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 #207.1 GCT tibia
43 year old male with knee pain for 4 months

27. CT scan

28. Cor T-1 T-2 Gad

29. Sag T-1 T-2 Gad

30. Axial T-1 T-2
Gad

31. Two stage cementation procedure

32. Post op x-ray

33. Case #208
28 year male
GCT distal radius

34. Coronal T-1 MRI

35. Axial T-2 MRI showing multiple hemorrhagic cysts

36. 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

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

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

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

40. Axial T-1 T-2
Gad

41. T-1 Axial T-2
Gad

42. Post op x-ray following curettage and cementation

43. Case #209
59 year female with GCT sacrum

44. CT scan

45. Bone scan

46. 9 years post curettement and radiation

47. Lateral view at 9 years and no recurrence

48. Case #209.1 CT scan GCT sacrum
Bone scan
47 year old male with LBP 3 months

49. T-2
Axial T-1

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

51. Coronal T-2 MRI
showing high signal
sarcoma

52. graft
Amputation specimen cut in path lab

53. Photomic showing pleomorphic sarcoma cells

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

55. Sagittal T-1 MRI

56. Axial T-1 MRI

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

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

59. Cor T-1 T-2
Gad

60. PO #1 PO #2
PO #2 PO #3
3 mos

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

62. Biopsy photomic

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

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

65. Coronal post gad contrast MRI

66. Surgical decompression and reconstruction

67. Anterior reconstruction
with bone cement and
titanium screw

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

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

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

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

72. osteoid
Biopsy photomic showing OGS

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

74. Lateral view

75. Coronal T-1 MRI

76. Axial T-1 MRI

77. Sagittal T-1 MRI

78. Sagittal T-2 MRI

79. Coronal gad contrast MRI

80. fracture
Surgical specimen with resection distal femur

81. Tumor breaking thru the back of lat fem condyle

82. Photomic

83. taper
spindle
anchor
Compress system used for reconstruction

84. spindle
Belleville washers
Anchor plug
Disarticulated Compress device

85. spindle compression nut
Belleville washers

86. Placement of anchor plug pins thru guide

87. Cementing tibial
component

88. Completed rotating hinge TKA

89. anchor
2 months post op

90. Lateral view

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

92. Oblique view

93. Lateral view

94. Photomic

95. Photomic showing foam cells

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

97. fracture line
Second batch of cement

98. 1 year post op with
normal knee function

99. Lateral view

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

101. Surgical exposure of tumor

102. Curetted specimen

103. Photomic showing neoplastic osteoid formation

104. Tumor cavity following aggressive curettement

105. cement
Completion of a 2 stage cementation

106. 4 years post op showing
radiolucent cement and
Steinman pins

107. 12 years and working
full time as electrician

108. 26 years and shows
early signs of DOA

109. Lateral view

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

111. Sagittal T-1 MRI

112. Axial T-2 MRI

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

114. Lateral view

115. CT scan

116. 1 year PO excisional
arthrodesis with titanium
spacer & cancellous
allograft

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

118. 1 year after cementation
procedure

119. 4 years later with normal
function of knee

120. 6 mos following a traumatic
fracture of tibia and again
normal knee function

121. 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

122. 1 year later with collapse of
patellofemoral joint and loss
of active knee extension

123. Lateral view showing
patella collapsed into
tumor cavity

124. Patellar-femoral view

125. Sagittal T-1 MRI

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

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

128. Removal of cancellous allograft placed over one year ago

129. Placement of Steinman pins ready for cementation

130. Completion of patellofemoral arthroplasty

131. One year later with
near normal ROM
of knee

132. Lateral view

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

134. Lateral view

135. CT scan

136. Immediate post op
X-ray following
cementation procedure

137. 4.5 years later with signs
of recurrent tumor at
upper pole of cement

138. Lateral view

139. CT scan showing recurrence of GCT

140. Bone scan shows
recurrence also

141. 1 year following a redo
cementation procedure
with no recurrence

142. Lateral view

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

144. AP view
cement

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

146. Photomic

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

148. 10/07
Cor T-2 Gad

149. Axial T-1 PD
Gad

150. 10/07
Sag T-2 Post op

151. 12/08
Recurrence 1 yr
later

152. 12/08
Axial T-1 T-2

153. Recementation 12/08

154. Axial T-1 Sag
T-1 MRI showing soft tissue recurrence 2/2010

155. Wide resection and Compress reconstruction 2/10

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

157. Cor T-1 T-2
Gad

158. Sag T-1 PD FS

159. Axial T-2 Gad

160. Post op x-ray

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

162. Lateral view shows questionable lysis distal femur

163. 4 months later with
obvious lytic changes

164. Lateral view

165. Coronal PD MRI

166. Axial PD MRI

167. 1 year post op
with cementation
and side plate

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

169. 2 mos post op bone
graft with recurrence

170. 4 mos post op and
even more signs of
recurrence

171. Surgical curettement of recurrent tumor

172. Photomic of recurrent tumor

173. Higher power with osteoid formation

174. Surgical appearance following curettement

175. Placement of Steinman pins prior to cementation

176. Cementation completed

177. 9 months post radiolucent
cementation and 6500
rads of RT

178. 13 years post op with
multiple path fractures
thru radiated bone with
multiple surgeries to fix
these fractures

