1. Volume 10
Giant cell tumor of bone-------Case 207-213 & 1040-1093

2. Giant Cell Tumors

3. Giant Cell Tumor of Bone
There are numerous primary tumors of bone with giant cell or
or macrophage activity seen within the tumor under the microscope.
These include the aneurysmal bone cyst, chondroblastoma, solitary
bone cyst, osteoid osteoma, osteoblastoma, fibrous dysplasia and
osteogenic sarcoma, hemorrhagic type. Some pathologists classify
these tumors as variants of the true giant cell tumor making it almost
a diagnosis of exclusion if none of the above diagnoses can be
established histologically. The clinical entity known as the benign
giant cell tumor of bone is seen typically in young adult females
between the ages of 20 and 40 years. It is less common in males. The
lesion is usually found in the ends of long bones, most commonly
about the knee joint where 50% of the lesions will be seen. The next
most common locations are the sacrum and distal radius. The other
epiphyseal tumor seen in children is the chondroblastoma that also
has giant cell activity in the tumor. Even the so-called brown tumor
of hyperparathyroidism has excessive macrophage activity but is a

4. pseudotumor induced by parathormone producing lesions such as
parathyroid adenomas and secondary hyperparathyroidism seen in
renal failure disease.
Currently most experts feel that the giant cell tumor is a low-grade,
benign mesenchymal tumor with a fibro-osteoblastic stem cell with a
molecular genetic defect similar to the stem cell of the osteosarcoma
but with a greater degree of molecular genetic stability. The giant cell
seen in this tumor is simply an immune response by the host in an
attempt to remove the neoplastic fibro-osseous tissue. Giant cell
tumors account for between 5-10 per cent of all benign tumors of the
skeletal system. They are usually associated with pain in the adjacent
joint involved, such as the knee joint, which may cause an effusion.
radiographically, the lesion is very characteristic because of its purely
lytic nature that can be very geographic in nature, located in the
epiphyseal-metaphyseal location of a long bone, frequently coming in
direct contact with the subchondral bone of the adjacent joint. In more
aggressive cases, the lesion can break through the adjacent metaphyseal

5. cortex and gain access to the subperiosteal space and take on the
appearance of a more malignant process, such as a hemorrhagic
osteosarcoma.
Even though this condition is considered benign with a very low
mitotic index seen in the stromal cells, one or two per cent of the
tumors can metastasize to the lung as a benign process. There is an
excellent prognosis for cure with simple surgical resection in 80% of
the cases. Treatment usually consists of an aggressive curettement
of the tumor followed by a packing of the defect with either bone
graft, in smaller lesions, or more typically with bone cement in
larger lesions which gives a better chance of a permanent cure with
about a 5 to 10% recurrence rate with the cementation technique. In
more aggressive lesions located in the sacrum or anterior portion
of the spinal column, surgical resection is very difficult because of
the adjacent nerve roots or spinal cord, in which case occasionally
local radiation is used. However, in about 5% of cases, this can
convert the tumor into a high-grade tumor sarcoma at a much later

6. date. The tumor also has the potential for spontaneous conversion
to a high grade tumor, such as an osteosarcoma or a malignant
fibrous histiocytoma, in about 1% of cases.
Giant cell tumors that have a local recurrence have a greater
potential for pulmonary metastasis, running as high as 6% and, for
this reason, chest x-rays should be obtained periodically for a
period of approximately three years after the primary treatment of
the tumor.

7. CLASSIC
Case #207
23 year female with
GCT proximal tibia

8. Rapid progression
5 months later

9. Tumor breaking thru periostium of tibia

10. Curettement of tumor thru cortical window

11. Photomic showing giant cells

12. femoral
condyle
Appearance of tumor cavity following curettement

13. Light coming thru tibial plateau articular cartilage

14. Cleaning up tumor cavity with high-speed burr

15. Further clean up with waterpic lavage

16. Lysis of remaining
tumor cells with
3% hydrogen peroxide

17. Washing tumor cavity with peroxide

18. Tumor cavity clean ready for cementation

19. Placement of large threaded Steinman pins

20. cement
2 stage cementation completed

21. Placement of autogenous cancellous graft

22. Immediate post op
radiograph

23. 18 months later
without recurrence
bone
graft

24. 16 years later came
to a routine TKA
old cement

25. AP view

26. Case #208
28 year male
GCT distal radius

27. Coronal T-1 MRI

28. Axial T-2 MRI showing multiple hemorrhagic cysts

29. ulna radius
X-ray following wide resection and transpostion of the
distal ulna with it’s blood supply and fixed with plates
and fused to carpus

