Giant cell tumor is a benign bone tumor composed of mononuclear cells and multinucleated giant cells. It typically occurs in long bones of young and middle-aged adults. Symptoms include pain and swelling. Treatment involves curettage of the tumor along with adjuvants like phenol or bone cement to reduce the risk of recurrence. For large tumors or those in critical locations, alternatives like denosumab or bisphosphonates can be considered to stabilize the disease.
GCT of bone presentation by prof.Ahmad shaheen,M.D. prof.of orthopedic surger...ahmad shaheen
GCT is one of the most common benign bone tumors,characterized by high incidence of local recurrence.
the pathogenesis,pathology,clinical presentation and treatment options will be discussed.
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
GIANT CELL LESIONS OF THE JAW
CONTENTS
INTRODUCTION
DEFINITION
CLASSIFICATION
CONCLUSION
REFERENCE
The term Giant cell is derived from a Latin word,” giges; huge and cella; storeroom.
It is defined as an abnormally large tissue cell which often contains more than one nucleus and sometimes may appear as a merger of several normal cells.
CLASSIFICATION OF GIANT CELL LESION
According To Paul Auclair et al
1. Entities in which giant cells are the predominant histologic finding and form the basis of their recognition:
Central giant cell granuloma.
Giant cell tumour of bone.
Aneurismal bone cyst.
Cherubism.
Brown tumour of hyperparathyroidism.
II. Lesions containing giant cells
I. Infectious diseases
Bacterial - Tuberculosis ,Leprosy ,Syphilis ,Actinomycosis ,Cat scratch disease
Viral -Herpes ,Measles
Mycotic -Histoplasmosis ,Blastomycosis
II .Inflammatory diseases of unknown origin
Wegener’s granulomatosis
III. Metabolic
Histiocytosis X
IV. Neoplastic
Benign - Giant cell fibroma ,Osteoblastoma
Malignant - Chondrosarcoma ,Hodgkin’s disease , Burkitt’s lymphoma.
LESIONS CONTAININGMULTINUCLEATED GIANT CELLS
Giant Cell Granuloma
Giant Cell Tumor
Hyperparathyroidism (HPT)
Cherubism
Aneurysmal Bone Cyst.
CENTRAL GIANT CELL GRANULOMA
Benign proliferation of fibroblasts and multinucleated giant cells
Clinical and Radiographic Features
most often found in children and young adults, with up to 75% of cases occurring before 30 years of age.
Females are affected twice as frequently as males.
Lesions are more common in the anterior portions of the jaws, and mandibular lesions frequently cross the midline.
Most giant cell granulomas of the jaws are asymptomatic and first come to attention during a routine radiographic examination or as a result of painless expansion of the affected bone.
A minority of cases, however, may be associated with pain, paresthesia, or perforation of the cortical bone plate, occasionally resulting in ulceration of the mucosal surface by the underlying lesion.
RADIOGRAPHIC FEATURES
appear as radiolucent defects, which may be unilocular or multilocular.
The defect is usually well delineated, but the margins are generally noncorticated .
The lesion may vary from a 5 X 5 mm incidental radiographic finding to a destructive lesion greater than 10 cm in size.
The radiographic findings are not specifically diagnostic.
Small unilocular lesions may be confused with periapical granulomas or cysts.
Multilocular giant cell lesions cannot be distinguished radiographically from ameloblastomas or other multilocular lesions.
Histopathologic Features
presence of few to many multinucleated giant cells in a background of ovoid to spindle shaped mesenchymal cells.
There is evidence that these giant cell s re resent osteoclasts, although others suggest the cells may be aligned more closely with macrophages.
The giant cells may be aggregated focally in the lesional tissue or may be present diffusely throughout the lesion.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
GCT of bone presentation by prof.Ahmad shaheen,M.D. prof.of orthopedic surger...ahmad shaheen
GCT is one of the most common benign bone tumors,characterized by high incidence of local recurrence.
the pathogenesis,pathology,clinical presentation and treatment options will be discussed.
