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Definition. 10 bone neoplasmGenerally benignPotential for :RecurrencePulmonary metastasisFrank malignancy. Epidemiology. 5 to 9 percent of all primary bony tumors20% benign bone tumors 70-80% age 20-40F : M 1.5 : 1Rare skeletally immatureEpiphyseal metapysial Monostotic. Incidence.
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1. Giant Cell Tumor Dr Neffati
2. Definition 10 bone neoplasm
Generally benign
Potential for :
Recurrence
Pulmonary metastasis
Frank malignancy
3. Epidemiology 5 to 9 percent of all primary bony tumors
20% benign bone tumors
70-80% age 20-40
F : M 1.5 : 1
Rare skeletally immature
Epiphyseal metapysial
Monostotic
only occur after the epiphyseal plates have closedonly occur after the epiphyseal plates have closed
4. Incidence found in the long bones: distal femur, proximal tibia, and distal radius.
>50% about knee.
10 malignant GCT <1%
High recurrence rate
1-2% benign pulm. Mets
Rare polyostotic form <1%
5. Clinic presentaion slowly progressive pain,swelling with or without a mass.
Symptoms arise when the lesion begins to destroy the cortex and irritate the periosteum or pathologic fracture.
Incidental
6. Radiology Finding eccentrically
long axis of the bone
radiolucent
destruction of the medullary cavity and adjacent cortex
Intact borders and a sharp inner margin
may expand into the soft tissue
Expansil
8. Imaging CT
Integrity cortical rim
MRI
Assess subchondral breakthrough
Bone Scan
Suspect multicentri loci
ie. HAND
10. DDx Consider: Age & Location
Fibrogenic/Telangiectatic Osteosarcoma
MFH
Brown tumor
Chondroblastoma
ABC
Chondromyxoid fibroma (rare)
Mets / Myeloma
11. Gross appearance
homogeneous, with foci of hemorrhage or necrosis
Firm
13. Microscopically Fibrohistiocytic origin
Multinucleated giant cells
Mononuclear stroma
Round / ovoid / spindle
Indistinct cell membrane
15. Biopsy Necessary for Dx
Tumor principles
Histologic grade not helpful
R/O 10 malignant GCT
Occ assoc.
ABC
Pagets
16. Treatment Controversial
Traditionally:
Intralesional curettage / resection & bone graft
Recurrence 35-42%
En Bloc resection
Recurrence ~10%
Multiple complications
Adjuvant Curettage:Wide decortication (windowing)
Curettage / high speed burr
Aggressive
Choice of adjuvant
Curettage:Wide decortication (windowing)
Curettage / high speed burr
Aggressive
Choice of adjuvant
17. Curettage Curettage / high speed burr
Aggressive
Choice of adjuvant
Wide decortication (windowing)
18. Adjuvant Tx Radiation - ~10% sarcomatous degeneration
PMMA, Liquid N2, Phenol, CO2 laser, Electrocautery
Local extension of margin
Kill residual foci
19. PMMA Fill tumor cavity
Heat kill of tumor cells?
Effect size dependent
8-26% recurrence
Easy recurrence detection
Degenerative changes
20. Cryotherapy 3 freeze thaw cycles
Irrigate cartilage with cool saline
Circumferential necrosis
“difficult”
Complications
Soft tissue injury
Late fractures
21. Phenol Wash cavity
Alcohol rinse
10-20% recurrence
22. Enbloc Resection Expendable bones
Prox fibula / Distal ulna
High recurrence with other Tx
Hand / Distal radius
Recurrence
Pathologic #
Joint involvement
Osteochondral allograft reconstruction
23. Following surgery patients should be made aware of the ongoing risk of local recurrence
regular basis for the first 2 years at least workup including CXR.
24. Take home points
Thanks