Giant Cell Tumor: Diagnosis and Treatment Methods

by Johnny Jacks

Giant cell tumor is a relatively rare, benign, locally aggressive bone cancer that often occurs in adults aged 20-40. The symptoms of giant cell tumor are usually non-specific. Most patients experience pain that gradually increases and may detect a bone or soft tissue mass at the affected site. Typically, symptoms occur due to destruction of the bone cortex and stimulation of the bone membrane or pathological fracture.

What is a giant cell tumor?

A giant cell tumor (GCT) is a benign tumor that has the potential to become malignant and metastasize, and is more common in females. Although rarely fatal, these benign bone tumors can disrupt the local bone structure, especially around the joints.

Giant cell tumors of the bone account for 20% of all benign bone tumors. They typically occur in young people, aged 20-40, but can also affect those over the age of 50.

There is a high prevalence of giant cell tumors (GCTs) in typical bone tissue, with these tumors often extending to the subchondral bone or even articulating with the cartilage. The most common locations for GCTs are in decreasing order from the distal femur, proximal tibia, distal radius, and proximal humerus. Up to 50% of GCTs are found in the periarticular region of the knee. Other locations for GCTs include the proximal fibula, proximal femur, and phalanges. GCTs in the pelvic region are rare but have been reported to occur in various locations, albeit extremely rarely.

How is GCT diagnosed?

How is GCT diagnosed?

How is GCT diagnosed?

Patients with GCTs often have no symptoms when first diagnosed or when the tumor is small.

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Symptoms of GCTs are usually nonspecific. Most patients experience pain, which is slow and progressive and may detect a bony or soft tissue mass at the site of injury. Typically, symptoms occur when the cortical bone is destroyed and stimulates the periosteum or when there is pathological bone fragility and fracture.

For GCTs near a joint, patients may experience pain and limitation of joint movement, even joint effusion.

In patients with GCTs in the spine, they may experience back pain, neck pain, and the disease is slowly progressive, often accompanied by root irritation.

As the injuries become larger, patients may experience swelling and bone deformities, and some cases may have pathological fractures.

In blood tests, both biochemical and blood count parameters are normal. Patients need to test calcium and phosphorus levels to rule out hyperparathyroidism suspicion.

Patients with GCTs undergoing X-rays will show the following images:

GCTs have the ability to be eccentric in bones. These injuries can occur in multiple locations and are often characterized by localized bone destruction, cortical breakthrough, and soft tissue expansion. When located in the head of the bone, GCTs often expand to the joint surface. When GCTs occur in soft tissue due to metastasis or local recurrence, patients are often peripherally ossified.

When performing CT or MRI to evaluate bone and soft tissue damage nearby.

Bone scan rarely used for diagnosis and evaluation of GCTs, as the concentration of radiation can often increase or be normal.

The stages of progression of giant cell tumor can be described as follows

The stages of progression of giant cell tumor can be described as follows.

The stages of progression of giant cell tumor can be described as follows

Stage 1, which is detected in less than 5% of patients: The tumor is small, with minimal progression, clear borders, intact bone shell, and the patient typically shows no symptoms. The histology is benign.

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Stage 2, which is present in 70-85% of patients: Symptoms are now apparent, and the patient may have pathological bone fractures. The histology is still benign. X-rays reveal more widespread damage, with thinning and expansion of the bone shell, but no perforation. X-ray scintigraphy in these patients shows an increased radioactive activity.

Stage 3, which is found in 10-15% of patients: The tumor is now rapidly progressing and the symptoms have become more severe. The histology is still benign. X-rays or CT scans reveal destruction of the bone shell and invasion of soft tissues by the tumor. X-ray scintigraphy shows radioactive activity exceeding the limits of bone damage. Additionally, an increase in vascularization is observed during angiography.

What are the treatment methods for giant cell tumor?

The appearance of a giant cell tumor is usually indicated for surgical treatment

Radiation therapy and chemotherapy are usually reserved for cases where surgery is not feasible. Radiation therapy has been used for patients who cannot undergo surgery, have tumors in locations that cannot be treated by surgery, or have tumors that are likely to recur.

Patients with giant cell tumors are also prescribed internal medicine treatment to reduce pain, in which bisphosphonates are often used.

Surgical methods for giant cell tumors

Surgical methods for giant cell tumors.

Surgical methods for giant cell tumors

The most commonly chosen surgical method for giant cell tumor treatment is curettage. Patients may undergo either simple curettage or wide curettage with the use of phenol or liquid nitrogen pump at the surgical site. The tumor cavity can then be filled with polymethyl methacrylate cement or treated with bone grafting.

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In cases where the giant cell tumor has spread extensively and caused significant destruction, wide excision surgery may be necessary. This method may also be used for tumors located in the joint or for recurrent tumors.

Different reconstructive methods may be employed depending on the extent of bone damage in the patient.

After treatment, patients with giant cell tumors should undergo continuous physical examination and X-ray imaging of the affected area and chest. Recurrence of the tumor has been observed years after initial treatment, thus long-term monitoring for at least 5 years is necessary.

These are the basic information about giant cell tumors in bones, and hopefully they are helpful for readers.

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