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
GIANT CELL LESIONS OF THE JAW
CONTENTS
INTRODUCTION
DEFINITION
CLASSIFICATION
CONCLUSION
REFERENCE
The term Giant cell is derived from a Latin word,” giges; huge and cella; storeroom.
It is defined as an abnormally large tissue cell which often contains more than one nucleus and sometimes may appear as a merger of several normal cells.
CLASSIFICATION OF GIANT CELL LESION
According To Paul Auclair et al
1. Entities in which giant cells are the predominant histologic finding and form the basis of their recognition:
Central giant cell granuloma.
Giant cell tumour of bone.
Aneurismal bone cyst.
Cherubism.
Brown tumour of hyperparathyroidism.
II. Lesions containing giant cells
I. Infectious diseases
Bacterial - Tuberculosis ,Leprosy ,Syphilis ,Actinomycosis ,Cat scratch disease
Viral -Herpes ,Measles
Mycotic -Histoplasmosis ,Blastomycosis
II .Inflammatory diseases of unknown origin
Wegener’s granulomatosis
III. Metabolic
Histiocytosis X
IV. Neoplastic
Benign - Giant cell fibroma ,Osteoblastoma
Malignant - Chondrosarcoma ,Hodgkin’s disease , Burkitt’s lymphoma.
LESIONS CONTAININGMULTINUCLEATED GIANT CELLS
Giant Cell Granuloma
Giant Cell Tumor
Hyperparathyroidism (HPT)
Cherubism
Aneurysmal Bone Cyst.
CENTRAL GIANT CELL GRANULOMA
Benign proliferation of fibroblasts and multinucleated giant cells
Clinical and Radiographic Features
most often found in children and young adults, with up to 75% of cases occurring before 30 years of age.
Females are affected twice as frequently as males.
Lesions are more common in the anterior portions of the jaws, and mandibular lesions frequently cross the midline.
Most giant cell granulomas of the jaws are asymptomatic and first come to attention during a routine radiographic examination or as a result of painless expansion of the affected bone.
A minority of cases, however, may be associated with pain, paresthesia, or perforation of the cortical bone plate, occasionally resulting in ulceration of the mucosal surface by the underlying lesion.
RADIOGRAPHIC FEATURES
appear as radiolucent defects, which may be unilocular or multilocular.
The defect is usually well delineated, but the margins are generally noncorticated .
The lesion may vary from a 5 X 5 mm incidental radiographic finding to a destructive lesion greater than 10 cm in size.
The radiographic findings are not specifically diagnostic.
Small unilocular lesions may be confused with periapical granulomas or cysts.
Multilocular giant cell lesions cannot be distinguished radiographically from ameloblastomas or other multilocular lesions.
Histopathologic Features
presence of few to many multinucleated giant cells in a background of ovoid to spindle shaped mesenchymal cells.
There is evidence that these giant cell s re resent osteoclasts, although others suggest the cells may be aligned more closely with macrophages.
The giant cells may be aggregated focally in the lesional tissue or may be present diffusely throughout the lesion.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. GIANT CELL TUMOR
• Giant cell tumor of bone is a distinctive neoplasm of undifferentiated cells.
• The multinucleated giant cells apparently result from fusion of the proliferating
mononuclear cells, and although they are a constant and prominent part of these
tumors, the giant cells are probably of less signifi cance than the mononuclear cells.
• Giant cell tumors usually are solitary lesions; however, 1% to 2% may be
synchronously or metachronously multicentric.
• It is unclear whether multicentric disease represents multiple primary lesions or
simply bone metastases from a single primary lesion.
• Although these tumors typically are benign, pulmonary metastases occur in
approximately 3% of patients.
• The overall mortality rate from disease for patients with pulmonary metastases is
approximately 15%.
3. • Malignant giant cell tumors represent less than 5% of cases and are classified as
primary or secondary.
