0
Prepared By-Dr. Md Nazrul IslamMBBS, M . sc. (BME).
Contents   Overview   Epidemiology   Incidence   Presentation   Radiology   Diagnosis   Treatment   Outcomes
Overview Giant cell myeloma or  Osteoclastoma Primary bone neoplasm Generally benign, locally invasive Presence of mul...
Epidemiology   5-10% of primary bone tumors   20% of benign   F : M = 1.5 : 1   70-80% occurs at age 20-40   Epiphyse...
Incidence   Affects Ends of long bones   >50% around knee   High recurrence rate   1-2% benign pulm. Mets   Primary m...
Location Common       sites:   Distal femur   Proximal tibia   Distal radius   Proximal humerus   Other sites:   Fi...
Presentation   Pain – ends of long bone   Swelling - mild to moderate   Visible Mass   Pathologic # (10-15%)   Limite...
Radiology   Lytic lesion   Epiphyseal , Eccentric, Expansile   Narrow zone transition   Soap bubble appearance   Cort...
Radiology(con…)•   Occ. Cortical breakthrough    •   +/- soft tissue mass•   Extend to subarticular cortex•   Often large ...
Other modalities CT   Integrity of cortical rim MRI   Assess subchondral breakthrough Bone Scan   Decreased radioiso...
Biopsy   Needle(accuracy >90%) &    excisional   Tumor principles , histologic    grade    Necessary for Dx.   Occ ass...
Gross Soft,brown mass Area of  haemorrhage (dark  red) Area of collagen  (gray)
Histology Fibrohistiocytic origin Multinucleated giant cells        Fusion of stromal cells        Uniformly distributed...
Enneking Staging             Stage 1 Stage 2 Stage 3             (latent) (active) (aggressi                              ...
Angiography Neovascularity with  intense, inhomogen  eous capillary blush Intra & extra  osseous extent
Sacrum / Pelvis
Differential Diagnosis   Aneurismal bone cyst (ABC)   Simple/solitary bone cyst   Chondroblastoma   Brown    tumor(hyp...
Treatment     Surgical    Intralesional curettage / resection &     bone graft (Rec.35-42%)   En Bloc resection   Curett...
Curettage,  electrocautery & bone graft Wide decortication  (windowing) Curettage / high  speed burr Recurrence 10-  20%%
Curettage,chemical cautery & bone graft  Phenol   5-80% phenol   Wash cavity with 70% Alcohol   10-20% recurrence  Disa...
Adjuvants    Liquid N2, Phenol, CO2    laser,H2O2    Electrocautery     Local extension of      margin     Kill residua...
PMMA Fill tumor cavity Heat kill of tumor cells 8-26% recurrence Easy recurrence detection Degenerative osteoarthriti...
Recurrence
Subchondral bone grafting
Enbloc Resection Expendable bones   Prox fibula / Distal ulna High recurrence with  other Tx   Hand / Distal radius P...
Cryotherapy   3 freeze thaw cycles   Irrigate cartilage with cool saline   Circumferential necrosis   “difficult”   R...
Excision & reconstruction Turn-O-plasty Arthrodesis Arthroplasty
Excision & reconstruction(Con..)
AmputationWidespread aggressive tumourLast resort
Non surgical Rx Irradiation therapy is for cases where  surgery not performed safely or effectively Malignant change 15%...
Metastasis Lung, Lymph node(rare) After 3-5 years Spontaneously regress,static,grow slowly  or rapidly Mortality 15-25...
Follow-up Observation   at least 5 years Physical examination & radiology  – affected site, lung Relapse – pain, swelling
Spine   < 3% vertebrae above sacrum   All levels affected equally   Affects vertebral body   Resection with stabilizat...
Sacrum / Pelvis GCT    often vascular   Pre-op angiography   Embolization, Intalesional    excision or radiation
Outcome Prognosis is good, despite of  recurrences and pulmonary metastases Depends on surgical technique and  expertise...
"GIANT CELL TUMOR" : CASE PRESENTATION- At Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
"GIANT CELL TUMOR" : CASE PRESENTATION- At Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
Upcoming SlideShare
Loading in...5
×

"GIANT CELL TUMOR" : CASE PRESENTATION- At Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh

1,162

Published on

"GIANT CELL TUMOR" : CASE PRESENTATION- At Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,162
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
52
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of ""GIANT CELL TUMOR" : CASE PRESENTATION- At Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh"

