tumor principles • Histologic grade not helpful • R/O 10 malignant GCT • Occ assoc. • ABC • Pagets

  16. Curettings

  17. Tx • Controversial • Traditionally: • Intralesional curettage / resection & bone graft • Recurrence 35-42% • En Bloc resection • Recurrence ~10% • Multiple complications • Adjuvant

  18. Curettage • Wide decortication (windowing) • Curettage / high speed burr • Aggressive • Choice of adjuvant

  19. Adjuvant Tx • Radiation - ~10% sarcomatous degeneration • PMMA, Liquid N2, Phenol, CO2 laser, Electrocautery • Local extension of margin • Kill residual foci

  20. PMMA • Fill tumor cavity • Heat kill of tumor cells? • Effect size dependent • 8-26% recurrence • Easy recurrence detection • Degenerative changes

  21. Recurrence

  22. Subchondral bone grafting

  23. Cryotherapy • 3 freeze thaw cycles • Irrigate cartilage with cool saline • Circumferential necrosis • “difficult” • Complications • Soft tissue injury • Late fractures

  24. Cryotherapy

  25. Phenol • Wash cavity • Alcohol rinse • 10-20% recurrence

  26. Enbloc Resection • Expendable bones • Prox fibula / Distal ulna • High recurrence with other Tx • Hand / Distal radius • Recurrence • Pathologic # • Joint involvement • Osteochondral allograft reconstruction

  27. Reconstruction

  28. Spine • < 3% vertebrae above sacrum • All levels affected equally • Affects vertebral body c ext. pedicle • Resection with stabilization • Often incomplete • ?radiation as adjuvant (low dose 3000 Gyc) • Incomplete excision • Local recurrence

  29. Sacrum / Pelvis • Intalesional excision • Adjuvant • +/- radiation

  30. Pelvis • GCT often vascular • Pre-op angiography • ? embolization

  31. Angiography

  32. Outcome

More Related