• Primary malignant giant cell tumors are extremely rare and are defined as
sarcomas that occur within lesions that otherwise are typical of benign giant cell
tumors.
• Secondary malignant giant cell tumors are sarcomas that occur at the sites of giant
cell tumors that have been treated, usually with radiation.
In fact, these osteoclast-like giant cells, with or without modification , occur in many
pathologic conditions of bone,such as
• aneurysmal bone cyst,
• benign chondroblastoma,
• chondromyxoid fibroma,
• unicameral bone cyst with a cellular lining,
• metaphyseal fibrous defect,
• giant cell reparative granuloma,
• hyperparathyroidism,
• giant cell-containing osteosarcoma, and other entities in the general category of
giant cell tumor.
4. • 5% of neoplasms of bone.
• occur in patients 20 to 40 years old, and there is a slight female
predominance.
5. LOCATION
• Most giant cell tumors are found at the ends (epiphyses) of
long bones.
• Approximately 46.2% of the lesions occurred around the knee
joint, with the distal femur being the most common single
location.
• 3rd – distal end of radius
• 4th –sacrum
• Vertebrae –mostly variants.
6. SYMPTOMS
• Pain of variable severity is almost always the
predominant symptom.
• The pain is rarely severe, unless a pathologic fracture
has occurred. In 10% to 30% of patients, pathologic
fractures are evident at initial examination.
• More than three-fourths of the patients had noted
swelling of the affected region.
• Less common symptoms included weakness, limitation
of motion of the joint, and signs of pathologic fracture.
7. PHYSICAL FINDINGS
• A hard, sometimes crepitant and painful mass
is found in more than 80% of the patients.
• Atrophy of muscles from disuse may be
present as well as effusion in the adjacent
joint or local rise in temperature .
8. RADIOGRAPHIC FEATURES
• Gee and Pugh summarized the radiographic
featuresas those of an expanding zone of
radiolucency situated eccentrically, usually in the
epiphyses of long bones and usually abut the
subchondral bone of an adult.
• The lesion usually extends to the articular cartilage,
although there may be a thin zone of normal bone
between the lesion and the articular cartilage.
• The lesion may be well marginated or poorly
marginated.
• It is unusual to see sclerosis around a benign giant
cell tumor.
• Radiographically, the lesions are purely lytic. The
zone of transition can be poorly defined on plain
radiographs.
11. On MRI, the lesion
usually is dark on T1-
weighted images
and bright on T2-
weighted images. MRI
also may reveal
fluid-fluid levels typical
of a secondary
aneurysmal bone cyst,
which occurs in 20% of
patients.
12. GROSS PATHOLOGIC FEATURES
• The tumor tissue is characteristically soft, friable, and dark
brown.
• Firmer portions may be seen as a result of previous fracture,
treatment, or degeneration, all of which may cause fi brosis
and osteoid production.
• Small cystic or necrotic portions, sometimes filled with blood,
may be present, but these ordinarily constitute an insignificant
feature of untreated lesions not modified by previous fracture.
• This cystification may be sufficiently prominent, especially in
recurrent neoplasms, to cause them to be confused with
aneurysmal bone cyst.
• The aggressive nature of giant cell tumors accounts for the
usually immense size when they have been neglected.
• Intact gross specimens show variable degrees of expansion of
the bone with corresponding expansion or destruction of the
cortex. The rest of the osseous structure in the region of the
tumor is completely replaced.
• The tumor practically always extends to the articular cartilage,
and its boundaries are only moderately well demarcated from
adjacent bone and cartilage. Even with very large lesions, the
periosteum is rarely breached
13. Typical giant cell tumor involving the distal radius, the third most common location.
A: The tumor is purely lytic and has expanded into soft tissue. There is a pathologic fracture.
B: Gross specimen. The cortices have been destroyed, and the lesion expands into soft tissue.
The tumor also extends up to the articular cartilage.
14. Giant cell tumor forming a destructive redbrown mass involving the entire distal femur.
The cystic areas represent a secondary aneurysmal bone cyst component.