  1. 1. Prepared By-Dr. Md Nazrul IslamMBBS, M . sc. (BME).
  2. 2. Contents Overview Epidemiology Incidence Presentation Radiology Diagnosis Treatment Outcomes
  3. 3. Overview Giant cell myeloma or Osteoclastoma Primary bone neoplasm Generally benign, locally invasive Presence of multinucleated giant cell Potential for :  Recurrence  Pulmonary metastasis  Frank malignancy
  4. 4. Epidemiology 5-10% of primary bone tumors 20% of benign F : M = 1.5 : 1 70-80% occurs at age 20-40 Epiphyseal Monostotic Rare in skeletally immature
  5. 5. Incidence Affects Ends of long bones >50% around knee High recurrence rate 1-2% benign pulm. Mets Primary malignant GCT<1% Rare polyostotic form <1%
  6. 6. Location Common sites: Distal femur Proximal tibia Distal radius Proximal humerus Other sites: Fibula , distal tibia Bones of pelvis, sacrum Vertebral body
  7. 7. Presentation Pain – ends of long bone Swelling - mild to moderate Visible Mass Pathologic # (10-15%) Limited range of motion Fluid accumulation in adjacent joint Rarely Neuro deficit if spine / sacrum involved
  8. 8. Radiology Lytic lesion Epiphyseal , Eccentric, Expansile Narrow zone transition Soap bubble appearance Cortical thinning Non sclerotic , sharply defined margin
  9. 9. Radiology(con…)• Occ. Cortical breakthrough • +/- soft tissue mass• Extend to subarticular cortex• Often large presentation
  10. 10. Other modalities CT  Integrity of cortical rim MRI  Assess subchondral breakthrough Bone Scan  Decreased radioisotope uptake in the center of lesion (Multicentric GCT)
  11. 11. Biopsy Needle(accuracy >90%) & excisional Tumor principles , histologic grade Necessary for Dx. Occ assoc.  ABC  Pagets
  12. 12. Gross Soft,brown mass Area of haemorrhage (dark red) Area of collagen (gray)
  13. 13. Histology Fibrohistiocytic origin Multinucleated giant cells Fusion of stromal cells Uniformly distributed Mononuclear stromal cell Round / ovoid / spindle Indistinct cell membrane Prominent mitotic activity
  14. 14. Enneking Staging Stage 1 Stage 2 Stage 3 (latent) (active) (aggressi ve)Pt % 10-15% ~70% 10-15%Symptoms Asymptom Pain Pain aticRadiograph Non Expanded Cortical sclerotic cortex Break rimHistology Benign Benign Benign
  15. 15. Angiography Neovascularity with intense, inhomogen eous capillary blush Intra & extra osseous extent
  16. 16. Sacrum / Pelvis
  17. 17. Differential Diagnosis Aneurismal bone cyst (ABC) Simple/solitary bone cyst Chondroblastoma Brown tumor(hyperparathyroidism)
  18. 18. Treatment Surgical Intralesional curettage / resection & bone graft (Rec.35-42%) En Bloc resection Curettage & bone cementation(PMMA) Curettage & cryosurgery Excision & reconstruction Amputation Non surgical Irradiation therapy Embolization of feeding vessels
  19. 19. Curettage, electrocautery & bone graft Wide decortication (windowing) Curettage / high speed burr Recurrence 10- 20%%
  20. 20. Curettage,chemical cautery & bone graft Phenol  5-80% phenol  Wash cavity with 70% Alcohol  10-20% recurrence Disadvantages  Systemically toxic  Chemical burn
  21. 21. Adjuvants Liquid N2, Phenol, CO2 laser,H2O2 Electrocautery  Local extension of margin  Kill residual foci
  22. 22. PMMA Fill tumor cavity Heat kill of tumor cells 8-26% recurrence Easy recurrence detection Degenerative osteoarthritis Difficulty in removing
  23. 23. Recurrence
  24. 24. Subchondral bone grafting
  25. 25. Enbloc Resection Expendable bones  Prox fibula / Distal ulna High recurrence with other Tx  Hand / Distal radius Pathologic # Joint involvement Recurrence ~10%
  26. 26. Cryotherapy 3 freeze thaw cycles Irrigate cartilage with cool saline Circumferential necrosis “difficult” Recurrence 2-12% Complications  Soft tissue injury  Late fractures
  27. 27. Excision & reconstruction Turn-O-plasty Arthrodesis Arthroplasty
  28. 28. Excision & reconstruction(Con..)
  29. 29. AmputationWidespread aggressive tumourLast resort
  30. 30. Non surgical Rx Irradiation therapy is for cases where surgery not performed safely or effectively Malignant change 15% Embolization of feeding vessels by catheter – shrink/disappearance of tumour Drugs e,g interferon – shrink/disappearance of tumour
  31. 31. Metastasis Lung, Lymph node(rare) After 3-5 years Spontaneously regress,static,grow slowly or rapidly Mortality 15-25% Rx- wide resection,iradiation,interferon
  32. 32. Follow-up Observation at least 5 years Physical examination & radiology – affected site, lung Relapse – pain, swelling
  33. 33. Spine < 3% vertebrae above sacrum All levels affected equally Affects vertebral body Resection with stabilization Resection often incomplete Radiation as adjuvant (low dose 3000 Gyc)  Incomplete excision  Local recurrence
  34. 34. Sacrum / Pelvis GCT often vascular Pre-op angiography Embolization, Intalesional excision or radiation
  35. 35. Outcome Prognosis is good, despite of recurrences and pulmonary metastases Depends on surgical technique and expertise and the histological grade of this tumour Angiovascular invasion does not have any significant influence on its prognosis The mortality rate is about 4%.
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×