30. Case #208.1 GCT radius
67 year old female with wrist pain 6 months

31. Coronal T-1 T-2 Gad C+

32. Sagittal T-1 T-2 Gad C+

33. T-1 Axial T-2
Gad

34. Post op x-ray following curettage and cementation

35. Case #209
59 year female with GCT sacrum

36. CT scan

37. Bone scan

38. 9 years post curettement and radiation

39. Lateral view at 9 years and no recurrence

40. Case #210
49 year male 10 yrs
post op bone graft old
plus radiation therapy graft
for GCT with current
radiation sarcoma

41. Coronal T-2 MRI
showing high signal
sarcoma

42. graft
Amputation specimen cut in path lab

43. Photomic showing pleomorphic sarcoma cells

44. Case #211
radius
45 year male with spontaneous conversion of GCT
to OGS 15 yrs post curettement without RT

45. Sagittal T-1 MRI

46. Axial T-1 MRI

47. Case #212
25 year male
aggressive GCT
proximal humerus

48. Case #212.1 GCT
22 year old female with
shoulder pain for 3 months

49. Cor T-1 T-2
Gad

50. PO #1 PO #2
PO #2 PO #3
3 mos

51. Case #213
Sagittal proton density
MRI of a 19 year
female with GCT T-1

52. Biopsy photomic

53. Sagittal T-1 MRI
2 years post op anterior
interbody fusion
without recurrence

54. Sagittal proton density
MRI one year later
showing recurrence and
cord compression

55. Coronal post gad contrast MRI

56. Surgical decompression and reconstruction

57. Anterior reconstruction
with bone cement and
titanium screw

58. cement
Post op sagittal T-1 MRI showing cord decompression

59. CT scan of chest shortly after spinal surgery
showing multiple pulmonary mets

60. tumor
lung tissue
Photomic showing benign GCT met in lung

61. Sagittal T-1 MRI
1 year later showing
recurrent tumor and
cord compression

62. osteoid
Biopsy photomic showing OGS

63. Case #1040
35 year male with
path fracture lateral
femoral condyle thru
GCT

64. Lateral view

65. Coronal T-1 MRI

66. Axial T-1 MRI

67. Sagittal T-1 MRI

68. Sagittal T-2 MRI

69. Coronal gad contrast MRI

70. fracture
Surgical specimen with resection distal femur

71. Tumor breaking out of back of lat fem condyle

72. Photomic

73. taper
spindle
anchor
Compress system used for reconstruction

74. spindle
Belleville washers
Anchor plug
Disarticulated Compress device

75. spindle compression nut
Belleville washers

76. Placement of anchor plug pins thru guide

77. Cementing tibial
component

78. Completed rotating hinge TKA

79. anchor
2 months post op

80. Lateral view

81. Case #1041
20 year female with
path fracture thru GCT
lateral femoral condyle

82. Oblique view

83. Lateral view

84. Photomic

85. Photomic showing foam cells

86. Steinman pins
Fracture reduced and fixed with 1st batch of cement

87. fracture line
Second batch of cement

88. 1 year post op with
normal knee function

89. Lateral view

90. Case #1042
35 year male with GCT
distal femur

91. Surgical exposure of tumor

92. Curetted specimen

93. Photomic showing neoplastic osteoid formation

94. Tumor cavity following aggressive curettement

95. cement
Completion of a 2 stage cementation

96. 4 years post op showing
radiolucent cement and
Steinman pins

97. 12 years and working
full time as electrician

98. 26 years and shows
early signs of DOA

99. Lateral view

100. Case #1043
32 year male with GCT distal femur

101. Sagittal T-1 MRI

102. Axial T-2 MRI

103. Case #1044
17 year female with
GCT lateral femoral
condyle

104. Lateral view

105. CT scan

106. 1 year PO excisional
arthrodesis with titanium
spacer & cancellous
allograft

