Giant cell tumor: Difference between revisions
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==Background== | ==Background<ref>Czerniak, Bogdan. “Benign Osteoblastic Tumors.” Dorfman and Czerniak's bone tumors. Elsevier Health Sciences, 2015, pp. 144 – 199.</ref>== | ||
[[File:3dee10fb0a8ad6244470738a8cb382 big gallery.jpg|thumb|Distribution of giant-cell tumors of bone]] | |||
*Benign tumor that is locally aggressive causing osteolytic destruction | *Benign tumor that is locally aggressive causing osteolytic destruction | ||
*Although classified as benign lesions, metastasis does occur in a small percentage of patients, typically to lungs | *Although classified as benign lesions, metastasis does occur in a small percentage of patients, typically to lungs | ||
**These are known as benign pulmonary implants as they do not carry the same poor prognostic implication as lung metastasis from other malignancies | **These are known as benign pulmonary implants as they do not carry the same poor prognostic implication as lung metastasis from other malignancies | ||
*3 to 5 | *3% to 5% of all primary bone tumors | ||
**Around 20 | **Around 20% in the Chinese population | ||
*Increased incidence in patients who have been diagnosed with Paget disease of the bone | *Increased incidence in patients who have been diagnosed with Paget disease of the bone | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Bone tumors and their mimics DDX}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:Giant cell tumor of bone08.jpg|thumb|X-ray of a giant-cell bone tumor in the head of the fourth metacarpal of the left hand]] | |||
*Plain radiograph showing a large lytic mass with soap bubble appearance | |||
*Obtain chest plain film to look for pulmonary metastasis | |||
*CT and MRI for more accurate assessment of tumor | |||
**Possibly can be done as outpatient | |||
*Biopsy for definitive diagnosis | |||
==Management== | ==Management== | ||
*Surgery is the treatment of choice | |||
*RANKL inhibitors (Denosumab) for unresectable metastatic disease | |||
*Can recur locally after curettage | |||
==Disposition== | ==Disposition== | ||
*Home with outpatient follow up | |||
*Admission if necessary for pain control or significant disease burden | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
[[Category:Heme/Onc]] | |||
Latest revision as of 21:02, 3 February 2020
Background[1]
- Benign tumor that is locally aggressive causing osteolytic destruction
- Although classified as benign lesions, metastasis does occur in a small percentage of patients, typically to lungs
- These are known as benign pulmonary implants as they do not carry the same poor prognostic implication as lung metastasis from other malignancies
- 3% to 5% of all primary bone tumors
- Around 20% in the Chinese population
- Increased incidence in patients who have been diagnosed with Paget disease of the bone
Clinical Features
- Pain and edema over a joint near a long bone (usually around the knee)
- Classically in a young female adult
- Can present as a pathological fracture
- Nearly all present with just a single tumor site
Differential Diagnosis
Bone tumors and their mimics
Malignant
- Multiple myeloma
- Chondrosarcoma
- Paget disease
- Osteosarcoma
- Adamantinoma
- Chordoma
- Primary bone lymphoma
- Fibrosarcoma
- Myosarcoma
Benign
- Giant cell tumor
- Chrondroblastoma
- Enchondroma
- Langerhans cell histiocytosis of bone
- Osteoblastoma
- Osteochondroma
- Osteoid osteoma
Other
Evaluation
- Plain radiograph showing a large lytic mass with soap bubble appearance
- Obtain chest plain film to look for pulmonary metastasis
- CT and MRI for more accurate assessment of tumor
- Possibly can be done as outpatient
- Biopsy for definitive diagnosis
Management
- Surgery is the treatment of choice
- RANKL inhibitors (Denosumab) for unresectable metastatic disease
- Can recur locally after curettage
Disposition
- Home with outpatient follow up
- Admission if necessary for pain control or significant disease burden
References
- ↑ Czerniak, Bogdan. “Benign Osteoblastic Tumors.” Dorfman and Czerniak's bone tumors. Elsevier Health Sciences, 2015, pp. 144 – 199.