15. Recurrent giant cell tumor involving the thigh.
When giant cell tumor recurs in the soft tissue, it is usually well circumscribed and is
enclosed by a shell of ossification. The lesion has the typical appearance of giant cell tumor.
16. Giant cell tumor of the proximal tibia. The tumor has the characteristic red-brown color of giant
cell tumor with a central golden yellow area that corresponds with degenerative necrosis.
17. HISTOPATHOLOGIC FEATURES
• The basic proliferating cells have a round-to-oval
or even spindle-shaped nucleus in the fi elds that
are diagnostic of true giant cell tumor.
• This nucleus is surrounded by an ill-defi ned
cytoplasmic zone, and discernable intercellular
substance is absent.
• Mitotic figures can be found in practically every
lesion, and in some lesions, they are numerous.
Mitotic activity has no prognostic signifi cance.
• The nuclei lack the hyperchromatism and
variation in size and shape that are characteristic
of sarcoma.
• Giant cells, usually containing 40 to 60 nuclei, are
scattered uniformly throughout the lesion. The
evidence that the giant cells are derived from
fusion of mononuclear cells includes some marked
similarity of their nuclei.
18. Nuclei of the mononuclear cells are very similar
to the nuclei of the giant cells, so that it may be
hard to tell where the giant cells stop and the
mononuclear cells begin
Mitotic figures are commonly
found in the mononuclear cells.
This field contains at least four
mitotic figures.
19. TREATMENT
• Historically, treatment consisted of simple curettage; however, subsequent
recurrence rates were greater than 50%.
• Now, most published series document recurrence rates of 5% to 15%.
• The decrease in recurrence rates probably can be attributed to several
factors:
MRI now allows for more accurate assessment of the extent of lesions,
and the technique of curettage has improved.
It is important to create a cortical window that is at least as large as the
lesion to prevent leaving residual tumor cells “around the corner”
adjacent to the near-side cortex. Also, use of a power burr to enlarge the
cavity 1 to 2 cm in all directions is now considered standard.
• Care should be taken, however, to avoid perforation through the
subchondral bone into the joint.
20. • The use of adjuvants, such as liquid nitrogen, phenol, bone cement,
electrocautery, or an argon beam coagulator, theoretically helps kill any
remaining tumor cells.
• Also, preliminary studies suggest that bisphosphonates (administered
systemicallor locally) might help prevent recurrence.
• To fill the defect after curettage, the surgeon has several options, including
autograft bone, allograft bone, an artificial bone graft substitute, or
methyl methacrylate bone cement.
• If an autograft is to be harvested from another site, separate gloves and
instruments should be used because cross-contamination could lead to
transplantation of tumor cells to the harvest site.
• A bone graft (or artificial substitute) has the theoretical advantage of
restoring normal biomechanics to the joint surface to prevent future
degenerative joint disease and restoring bone stock, which may help if
future procedures are necessary.
21.
22.
23.
24.
25.
26.
27.
28. MEDICAL MANAGEMENT
• There is clinical rationale for the use of bisphosphonates in treating giant cell
tumor of bone, as these drugs inhibit osteoclastic activity and promote osteoclast
apoptosis.
• Studies using systemic zoledronic acid in inoperable tumors have reported
stabilization of both local and metastatic disease.
• Bisphosphonates have been proposed for use as a surgical adjuvant or as an
option in unresectable tumors; however, high-level evidence is still lacking, and
further investigation is required to validate its use.
• Another new treatment under examination is the systemic administration of
denosumab. Denosumab is a fully human monoclonal antibody that inhibits
normal and tumorassociated bone lysis by limiting osteoclastic maturation (i.e.,
prevents activation of receptor activator of nuclear factorkB [RANK]).
• This drug has approval from the US Food and Drug Administration for use in adults
and skeletally mature patients who have an unresectable giant cell tumor or a
condition in which surgical resection would result in severe morbidity.