107. Case #1045
20 year female with
GCT distal femur

108. 1 year after cementation
procedure

109. 4 years later with normal
function of knee

110. 6 mos following a traumatic
fracture of tibia and again
normal knee function

111. Case #1046
37 year female with prior
cementation procedure for
GCT followed later with
a recent removal of cement
and replacement with present
cancellous allograft

112. 1 year later with collapse of
patellofemoral joint and loss
of active knee extension

113. Lateral view showing
patella collapsed into
tumor cavity

114. Patellar-femoral view

115. Sagittal T-1 MRI

116. Axial T-1 MRI
showing anterior
collapse of lateral
femoral condyle

117. Surgical exposure at time of patellofemoral reconstruction
with early findings of degenerative osteoarthritis

118. Removal of cancellous allograft placed over one year ago

119. Placement of Steinman pins ready for cementation

120. Completion of patellofemoral arthroplasty

121. One year later with
near normal ROM
of knee

122. Lateral view

123. Case #1047
45 year female with
GCT lateral femoral
condyle

124. Lateral view

125. CT scan

126. Immediate post op
X-ray following
cementation procedure

127. 4.5 years later with signs
of recurrent tumor at
upper pole of cement

128. Lateral view

129. CT scan showing recurrence of GCT

130. Bone scan shows
recurrence also

131. 1 year following a redo
cementation procedure
with no recurrence

132. Lateral view

133. Case #1048
23 year male with recurrent
GCT following a prior
curettement and cementation

134. AP view
cement

135. recurrent
tumor
Cut specimen in path
lab following wide
resection and rotating
hinge arthroplasty
cement

136. Photomic

137. GCT 9/07
Case #1048.1
29 year male with
knee pain 3 months

138. 10/07
Cor T-2 Gad

139. Axial T-1 PD
Gad

140. 10/07
Sag T-2 Post op

141. 12/08
Recurrence 1 yr
later

142. 12/08
Axial T-1 T-2

143. Recementation 12/08

144. Case #1048.2
GCT
23 yr female with pain
R knee for 3 months

145. Cor T-1 T-2
Gad

146. Sag T-1 PD FS

147. Axial T-2 Gad

148. Post op x-ray

149. Case #1049
R L
50 year male with pain L knee 2 mos but normal x-ray

150. Lateral view shows questionable lysis distal femur

151. 4 months later with
obvious lytic changes

152. Lateral view

153. Coronal PD MRI

154. Axial PD MRI

155. 1 year post op
with cementation
and side plate

156. Case #1050
16 year female with
GCT distal femur

157. 2 mos post op bone
graft with recurrence

158. 4 mos post op and
even more signs of
recurrence

159. Surgical curettement of recurrent tumor

160. Photomic of recurrent tumor

161. Higher power with osteoid formation

162. Surgical appearance following curettement

163. Placement of Steinman pins prior to cementation

164. Cementation completed

165. 9 months post radiolucent
cementation and 6500
rads of RT

166. 13 years post op with
multiple path fractures
thru radiated bone with
multiple surgeries to fix
these fractures

167. 20 years after 1st surgery with continued stress fractures

168. Shortly after last x-ray she developed pulmonary mets
2nd to radiation OGS seen in this photomic of lung biopsy

169. Case #1051
GCT
19 year female with
GCT distal femur and
ABC proximal tibia
ABC

170. Lateral view

171. Coronal T-1 MRI

172. GCT
Coronal T-2 MRI
ABC

173. Photomic from femoral biopsy showing GCT

174. Case #1052
69 year male with prior
history of GCT distal
femur treated with curettement
and bone graft 35 years ago.
Now has a path fracture thru
OGS at the same site
old bone graft

175. Biopsy photomic shows OGS

176. CT scan shows metastatic OGS to inguinal lymph node

177. Case #1053
31 year male with GCT
femoral neck

178. Coronal T-1 MRI

179. Axial T-2 MRI

180. Axial T-2 MRI
at lower level

181. Bone scan

182. Biopsy photomic

183. Post op curettement with cementation and pins

184. Case #1054
34 year female with GCT
femoral neck 2 mos. PO
DHS fixation but no
removal of tumor

185. 3 months PO complete
curettement thru anterior
approach and cementation
with DHS screw

