Review Question - QID 4868

This patient presents with a distal radius Giant Cell Tumor (GCT). With no cortical breakthrough, this should be treated with intralesional curettage followed by local adjuvant therapy (argon beam, liquid nitrogen, cement with bisphosphonates).

Giant cell tumor of bone (GCT) is a benign aggressive tumor typically found in the epiphysis of long bones. 50% of tumors occur around the knee (distal femur or proximal tibia). The most common sites of giant cell tumors in bone, which are the distal radius, sacrum, distal femur, proximal tibia and proximal humerus. GCT is characterized by proliferation of mononuclear stromal cells and the presence of multi-nucleated giant cells with homogenous distribution. Treatment typically involves intralesional curettage with adjuvant treatment (e.g., phenol, hydrogen peroxide, argon beam, etc).

Becker et al. looked at the use of polymethylmethacrylate after curettage in the treatment of giant cell tumor of bone. They found that polymethylmethacrylate, as an adjuvant, significantly reduced the recurrence rate following intralesional treatment of benign giant cell tumours compared to no adjunct treatment (22% vs 49% respectively).

Figure A shows an expansile mass proximal to the wrist joint. Figure B shows an AP radiograph of the wrist with an expansile, lytic lesion in the distal radius. Figure C is a low powered biopsy showing multiple multinucleated giant cells in mononuclear background cells, which is indicative of GCT.

Incorrect Answers:
Answers 1-3: Occasionally, GCT of bone may demonstrate profound responses to chemotherapy but these cases are usually anecdotal. Radiotherapy is recommended when complete excision or curettage is impractical for medical or functional reasons (generally for lesions of the spine and sacrum) or for aggressive, multiply recurrent tumours.
Answer 5: Amputation is not a routine treatment option for upper extremity GCT.