Giant cell tumor of bone is a benign but aggressive tumor comprising 5% of bone tumors. It typically occurs in the long bones of the lower extremity in 20-40 year olds. Diagnosis is made based on imaging showing an eccentric, osteolytic lesion extending into the subchondral bone. Treatment involves curettage with phenolization or cryosurgery to minimize the high recurrence rate of 40-60%.

1. Giant Cell Tumor of Bone
An examination of benign and
malignant tumors of bone and a
case study involving the foot

2. Giant Cell Tumor of Bone
• Comprises 5% of bone tumors.
• 3% present in the lower extremity.
• Seen in 20-40 year old patient, with a
predisposition of 1:1 male to female.
• Pain is the most common
presentation, followed by local
swelling and limitation of motion.
• Usually epiphyseal involvement in
mature bone and metaphyseal in
immature bone.
• An eccentric, osteolytic lesion,
extending to subchondral bone
causing cortical thinning and
expansion with a delicate trabecular
pattern.
• Neither a sclerotic rim nor a
periosteal reaction is usually seen.

3. Giant Cell Tumor of Bone
• Associated with Paget’s disease, but then only
appears in the skull. Rare to find in the skull when
not assoc. with Paget’s disease
• Diagnosis is complicated by the similar appearence
of a lesion known as a giant cell reparative
granuloma
• Can be transformed in Paget’s to metastatic
carcinoma to the lung
• Other neoplastic involvement in Paget’s includes
sarcomatous degeneration

4. Giant Cell Tumor of Bone
• Considered a benign, but aggresive tumor of bone
• Aggresive nature demonstrated by the violation of
the cortex and involvent to adjacent soft tissue
• Transformation to malignant tumor is 5% to 10%
• Caused primarily by irradiation of the tumor
• Will transform to a fibrosarcoma, osteosarcoma,
malignant fibrous histiocytoma

5. Giant Cell Tumor of Bone
• Malignant Tumors
• Benign Tumors
– Osteosarcoma
– Osteochondroma
– Osteosarcoma Variants:
– Enchondroma
• Parosteal
– Chondroblastoma • Periosteal
– Osteoblastoma • Small Cell
– Osteoid Osteoma – Chondrosarcoma
– Malignant Fibrous Histiocytoma
– Unicameral Bone Cyst
– Fibrosarcoma
– Fibrous Dysplasia
– Ewing’s Sarcoma
– Giant Cell
– Metastatic Carcinoma
– Non-ossifying Fibroma
– Others:
– Eosinophillic Granuloma
• Lymphoma
– Chondromyxoid Fibroma – Non-Hodgkins
– Hodgkins
– Aneurysmal Bone Cyst
• Multiple Myeloma
• Leukemia

6. Giant Cell Tumor of Bone
• Differential Diagnosis would include:
– Metastatic Carcinoma (differentiate from brown cell tumor)
– Chondroblastoma (occurs in immature skeleton, calcifies)
– Intraosseous ganglion (usually at the medial malleolus, carpal bones or periarticular
region of the hip. They are multilocular with a sclerotic margin and associated with soft
tissue ganglions.)
– Subchondral Cysts (occur in RA, Gout, CPPD, Hemophilia, Pigmented Villonodular
Synovitis. These cysts are usually multiple, communicate with the joint and are associated
with additional articular abnormalities.)
– Aneurysmal Bone Cyst
– Fibrous Dysplasia
– Eosinophilic Granuloma
– Brown Tumors
– Giant Cell Reparative Granuloma (occur at facial bones, in females, the young and
present with swelling, pain, headache, diplopia, epistaxis)
– Amelonotic Melanoma

7. Giant Cell Tumorbone Bone
of
Common tumors of
and where they occur

8. Giant Cell Tumor of Bone
• Treatment:
– Currettage
• associated with a high recurrance rate when used alone
– En Bloc excision
– Amputation (if the tumor has penetrated the joint)
– It is recommended that phenolization or cryosurgery be used after
curretage
– Bone chips or PMMA (polymethylmethacrylate) used to fill the defect left
at site of excised tumor
– Irradiation is contraindicated due to the high incidence of recurrence and
possible transformation to fibrosarcoma or osteogenic sarcoma
– Rates of recurrence stands at 40%-60%, within 2 years and usually at
original site of tumor
– Transformation to malignant tumor is 5% to 10% and occurs after
irradiation of tumor

9. Giant Cell Tumor of Bone
• Case Study
• 24 year old White male
• Presents to F&A Institute for treatment of pain in right ankle of 4 months
duration. Patient reports sprain of same ankle 2 years ago with frequent
turns afterwards. Pain is sharp, and without radiation. No other
examination is contributory except for the orthopaedic exam which reveals
crepitus at the right ankle upon ROM., and the dermatologic exam, which
divulged a palpable, non-fluctuant mass at the inferior area of the right
medial malleolus.
• Pt. is scheduled to have an MRI study performed on the right ankle and foot.
• Diagnosis of giant cell tumor of bone made by radiologist and pathology.
• Pt. is operated and excison of bone tumor undertaken. Area is packed with
bone chips.
• After 6 months of casting treatment, patient undergoes physical therapy and
is informed of future possibility of fusion to address pain.

10. Giant Cell Tumor of Bone
• Conclusions
• Giant Cell tumor is an uncommon tumor presenting in
the bones of the lower extremity
• When occurring, the tumor must be treated by means
which will allow total excision, as the recurrence rate is
high
• If seen in the facial bones, it is assumed to be secondary
to Paget’s disease until proven otherwise. There is a high
association of metastasis to the lung in these patients
• Treatment should be en bloc, or if curretage is used,
cryosurgical or phenol ablatement should be used
• Area can be packed with bone, or with PMMA