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Giant Cell Tumor of Bone
Behrang Amini, MD, PhD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Giant cell tumor of bone (GCTB)
        • Synonyms

          • Not recommended: benign fibrous histiocytoma, osteoclastoma
        • Definitions

          • Locally aggressive, rarely metastasizing tumor of neoplastic mononuclear stromal cells with macrophages and osteoclast-like giant cells
          • Malignant GCTB (< 10% of cases)
            • Primary malignant GCTB: malignant nodule within benign GCTB
            • Secondary malignant GCTB: secondary to treatment of initially benign GCTB
              • More common than primary malignant GCTB
              • Almost all cases are related to radiation therapy
            • Dedifferentiated GCTB: malignant GCTB with sharp delineation between conventional and malignant components

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Haygood TM et al: Benign osseous tumors and tumor-like conditions. Semin Ultrasound CT MR. 42(2):150-63, 2021
                                      2. Palmerini E et al: Malignancy in giant cell tumor of bone: analysis of an open-label phase 2 study of denosumab. BMC Cancer. 21(1):89, 2021
                                      3. Flanagan AM et al: Giant cell tumour of bone. In Fletcher CDM et al: WHO Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press. 440-6, 2020
                                      4. Luengo-Alonso G et al: Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature. Arch Orthop Trauma Surg. 139(10):1339-49, 2019
                                      5. Palmerini E et al: Malignancy in giant cell tumor of bone: a review of the literature. Technol Cancer Res Treat. 18:1533033819840000, 2019
                                      6. Kumar R et al: Giant cell tumor of cervical spine presenting as acute asphyxia: successful surgical resection after down-staging with denosumab. Spine (Phila Pa 1976). 42(10):E629-32, 2017
                                      7. Hakozaki M et al: Radiological and pathological characteristics of giant cell tumor of bone treated with denosumab. Diagn Pathol. 9:111, 2014
                                      8. Mak IW et al: A translational study of the neoplastic cells of giant cell tumor of bone following neoadjuvant denosumab. J Bone Joint Surg Am. 96(15):e127, 2014
                                      9. Chakarun CJ et al: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 33(1):197-211, 2013
                                      10. Xu SF et al: Denosumab and giant cell tumour of bone-a review and future management considerations. Curr Oncol. 20(5):e442-7, 2013
                                      11. Raskin KA et al: Giant cell tumor of bone. J Am Acad Orthop Surg. 21(2):118-26, 2013
                                      12. Balke M et al: Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol. 135(1):149-58, 2009
                                      13. Gebre-Medhin S et al: Telomeric associations correlate with telomere length reduction and clonal chromosome aberrations in giant cell tumor of bone. Cytogenet Genome Res. 124(2):121-7, 2009
                                      14. Guo W et al: Outcome of conservative surgery for giant cell tumor of the sacrum. Spine (Phila Pa 1976). 34(10):1025-31, 2009
                                      15. Kudo N et al: Expression of bone morphogenetic proteins in giant cell tumor of bone. Anticancer Res. 29(6):2219-25, 2009
                                      16. Mak IW et al: Upregulation of MMP-13 via Runx2 in the stromal cell of giant cell tumor of bone. Bone. 45(2):377-86, 2009
                                      17. Moskovszky L et al: Genomic instability in giant cell tumor of bone. A study of 52 cases using DNA ploidy, relocalization FISH, and array-CGH analysis. Genes Chromosomes Cancer. 48(6):468-79, 2009
                                      18. Thomas DM et al: Giant cell tumour of bone. Curr Opin Oncol. 21(4):338-44, 2009
                                      19. Arbeitsgemeinschaft Knochentumoren et al: Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 90(5):1060-7, 2008
                                      20. Balke M et al: Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 134(9):969-78, 2008
                                      21. Ofluoglu O: Aggressive treatment of giant cell tumour with multiple local adjuvants. Acta Orthop Belg. 74(6):831-6, 2008
                                      22. Tse LF et al: Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone. 42(1):68-73, 2008
                                      23. Hoch B et al: Giant cell tumor complicating Paget disease of long bone. Skeletal Radiol. 36(10):973-8, 2007
                                      24. Puri A et al: Giant cell tumor of bone in children and adolescents. J Pediatr Orthop. 27(6):635-9, 2007
                                      25. Hoch B et al: Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am. 88(9):1998-2008, 2006
                                      26. Reid R et al: Giant cell tumour. In Fletcher CDM et al: WHO Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press, 2002
                                      27. Murphey MD et al: From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics. 21(5):1283-309, 2001
                                      28. Aoki J et al: MR findings indicative of hemosiderin in giant-cell tumor of bone: frequency, cause, and diagnostic significance. AJR Am J Roentgenol. 166(1):145-8, 1996
                                      29. Tubbs WS et al: Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol. 158(2):331-4, 1992
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Giant cell tumor of bone (GCTB)
                                            • Synonyms