179. 20 years after 1st surgery with continued stress fractures

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

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

182. Lateral view

183. Coronal T-1 MRI

184. GCT
Coronal T-2 MRI
ABC

185. Photomic from femoral biopsy showing GCT

186. 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

187. Biopsy photomic shows OGS

188. CT scan shows metastatic OGS to inguinal lymph node

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

190. Coronal T-1 MRI

191. Axial T-2 MRI

192. Axial T-2 MRI
at lower level

193. Bone scan

194. Biopsy photomic

195. Post op curettement with cementation and pins

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

197. 3 months PO complete
curettement thru anterior
approach and cementation
with DHS screw

198. 5 years later with good
calcar hypertrophy and
normal hip function

199. Lateral view

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

201. 5 months later without treatment

202. Coronal T-1 MRI

203. Coronal T-2 MRI

204. Post op x-ray showing bipolar prosthesis

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

206. Coronal T-1 MRI

207. Photomic

208. 14 months post op
cementation and pins

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

210. CT scan

211. Photomic

212. 6 months post op cementation with pins

213. Lateral view

214. Two years post op

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

216. 1 year later with central
fracture dislocation hip

217. 4 years post op Tronzo
THA

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

219. Shortly after she
developed this second
GCT in ilium

220. tumor
CT scan

221. Photomic showing tumor osteoid

222. More tumor osteoid

223. 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

224. Case #1060
31 year male with GCT patella

225. 17 months following
curettage with recurrent
tumor

226. Photomic

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

228. Lateral view

229. Surgical specimen from prox tibial resection

230. Surgical specimen showing lateral plateau fracture

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

232. Photomic

233. Reconstructed with cemented
long stem single axial long
stem Guepar knee prosthesis
placed upside down
cement

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

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

236. 6 months post op
cementation with
painful chondrolysis
medial joint space

237. Post op revision to a
unicondylar prosthesis

238. Lateral view

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

240. Surgical curettement of tumor

241. Curetted specimen

242. Yellow portion of specimen showing foam cells

243. burr
Tumor cavity following aggressive curettement
and use of a high speed bur

244. radiolucent
cement
Cementation completed

245. 2 year post op with
radiolucent cement

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

247. Lateral view

248. Sagittal T-1 MRI

249. Coronal T-2 MRI

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

251. Axial T-1 T-2 FS
Gad

252. Sag T-1 STIR
Gad

253. Cor Gad

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

255. Cor T-1 T-2

256. Axial T-2
Sag T-1

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

258. CT scan

259. Cor T-1 T-2 Gad

260. Sag T-1 T-2 Gad

261. Axial T-1 T-2
Gad

262. Case #1064.3 Giant Cell Pseudotumor of Hip
64 yr male with primary THA 15 yrs ago

263. Periarticular biopsy

264. Similar case
Pseudo tumor
of fibula
69 yr male
TKA

265. Fibular head biopsy

266. Polarized microscope

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

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

270. Proximal tibial resection specimen

271. Photomic

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

273. Lateral view

274. Immediate post op
cementation procedure

275. 9 months later with
tumor recurrence

276. Post op cementation
revision procedure

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

278. Lateral view

279. Sagittal T-1 MRI

280. Sagittal T-2 MRI

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

282. Post op cementation
with pins

283. Lateral view

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

285. Lateral view

286. 3 years later showing recurrent tumor

287. tumor
Surgical resection specimen

288. Allograft replacement fixed to side plate

289. Allograft reconstruction completed

290. allograft
Early post op x-ray

291. 4 years later showing collapse of allograft

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

293. Resection of distal radius and ulna

294. Distal face of radius engulfed with tumor

295. Macro section of distal radius

296. Photomic

297. carpus
Surgical appearance prior to reconstruction

298. Completion of cemented Volz total wrist arthroplasty

299. Post op x-ray

300. Lateral view

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

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

303. Sagittal T-1
Sagittal T-2

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

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

306. Post op Darrach
resection distal ulna

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

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

309. Lateral view

310. Axial T-2 MRI

311. Coronal T-2 MRI

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

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

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

315. 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

316. osteoid
Photomic of benign GCT 5 yrs ago

317. Photomic of present biopsy showing OGS

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

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

320. Coronal T-1 MRI

321. Axial T-1 MRI

322. Coronal T-2 MRI

323. Photomic

324. Post op cementation
with pins one year later

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

326. Lateral view showing
aneurysmal appearance

327. Sagittal T-1 MRI

328. Sagittal T-2 MRI showing large hemorrhagic cysts

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

330. Post op cementation
with single pin

331. Lateral view

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

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

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

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

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

337. Laminogram x-ray

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

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

340. CT scan

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

342. T-1 MRI
sagittal
coronal axial

343. Sagittal T-2 MRI

344. Sagittal & coronal Gad MRI

345. Post op curettement and cementation

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

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

348. Lateral view

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

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

351. Oblique view

352. Coronal T-1 MRI

353. Axial T-2 MRI

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

355. photomic

356. Pulmonary metastasis

357. Photomic from pulmonary met

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

359. AP view

360. Photomic

361. Post op spine fusion

362. Lateral view with posterior
Harrington rods and
anterior bone graft

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

364. AP view

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

366. R
Bone scan

367. CT scan

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