This document summarizes information about giant cell tumors (GCT), including their history, definition, epidemiology, presentation, diagnosis and management. GCTs are benign bone tumors composed of stromal cells and multinucleated giant cells. They most commonly affect long bones of the extremities in patients aged 20-40. Diagnosis is made through imaging studies and biopsy. Treatment involves surgical curettage with or without adjuvants like phenol or liquid nitrogen. Wide excision or en bloc resection may be needed for more aggressive tumors.
2. History
First described in 1818 by Sir Astley
Cooper
Dr. Paget called it “brown or Myeloid
tumour” in 1853
WHO- ‘ an aggressive potentially
malignant lesion’
Described in detail in 1940 by Jaffe and
Litchenstein
3. GIANT CELL TUMOUR
DEFINITION:
Distinct neoplasm arising from non-bone
forming supportive connective tissue of
marrow with network of stromal cells regularly
interspersed with giant cells.
( Jaffe & Liechtenstein )
4. EPIDEMIOLOGY
5% OF ALL SKELETAL TUMOURS
21% OF BENIGN TUMOURS
PREPONDERANCE OF GCT COMMOM FEATURE
OF MANY REPORTS FROM INDIA
INCIDENCE IS 30% OF ALL BONE TUMOURS IN
INDIA
5. AGE OF PRESENTATION
70% OF PATIENTS 20-40YRS
10% >65 yrs
<5% in patients with open physis
6. SITE
Epiphyseo-metaphyseal
region of long bones, usually
eccentrical
GCT –Described from all bones
EXCEPT middle ear bones
Axial skeleton- 8%
UL:LL-1:3
10. Types
Benign
Malignant- less than 5% cases
primary –extremely rare and defined as
sarcomas that arise within lesions that otherwise
are typical of benign GCT secondary- sarcomas
that arise at the sites of giant cell tumour that
have been treated usually with radiation
13. Clinical Picture
Overlying skin is stretched , shiny
with no engorged veins.
● PALPATION- The swelling is
warm , smooth with variable
consistency, predominantly
bony and tenderness is present
on firm palpation.
● EGG SHELL CRACKLING-
ELICITABLE WHEN THERE
IS PATHOLOGICAL
FRACTURE OR TOO MUCH
THINNING OF CORTEX.
16. CAMPANACCI RADIOGRAPHIC GRADING
●Grade 1- tumor has
well marginated
border of a thin rim
of mature bone, and
the cortex is intact
or slightly thinned
but not deformed.
17. CAMPANACCI RADIOGRAPHIC GRADING
●Grade 2- tumor has
relatively well defined
margins, but no radio
opaque rim, cortex is
thin and expanded but
is present.
21. ● Subcortical
destruction can be
well appreciated
with a ct scan.
● Limitation- soft
tissue extension of
tumour and its
relationship with
adjacent structures
cannot be seen .
22. M.R.I
● With mri the
morphologic analysis
and extent of disease
into surrounding soft
tissue can be
assessed.
● As in CT SCAN, sub
cortical destruction
can be well
appreciated by
multiplanar mri.
26. Tumour marker
Total serum acid phosphatase (TACP) could be
used as a tumour marker for monitoring response
to treatment of GCT
High preoperative TACP value normalizes after
surgical excision
TACP level in GCT correlates with tumour size
27. Biopsy
This is the final diagnostic tool for
diagnosis of gct.
Sample can be taken by
●FINE NEEDLE ASPIRATION
●CORE NEEDLE BIOPSY
●OPEN INCISIONAL BIOPSY
●EXICISIONAL BIOPSY
28. GROSS APPEARANCE
● Epiphyseal end of long bone
will be expanded with thining
of periosteum and cortex,
being easily broken by
handling.
● Composed of ragged , very
friable, readily bleeding
tissue containing variously
sized cavitations and small
cysts.
29. ● colour -varies from reddish
brown to chocolate color in
which vascular tissue
predominates , to greyish or
mottled where connective
tissue is major component.
● no evidence of periosteal new
bone formation.
● the inner wall of tumor is lined
by a fibrous capsule from
which the septae extend
inwards to partition the tumor.
31. ● GIANT CELLS in this
tumor are
characteristic and
specific having size of
10 to 100 microns with
centrally placed
uniform sized nuclei
numbering 15 to 150
max.
● SPINDLE CELLS- They
are oval ,elongated and
contain relatively large
chromatinized nucleus
and small acidophilic
cytoplasm
32. Giant Cell Variants
1.Aneurysmal bone cyst
2.Brown tumor of
hyperparathyroidism
3.non ossifying fibroma
4.Unicameral bone cyst
5.Fibrous dysplasia
37. Excision :
this is the treatment of
choice when the tumour
affects a bone whose
removal does not hamper
with function e.g fibula
Excision with
reconstruction
~ arthrodesis by
Turn –o- Plasty
~ fibular grafting
~ replacement