186. 5 years later with good
calcar hypertrophy and
normal hip function

187. Lateral view

188. Case #1055
39 year male with early GCT femoral head

189. 5 months later without treatment

190. Coronal T-1 MRI

191. Coronal T-2 MRI

192. Post op x-ray showing bipolar prosthesis

193. Case #1056
44 year male with GCT
proximal femur

194. Coronal T-1 MRI

195. Photomic

196. 14 months post op
cementation and pins

197. Case #1057
tumor
46 year female with GCT pelvis

198. CT scan

199. Photomic

200. 6 months post op cementation with pins

201. Lateral view

202. Two years post op

203. Case #1058
29 year female with GCT
supra acetabular area

204. 1 year later with central
fracture dislocation hip

205. 4 years post op Tronzo
THA

206. Case #1059
73 year female with prior
GCT tibia treated with
curettage and cementation

207. Shortly after she
developed this second
GCT in ilium

208. tumor
CT scan

209. Photomic showing tumor osteoid

210. More tumor osteoid

211. Later she developed a
recurrence in the tibia
which led to an AK amp
and then developed the
path fracture in femoral
stump seen here thru yet
another multifocal GCT
Later on she developed
benign pulmonary mets
and died 6 mos later while
on chemotherapy

212. Case #1060
31 year male with GCT patella

213. 17 months following
curettage with recurrent
tumor

214. Photomic

215. Case #1061
30 year female with
path fracture thru GCT
lateral tibial plateau

216. Lateral view

217. Surgical specimen from prox tibial resection

218. Surgical specimen showing lateral plateau fracture

219. Cut specimen in path
lab showing plateau
fracture into tumor

220. Photomic

221. Placement of cemented
long stem hinged
knee prosthesis
cement

222. Post op x-ray with
hinge prosthesis and
radiolucent cement

223. Case #1062
35 year male with GCT
proximal tibia

224. 6 months post op
cementation with
painful chondrolysis
medial joint space

225. Post op revision to a
unicondylar prosthesis

226. Lateral view

227. Case #1063
17 year female with
GCT proximal tibia

228. Surgical curettement of tumor

229. Curetted specimen

230. Yellow portion of specimen showing foam cells

231. burr
Tumor cavity following aggressive curettement

232. radiolucent
cement
Cementation completed

233. 2 year post op with
radiolucent cement

234. Case #1064
27 year female with
GCT proximal tibia

235. Lateral view

236. Sagittal T-1 MRI

237. Coronal T-2 MRI

238. Case #1064.1
14 yr female with knee pain for 3 months

239. Axial T-1 T-2 FS
Gad

240. Sag T-1 STIR
Gad

241. Cor Gad

242. Case #1064.1 GCT pseudotumor Geode in DOA
52 yr female with pain in knee for 1 yr

243. Cor T-1 T-2

244. Axial T-2
Sag T-1

245. Case #1064.2 GCT pseudotumor - geode
61 year male with increasing pain in knee for 5 years

246. CT scan

247. Cor T-1 T-2 Gad

248. Sag T-1 T-2 Gad

249. Axial T-1 T-2
Gad

250. Case #1065
25 year female with
aggressive GCT
proximal tibia

251. Lateral view prior to
wide resection and
Compress TKA recon

252. Proximal tibial resection specimen

253. Photomic

254. Case #1066
28 year male with GCT
distal tibia

255. Lateral view

256. Immediate post op
cementation procedure

257. 9 months later with
tumor recurrence

258. Post op cementation
revision procedure

259. Case #1067
27 year female with
GCT distal tibia

260. Lateral view

261. Sagittal T-1 MRI

262. Sagittal T-2 MRI

263. Case #1068
42 year female with
GCT distal radius

264. Post op cementation
with pins

265. Lateral view

266. Case #1069
19 year female with GCT distal radius

267. Lateral view

268. 3 years later showing recurrent tumor

269. tumor
Surgical resection specimen

270. Allograft replacement fixed to side plate

