Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

Abstract

Abstract. Giant cell tumor of bone (GCTB) is a primary benign bone tumor with a locally aggressive character. Definitive descriptions of the site of origin for this type of tumor are not available. The aim of the present study was to evaluate the site of origin of GCTB of long bones with regards to epiphyseal lines by means of radiographic examination. For that purpose, plain X-ray scans of 71 GCTBs arising in long bones were retrospectively reviewed. The tumor locations were the distal femur in 31 cases, proximal femur in 11 cases, proximal tibia in 13 cases, distal radius in 6 cases, proximal humerus in 5 cases and proximal fibula in 5 cases. The vertical center (VC) of the tumor was determined with X-ray anteroposterior view, and the correlation between the VC and the epiphyseal line, and between the distance from the epiphyseal line to the VC and tumor area or volume were analyzed using a regression model equation based on scatter plot diagrams. The VC of the tumor was located in the metaphyseal region in 57 cases, in the epiphyseal line in 11 cases and in the epiphyseal region in 3 cases. In cases of GCTB located in the distal femur or proximal tibia, significant correlations between the distance from the VC to the epiphyseal line and tumor area or volume were identified. The site of origin of GCTB was estimated to be located in the metaphyseal region. GCTB often occurs in mature patients, which renders it challenging to estimate the true site of origin of this lesion, since the metaphyseal line has disappeared in mature patients. The results of the present study suggest that GCTB possibly originates in the metaphyseal region. IntroductionGiant cell tumor of bone (GCTB) is a relatively uncommon primary bone tumor that exhibits an aggressive character and a high risk of local recurrence following surgery. GCTB accounts for 4-5% of all primary bone tumors and 13-20% of all benign bone tumors (1,2). These tumors frequently occur in skeletally mature persons, with a peak incidence in the third to fourth decade of life, while rarely arise in patients with an open growth plate. In addition, GCTBs display a slight female preponderance (3). The majority of GCTBs follow a benign course. However, GCTBs often exhibit local recurrence following surgery (3), and a previous study reported that pulmonary metastases develop despite the presence of benign histological features in 3% of patients with GCTB (4). GCTBs may undergo malignant transformation (3). Rock et al (5) reported that this may occur as a result of dedifferentiation of the primary tumor, or secondary to prior radiation therapy.The majority of GCTBs are located at the end of long bones, and ~50~60% of them are located around the knee, distal femur and proximal tibia, being the distal femur the bone most frequently involved (6-8).A previous study described that GCTB arises in the epiphyseal region of long tubular bones (9). The recent literature states that the majority of GCTBs exhibit a typical metaphyseal/epiphyseal location (10), whereas GCTBs may be cente...

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“…GCTs have also been reported in patients with open epiphyseal growth plates and these are metaphyseal in location with growth plate acting as a barrier to tumor growth that suggests metaphyseal origin of this tumor. 13 Most commonly GCT is located around the knee joint (50 to 65% of all the cases). In our series too, most of the lesions were around the knee joint (47.1%).…”

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“…The differentiation among ABC and other giant cell-containing tumors of the bone, such as GCT, GCRG and Brown tumor, is crucial 13 . GCT is composed of mononuclear and osteoclast-like multinucleated giant cells, which have the potential to be locally aggressive 14,15. In GCT, the tumor is always eccentrically located in the epiphysis and metaphysis of the bone, and exhibits lytic expansion 16 . GCRG is a rare, benign, intraosseous reactive lesion, histologically characterized by a predominance of giant and mononuclear cells in areas of hemorrhage 17 .…”