Clinical Scenario and Imaging with Illustrations of Giant Cell Tumor of Bone: A Retrospective Analysis

Document Type : RESEARCH PAPER

Authors

Govt Medical College Srinagar, India

Abstract

Background: The giant cell tumour of the bone has a spectrum of clinical-radiological presentation. This study aims to describe this varied presentation in our institution. Methods: This retrospective study was conducted on twenty-nine pathologically labelled cases of giant cell tumours of the bone. The medical records for their clinical presentation and diagnostic imaging studies were studied and evaluated. Results: Mean age of the patients at presentation was 35.3±12.9 years. Pain, local swelling and restricted joint function were seen in 93 %, 58.6 % and 52 % patients, respectively. The cortical breach was seen in 15 (51.7 %) and 22 (75.9 %) lesions on plain radiographs and CT images, respectively. 14(48.3 %) cases had soft tissue invasion on MRI at presentation. 26 (89.7 %) lesions were located within 1 cm from the articular cartilage. The solid tumour component was hypo to iso-intense in signal intensity in 27 (93.1 %) lesions in T1 weighted and 21 (72.4 %) in T2 weighted images. 14 (48.3 %) had hyperintense cystic areas, and fluid-fluid levels, suggestive of aneurysmal bone cysts, were seen in 4 (13.8 %) cases on T2 weighted images. Hypo-echoic nodular areas in solid tumour component, suggestive of hemosiderin deposits, were present in 3 (10.3 %) lesions on T1 and T2 weighted images. Conclusion: The tumour classically presents as an epiphysial-metaphyseal, eccentric, expansile, lytic lesion in a skeletally mature patient. The MRI picture is variable and the surgeon should have a sound knowledge of these variations to obtain a biopsy sample from a proper site of the lesion and to avoid misdiagnosis especially of a primary ABC. Level of evidence: IV

Keywords


1. Mavrogenis AF, Igoumenou VG, Megaloikonomos PD, Panagopoulos GN, Papagelopoulos PJ, Soucacos PN. Giant cell tumor of bone revisited. Sicot-j. 2017;3.
2. Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone-an overview. Archives of Bone and Joint Surgery. 2016;4(1):2-9.
3. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics. 2001;21(5):1283-309.
4. Forsyth RG, De Boeck G, Bekaert S, De Meyer T, Taminiau AH, Uyttendaele D, et al. Telomere biology in giant cell tumour of bone. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2008;214(5):555-63.
5. McGrath PJ. Giant-cell tumour of bone: an analysis of fifty-two cases. J Bone Joint Surg Br. 1972;54(2):216-29.
6. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. American journal of clinical oncology. 2006;29(1):96-9.
7. Comunoglu N, Kepil N, Dervisoglu S. Histopathology of giant cell tumors of the bone: With special emphasis on fibrohistiocytic and aneurismal bone cyst like components. Acta Orthop Traumatol Turc. 2019;53(1):35-9.
8. Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk Jr GR. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013;33(1):197-211.
9. Pereira HM, Marchiori E, Severo A. Magnetic resonance imaging aspects of giant-cell tumours of bone. J Med Imaging Radiat Oncol. 2014;58(6):674-8.
10. Elshenawy MA, Badran AA, Memon MA, Elshentenawy AM, Elhassan T. Outcome of treatment in giant cell tumors of bones: A single institutional retrospective review. Annals of Oncology. 2018;29:viii589.
11. van der Heijden L, Dijkstra PS, Campanacci DA, Gibbons CM, van de Sande MA. Giant cell tumor with pathologic fracture: should
we curette or resect?. Clinical Orthopaedics and Related Research®. 2013;471(3):820-9.
12. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006;37:35-51.
13. Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ. Giant cell tumor of bone. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2013;21(2):118-26.
14. Futamura N, Urakawa H, Tsukushi S, Arai E, Kozawa E, Ishiguro N, et al. Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region. Oncology letters. 2016;11(4):2629-34.
15. Miller TT. Bone tumors and tumor like conditions: analysis with conventional radiographs. Radiology. 2008;246(3):662-74.
16. Manaster BJ, Doyle AJ. Giant cell tumors of bone. Radiol Clin North Am. 1993;31:299-323.
17. Levine E, desmet AA, Neff JR. Role of radiologic imaging in management planning of giant cell tumor of bone. Skeletal Radiol. 1984;12:79-89.
18. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics. 2001;21(5):1283-309.
19. Pardiwala DN, Vyas S, Puri A, Agarwal MG. Pictorial essay: Giant cell tumor of bone. Indian Journal of Radiology and Imaging. 2001;11(3):119.
20. Lans J, Oflazoglu K, Lee H, Harness NG, Castelein RM, Chen NC, et al. Giant Cell Tumors of the Upper Extremity: Predictors of Recurrence. The Journal of Hand Surgery. 2020;45(8):738-45.
21. Girish G, Finlay K, Morag Y, Brandon C, Jacobson J, Jamadar D. Imaging review of skeletal tumors of the pelvis—part I: benign tumors of the pelvis. The Scientific World Journal. 2012;2012.
22. Kwon JW, Chung HW, Cho EY, Hong SH, Choi SH, Yoon YC, et al. MRI findings of giant cell tumors of the spine. American Journal of Roentgenology. 2007 Jul;189(1):246-50.
23. Haque AU, Moatasim A. Giant cell tumor of bone: a neoplasm or a reactive condition? Int J Clin Exp Pathol. 2008;1(6):489-501. 24. Kaplan PA, Murphey M, Greenway G, Resnick D, Sartoris DJ, Harms S. Fluid-fluid levels in giant cell tumors of bone: report of two cases. Journal of Computed Tomography. 1987;11(2):151-5.
25. Anchan C. Giant cell tumor of bone with secondary aneurysmal bone cyst. Int J Shoulder Surg. 2008;2(3):68.
26. Aoki J, Moriya K, Yamashita K, Fujioka F, Ishii K, Karakida O, et al.
Giant cell tumors of bone containing large amounts of hemosiderin: MR-pathologic correlation. Journal of computer assisted tomography. 1991;15(6):1024-7.
27. Aoki J, Tanikawa H, Ishii K, Seo GS, Karakida O, Sone S, et al. MR findings indicative of hemosiderin in giant-cell tumor of bone: frequency, cause, and diagnostic significance. AJR. American journal of roentgenology. 1996;166(1):145-8.