Giant

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Giant

  1. 1. Giant Cell Tumor of Bone An examination of benign and malignant tumors of bone and a case study involving the foot
  2. 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. 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. 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. 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. 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. 7. Giant Cell Tumorbone Bone of Common tumors of and where they occur
  8. 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. 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. 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

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