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Giant Cell Tumor of Bone
Overview Definition Epidemiology Hx Presentation/Exam Radiology Dx Tx Outcomes
Definition10 bone neoplasmFirst described Cooper 1818Lebert microscopic description 1845Generally benignPotential for : R...
Epidemiology5-10% 10 bone tumors20% benign bone tumorsF : M 1.5 : 170-80% age 20-40Rare skeletally immatureEpiphysealMonos...
IncidenceEnds of long bones>50% about kneeHigh recurrence rate1-2% benign pulm. Mets10 malignant GCT <1%Rare polyostotic f...
Location
PresentationPain x wks. – mos.SwellingMassPathologic #Neuro deficit (spine / sacrum)incidental
RadiologyLytic lesionEpipysealEccentric or centralNarrow zone transitionCortical thinningexpansileNo sclerotic margin
ImagingOcc. Cortical breakthrough   +/- soft tissue massExtend to subarticular cortexTypically no host responseOften larg...
Other modalitiesCT   Integrity cortical rimMRI   Assess subchondral breakthroughBone Scan Suspect multicentri loci ie....
DDxConsider: Age & Location Fibrogenic/Telangiectatic Osteosarcoma MFH Brown tumor Chondroblastoma ABC Chondromyxoid...
HistologyFibrohistiocytic originMultinucleated giant cellsMononuclear stroma   Round / ovoid / spindleIndistinct cell mem...
Gross
Enneking Staging            Stage 1    Stage 2    Stage 3Pt %        10-15%     ~70%       10-15%Symptoms    asymp      pa...
BiopsyNecessary for DxTumor principlesHistologic grade not helpfulR/O 10 malignant GCTOcc assoc. ABC Pagets
Curettings
TxControversialTraditionally: Intralesional curettage / resection & bone graft Recurrence 35-42%En Bloc resection Recur...
CurettageWide decortication (windowing)Curettage / high speed burrAggressiveChoice of adjuvant
Adjuvant TxRadiation - ~10% sarcomatous degenerationPMMA, Liquid N2, Phenol, CO2 laser,Electrocautery Local extension of ...
PMMAFill tumor cavityHeat kill of tumor cells?Effect size dependent8-26% recurrenceEasy recurrence detectionDegenerative c...
Recurrence
Subchondral bone grafting
Cryotherapy3 freeze thaw cyclesIrrigate cartilage with cool salineCircumferential necrosis“difficult”Complications Soft t...
Cryotherapy
PhenolWash cavityAlcohol rinse10-20% recurrence
Enbloc ResectionExpendable bones   Prox fibula / Distal ulnaHigh recurrence with other Tx   Hand / Distal radiusRecurren...
Reconstruction
Spine< 3% vertebrae above sacrumAll levels affected equallyAffects vertebral body c ext. pedicleResection with stabilizati...
Sacrum / PelvisIntalesional excisionAdjuvant+/- radiation
PelvisGCT often vascular Pre-op angiography ? embolization
Angiography
Outcome
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
Giant cell tumor of bone
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Giant cell tumor of bone

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Transcript of "Giant cell tumor of bone"

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