Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment

Abstract

Giant cell tumor (GCT) of bone is generally a benign tumor composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but nonsclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. However, GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. Rarely, GCT is associated with histologically benign lung metastases or undergoes malignant degeneration. In the past, the mainstay of treatment was surgical, primarily consisting of curettage with cement placement, with recurrence rates of 15%-25%. Recurrence is suggested by development of progressive lucency at the cement-bone interface. Other complications include pathologic fracture and postoperative infection. Denosumab, a monoclonal antibody that targets the osteoclastic activity of GCT, has produced 90% tumor necrosis in early studies, results indicative of promise as a potential adjuvant therapy.

Denosumab and Giant Cell Tumour of Bone—A Review and Future Management Considerations

“…Most lesions develop in the long bones (75%-90%), with most cases (50%-65%) occurring near the knee 1,2,8 . Other frequent sites are the distal radius, proximal humerus, fibula, sacrum, and vertebral body (fewer than 3% of cases) 2,8 . In no reported case has gctb ABSTRACT Giant cell tumour of bone (gctb) is one type of giantcell-rich bone lesion characterized by the presence of numerous multinucleated osteoclast-type giant cells.…”

“…Giant cell tumour of bone occurs most commonly during the second to fourth decades of life (60%-75%) and has a maleto-female ratio in the range 1:1.2 to 1:1.5 2,5 . Most lesions develop in the long bones (75%-90%), with most cases (50%-65%) occurring near the knee 1,2,8 . Other frequent sites are the distal radius, proximal humerus, fibula, sacrum, and vertebral body (fewer than 3% of cases) 2,8 .…”

Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna

“…GCTs are generally composed of mononuclear histiocytic cells, multinucleated giant cells resembling osteoclasts and neoplastic stromal cells that are the predominant proliferating cell population (4,5). The disease is generally recognized as a border or low-grade, with a certain degree of invasive characteristics, demonstrated by biological behavior (6,7). The predominant problem in the management of GCT is local recurrence following surgical treatment: 27-65% following isolated curettage; 12-27% following curettage with adjuvants such as high-speed burr, phenol, liquid nitrogen, or polymethylmethacrylate; and 0-12% after en bloc resection (6).…”

Morphologic evaluation of the effect of denosumab on giant cell tumors of bone and a new grading scheme

“…Surgery is the preferred treatment but treatment with denosumab was recently shown to delay the need for surgery and prevent morbid surgical procedures [7].…”