4. Overview
Giant cell myeloma or
Osteoclastoma
Primary bone neoplasm
Generally benign, locally invasive
Presence of multinucleated giant
cell
Potential for :
Recurrence
Pulmonary metastasis
Frank malignancy
5. Epidemiology
5-10% of primary bone tumors
20% of benign
F : M = 1.5 : 1
70-80% occurs at age 20-40
Epiphyseal
Monostotic
Rare in skeletally immature
6. Incidence
Affects Ends of long bones
>50% around knee
High recurrence rate
1-2% benign pulm. Mets
Primary malignant GCT<1%
Rare polyostotic form <1%
7. Location
Common sites:
Distal femur
Proximal tibia
Distal radius
Proximal humerus
Other sites:
Fibula , distal tibia
Bones of pelvis, sacrum
Vertebral body
8. Presentation
Pain – ends of long bone
Swelling - mild to moderate
Visible Mass
Pathologic # (10-15%)
Limited range of motion
Fluid accumulation in adjacent
joint
Rarely Neuro deficit if spine /
sacrum involved
9. Radiology
Lytic lesion
Epiphyseal , Eccentric, Expansile
Narrow zone transition
Soap bubble appearance
Cortical thinning
Non sclerotic , sharply defined
margin
10. Radiology(con…)
• Occ. Cortical breakthrough
• +/- soft tissue mass
• Extend to subarticular cortex
• Often large presentation
11. Other modalities
CT
Integrity of cortical rim
MRI
Assess subchondral breakthrough
Bone Scan
Decreased radioisotope
uptake in the center of lesion
(Multicentric GCT)
31. Non surgical Rx
Irradiation therapy is for cases where
surgery not performed safely or effectively
Malignant change 15%
Embolization of feeding vessels by
catheter – shrink/disappearance of tumour
Drugs e,g interferon –
shrink/disappearance of tumour
32. Metastasis
Lung, Lymph node(rare)
After 3-5 years
Spontaneously regress,static,grow slowly
or rapidly
Mortality 15-25%
Rx- wide resection,iradiation,interferon
33. Follow-up
Observation at least 5 years
Physical examination & radiology
– affected site, lung
Relapse – pain, swelling
34. Spine
< 3% vertebrae above sacrum
All levels affected equally
Affects vertebral body
Resection with stabilization
Resection often incomplete
Radiation as adjuvant (low dose 3000 Gyc)
Incomplete excision
Local recurrence
35. Sacrum / Pelvis
GCT often vascular
Pre-op angiography
Embolization, Intalesional
excision or radiation
36. Outcome
Prognosis is good, despite of
recurrences and pulmonary metastases
Depends on surgical technique and
expertise and the histological grade of
this tumour
Angiovascular invasion does not have
any significant influence on its prognosis
The mortality rate is about 4%.