271. Allograft reconstruction completed

272. allograft
Early post op x-ray

273. 4 years later showing collapse of allograft

274. Case #1070
74 year female with
path fracture thru
GCT distal radius

275. Resection of distal radius and ulna

276. Distal face of radius engulfed with tumor

277. Macro section of distal radius

278. Photomic

279. carpus
Surgical appearance prior to reconstruction

280. Completion of cemented Volz total wrist arthroplasty

281. Post op x-ray

282. Lateral view

283. Case #1070.1
X-ray of 40 year
male with wrist pain
for 4 months

284. Axial T-1 Axial T-2
hemorrhagic
cysts
Gad C.

285. Sagittal T-1
Sagittal T-2

286. Post op x-ray
following curettment
and cementation with
a single Steinman pin

287. Case #1071
22 year female with
GCT distal ulna

288. Post op Darrach
resection distal ulna

289. Case #1072
29 year female with
GCT distal ulna

290. Case #1073
31 year male with GCT
distal humerus and
proximal ulna

291. Lateral view

292. Axial T-2 MRI

293. Coronal T-2 MRI

294. Post op x-ray with
Compress total elbow
arthroplasty

295. Case #1074
42 year female with large aneurysmal GCT prox radius

296. AP view
This huge benign tumor required an AE amputation

297. Case #1075
31 year male with
prior history of GCT
prox ulna treated 5
years ago with bone
graft and radiation
Now we see x-ray
evidence of OGS
2nd to the radiation

298. osteoid
Photomic of benign GCT 5 yrs ago

299. Photomic of present biopsy showing OGS

300. Numerous large
pulmonary mets seen
following AE amp
and chemotherapy

301. Case #1076
62 year male with GCT proximal humerus

302. Coronal T-1 MRI

303. Axial T-1 MRI

304. Coronal T-2 MRI

305. Photomic

306. Post op cementation
with pins one year later

307. Case #1077
23 year female with
ABC arising from a
GCT of distal humerus

308. Lateral view showing
aneurysmal appearance

309. Sagittal T-1 MRI

310. Sagittal T-2 MRI showing large hemorrhagic cysts

311. Axial T-2 MRI showing fluid-fluid levels

312. Post op cementation
with single pin

313. Lateral view

314. Case #1078
57 year male with GCT body of scapula

315. Case #1079
33 year female with GCT 3rd metatarsal

316. Case #1080
33 year female with
GCT 1st metatarsal

317. Case #1081
10 year male with
path fracture thru a
giant cell reparative
granuloma of the
2nd metatarsal

318. Case #1082
21 year male with
large GCT mid foot

319. Laminogram x-ray

320. Case#1083
26 year male with GCT great toe

321. Case #1084
23 year female with GCT os calcis

322. CT scan

323. Case #1084.1
AP and lat x-ray of a 43 yr. female with GCT talus

324. T-1 MRI
sagittal
coronal axial

325. Sagittal T-2 MRI

326. Sagittal & coronal Gad MRI

327. Post op curettement and cementation

328. Case #1085
31 year male with GCT 2nd metacarpal

329. Case #1086
25 year female with
GCT middle finger

330. Lateral view

331. Case #1087
28 year male with GCT 5th metacarpal

332. Case #1088
44 year male with GCT hamate bone

333. Oblique view

334. Coronal T-1 MRI

335. Axial T-2 MRI

336. Case #1089
35 year female with aggressive GCT finger

337. photomic

338. Pulmonary metastasis

339. Photomic from pulmonary met

340. Case #1090
26 year male with GCT body od L-2

341. AP view

342. Photomic

343. Post op spine fusion

344. Lateral view with post
Harrington rods and
anterior bone graft

345. Case #1091
27 year male with
GCT lumbar spine
treated with anterior
bone graft and post
Harrington rods 6
years ago

346. AP view

347. Case #1092
52 year male with GCT T-1 vertebra

348. R
Bone scan

349. CT scan

350. Case #1093
24 year female with GCT
C-spine 3 years post op
curettement and combined
anterior and posterior
spinal fusion