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
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
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%
Location Common sites: Distal femur Proximal tibia Distal radius Proximal humerus Other sites: Fibula , distal tibia Bones of pelvis, sacrum Vertebral body
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
Radiology Lytic lesion Epiphyseal , Eccentric, Expansile Narrow zone transition Soap bubble appearance Cortical thinning Non sclerotic , sharply defined margin
Radiology(con…)• Occ. Cortical breakthrough • +/- soft tissue mass• Extend to subarticular cortex• Often large presentation
Other modalities CT Integrity of cortical rim MRI Assess subchondral breakthrough Bone Scan Decreased radioisotope uptake in the center of lesion (Multicentric GCT)
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
Metastasis Lung, Lymph node(rare) After 3-5 years Spontaneously regress,static,grow slowly or rapidly Mortality 15-25% Rx- wide resection,iradiation,interferon
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 stabilization Resection often incomplete Radiation as adjuvant (low dose 3000 Gyc) Incomplete excision Local recurrence
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 and the histological grade of this tumour Angiovascular invasion does not have any significant influence on its prognosis The mortality rate is about 4%.
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