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"GIANT CELL TUMOUR (GCT)"

December 23, 2020 Edit this post

“ Relatively common benign tumour (accounts for 20% of all benign bone tumours) composed of stromal cells and multinucleated giant cells tha...

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Relatively common benign tumour (accounts for 20% of all benign bone tumours) composed of stromal cells and multinucleated giant cells that behave like osteoclasts. Slightly more common in females ( M:F 2:3) ; 80% occur between 20 and 50 years of age. Multiple GCT May occur with Paget disease,. They are locally aggressive in behaviour, and recurrence is up to 30% after resection. GCTs can metastasise to the lungs in up to 6% (may not require treatment). 
Rarely (less than1%) GCTs undergo malignant transformation (usually to high-grade sarcoma).
Multifocal metachronous GCT can occur often within the hands, associated with hyperparathyroidism
PLAIN FILM

•  Up to 90% are seen in long bones (femur 30%, tibia 25%, radius 10%, humerus 6%. Rare in the skull).
•  More common in the spine when there is Paget disease—usually the sacrum or a vertebral body are affected.
•  Lucent  lesion with a well-defined non-sclerotic margin, eccentric location.
•  Extends to the subchondral (i.e. subarticular) bone.
•  Mild expansion of the affected bone.
•  No internal matrix calcification.
•  With or without pathological fracture.
•  Can have aggressive features: wide zone of transition, cortical destruction, soft tissue mass.

MRI

•  Non-specific features: mainly low signal on T1 and T2, enhancement with contrast.
•  Heterogeneous low signal on T2 in a whorled or uniform pattern from cellularity and deposition of haemosiderin and collagen.
•  Sharp low signal rim due to haemosiderin.
•  Fluid-fluid levels are seen in up to 14% from formation of a secondary ABC.

NUCLEAR MEDICINE

•  Increased uptake of technetium-99m methylene diphosphonate at the periphery of the lesion.
•  Central photopoenia due to lysis/necrosis.

•Treatment: surgical curettage (there is a tendency to recur)
 Giant cell tumour. Frontal and lateral radiographs of the wrist demonstrating a lucent expansile lesion with a narrow zone of transition within the distal radius. The dorsal cortex is involved, but there is no perisoteal reaction and no associated soft tissue mass.

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