Giant cell tumor of bone

  • 1,272 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
1,272
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
80
Comments
1
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Giant Cell Tumor of Bone
  • 2. Overview Definition Epidemiology Hx Presentation/Exam Radiology Dx Tx Outcomes
  • 3. Definition10 bone neoplasmFirst described Cooper 1818Lebert microscopic description 1845Generally benignPotential for : Recurrence Pulmonary metastasis Frank malignancy
  • 4. Epidemiology5-10% 10 bone tumors20% benign bone tumorsF : M 1.5 : 170-80% age 20-40Rare skeletally immatureEpiphysealMonostotic
  • 5. IncidenceEnds of long bones>50% about kneeHigh recurrence rate1-2% benign pulm. Mets10 malignant GCT <1%Rare polyostotic form <1%
  • 6. Location
  • 7. PresentationPain x wks. – mos.SwellingMassPathologic #Neuro deficit (spine / sacrum)incidental
  • 8. RadiologyLytic lesionEpipysealEccentric or centralNarrow zone transitionCortical thinningexpansileNo sclerotic margin
  • 9. ImagingOcc. Cortical breakthrough +/- soft tissue massExtend to subarticular cortexTypically no host responseOften large @ presentation
  • 10. Other modalitiesCT Integrity cortical rimMRI Assess subchondral breakthroughBone Scan Suspect multicentri loci ie. HAND
  • 11. DDxConsider: Age & Location Fibrogenic/Telangiectatic Osteosarcoma MFH Brown tumor Chondroblastoma ABC Chondromyxoid fibroma (rare) Mets / Myeloma
  • 12. HistologyFibrohistiocytic originMultinucleated giant cellsMononuclear stroma Round / ovoid / spindleIndistinct cell membraneMitosesGiant cells 20 fusion stromal cells
  • 13. Gross
  • 14. Enneking Staging Stage 1 Stage 2 Stage 3Pt % 10-15% ~70% 10-15%Symptoms asymp pain painRadiograph sclerotic expanded cortical rim cortex perforationHistology benign benign benign
  • 15. BiopsyNecessary for DxTumor principlesHistologic grade not helpfulR/O 10 malignant GCTOcc assoc. ABC Pagets
  • 16. Curettings
  • 17. TxControversialTraditionally: Intralesional curettage / resection & bone graft Recurrence 35-42%En Bloc resection Recurrence ~10% Multiple complicationsAdjuvant
  • 18. CurettageWide decortication (windowing)Curettage / high speed burrAggressiveChoice of adjuvant
  • 19. Adjuvant TxRadiation - ~10% sarcomatous degenerationPMMA, Liquid N2, Phenol, CO2 laser,Electrocautery Local extension of margin Kill residual foci
  • 20. PMMAFill tumor cavityHeat kill of tumor cells?Effect size dependent8-26% recurrenceEasy recurrence detectionDegenerative changes
  • 21. Recurrence
  • 22. Subchondral bone grafting
  • 23. Cryotherapy3 freeze thaw cyclesIrrigate cartilage with cool salineCircumferential necrosis“difficult”Complications Soft tissue injury Late fractures
  • 24. Cryotherapy
  • 25. PhenolWash cavityAlcohol rinse10-20% recurrence
  • 26. Enbloc ResectionExpendable bones Prox fibula / Distal ulnaHigh recurrence with other Tx Hand / Distal radiusRecurrencePathologic #Joint involvementOsteochondral allograft reconstruction
  • 27. Reconstruction
  • 28. Spine< 3% vertebrae above sacrumAll levels affected equallyAffects vertebral body c ext. pedicleResection with stabilizationOften incomplete?radiation as adjuvant (low dose 3000 Gyc) Incomplete excision Local recurrence
  • 29. Sacrum / PelvisIntalesional excisionAdjuvant+/- radiation
  • 30. PelvisGCT often vascular Pre-op angiography ? embolization
  • 31. Angiography
  • 32. Outcome