                                              • Not recommended: benign fibrous histiocytoma, osteoclastoma
                                            • Definitions

                                              • Locally aggressive, rarely metastasizing tumor of neoplastic mononuclear stromal cells with macrophages and osteoclast-like giant cells
                                              • Malignant GCTB (< 10% of cases)
                                                • Primary malignant GCTB: malignant nodule within benign GCTB
                                                • Secondary malignant GCTB: secondary to treatment of initially benign GCTB
                                                  • More common than primary malignant GCTB
                                                  • Almost all cases are related to radiation therapy
                                                • Dedifferentiated GCTB: malignant GCTB with sharp delineation between conventional and malignant components

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Nuclear Medicine Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Haygood TM et al: Benign osseous tumors and tumor-like conditions. Semin Ultrasound CT MR. 42(2):150-63, 2021
                                                                          2. Palmerini E et al: Malignancy in giant cell tumor of bone: analysis of an open-label phase 2 study of denosumab. BMC Cancer. 21(1):89, 2021
                                                                          3. Flanagan AM et al: Giant cell tumour of bone. In Fletcher CDM et al: WHO Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press. 440-6, 2020
                                                                          4. Luengo-Alonso G et al: Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature. Arch Orthop Trauma Surg. 139(10):1339-49, 2019
                                                                          5. Palmerini E et al: Malignancy in giant cell tumor of bone: a review of the literature. Technol Cancer Res Treat. 18:1533033819840000, 2019
                                                                          6. Kumar R et al: Giant cell tumor of cervical spine presenting as acute asphyxia: successful surgical resection after down-staging with denosumab. Spine (Phila Pa 1976). 42(10):E629-32, 2017
                                                                          7. Hakozaki M et al: Radiological and pathological characteristics of giant cell tumor of bone treated with denosumab. Diagn Pathol. 9:111, 2014
                                                                          8. Mak IW et al: A translational study of the neoplastic cells of giant cell tumor of bone following neoadjuvant denosumab. J Bone Joint Surg Am. 96(15):e127, 2014
                                                                          9. Chakarun CJ et al: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 33(1):197-211, 2013
                                                                          10. Xu SF et al: Denosumab and giant cell tumour of bone-a review and future management considerations. Curr Oncol. 20(5):e442-7, 2013
                                                                          11. Raskin KA et al: Giant cell tumor of bone. J Am Acad Orthop Surg. 21(2):118-26, 2013
                                                                          12. Balke M et al: Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol. 135(1):149-58, 2009
                                                                          13. Gebre-Medhin S et al: Telomeric associations correlate with telomere length reduction and clonal chromosome aberrations in giant cell tumor of bone. Cytogenet Genome Res. 124(2):121-7, 2009
                                                                          14. Guo W et al: Outcome of conservative surgery for giant cell tumor of the sacrum. Spine (Phila Pa 1976). 34(10):1025-31, 2009
                                                                          15. Kudo N et al: Expression of bone morphogenetic proteins in giant cell tumor of bone. Anticancer Res. 29(6):2219-25, 2009
                                                                          16. Mak IW et al: Upregulation of MMP-13 via Runx2 in the stromal cell of giant cell tumor of bone. Bone. 45(2):377-86, 2009
                                                                          17. Moskovszky L et al: Genomic instability in giant cell tumor of bone. A study of 52 cases using DNA ploidy, relocalization FISH, and array-CGH analysis. Genes Chromosomes Cancer. 48(6):468-79, 2009
                                                                          18. Thomas DM et al: Giant cell tumour of bone. Curr Opin Oncol. 21(4):338-44, 2009
                                                                          19. Arbeitsgemeinschaft Knochentumoren et al: Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 90(5):1060-7, 2008
                                                                          20. Balke M et al: Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 134(9):969-78, 2008
                                                                          21. Ofluoglu O: Aggressive treatment of giant cell tumour with multiple local adjuvants. Acta Orthop Belg. 74(6):831-6, 2008
                                                                          22. Tse LF et al: Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone. 42(1):68-73, 2008
                                                                          23. Hoch B et al: Giant cell tumor complicating Paget disease of long bone. Skeletal Radiol. 36(10):973-8, 2007
                                                                          24. Puri A et al: Giant cell tumor of bone in children and adolescents. J Pediatr Orthop. 27(6):635-9, 2007
                                                                          25. Hoch B et al: Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am. 88(9):1998-2008, 2006
                                                                          26. Reid R et al: Giant cell tumour. In Fletcher CDM et al: WHO Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press, 2002
                                                                          27. Murphey MD et al: From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics. 21(5):1283-309, 2001
                                                                          28. Aoki J et al: MR findings indicative of hemosiderin in giant-cell tumor of bone: frequency, cause, and diagnostic significance. AJR Am J Roentgenol. 166(1):145-8, 1996
                                                                          29. Tubbs WS et al: Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol. 158(2):331-4, 1992