What Is a Giant Cell Tumor?

Giant cell tumor of bone was first discovered by Jaffe in 1940, and it is one of the common primary bone tumors. The source is unknown, and it may originate in the mesenchymal tissue of the bone marrow. Giant cell tumor of bone is highly invasive and has a large erosion and destruction effect on bone. Very few have the tendency to respond to new bone formation and self-healing. It can pass through the cortical bone to form a soft tissue mass. The recurrence rate is high after curettage. A small number may develop localized malignant changes or pulmonary metastases (so-called benign metastases). Giant cell tumor of bone is a low-grade or potentially malignant tumor.

Basic Information

English name

giantcelltumour

Visiting department

orthopedics

Multiple groups

20 to 50 women

Common symptoms

pain

Causes of giant cell tumor of bone

The cause of giant cell tumor of bone is still unknown. Tumor tissue is rich in blood supply, soft and brittle, like granulation tissue, with fibrotic mechanized area and bleeding area. It is divided into three degrees according to benign and malignant degrees: once: benign, there are many giant cells and few cell divisions. Second degree: Between malignant or benign, there are more interstitial cells and less giant cells than once. Third degree: It is malignant, with less occurrence, more interstitial cells, and large nuclei, morphology such as sarcoma, more cell division, fewer and smaller giant cells, and fewer nuclei. The first and second degrees can be converted into third degrees.

Clinical manifestations of giant cell tumor of bone

The main clinical manifestations of giant cell tumor of bone are those with large lesions, sore or dull pain, occasional severe pain and nocturnal pain, which are the main reasons for patients to seek medical treatment. Some patients have local swelling, which may be related to bone swelling. When the lesion penetrated the cortical bone and invaded the soft tissue, the local mass was obvious. Patients often have tenderness and an increase in skin temperature, which is one of the criteria for judging recurrence after surgery. The tumors in the active phase are rich in blood flow, and angiography shows that the diffuse vascular network enters the tumor, similar to the image of a malignant mass. The motion of the joint adjacent to the lesion is limited. Tumors of the trunk bone can produce corresponding symptoms, such as anterior iliac mass can compress the sacral plexus nerve, causing severe pain, oppression of the rectum and difficulty in defecation.

Giant cell tumor of bone

X-ray changes of giant cell tumor of bone provide important clues for the diagnosis of this disease. Mainly manifested as osteolytic lesions invading the epiphysis, with eccentricity and swelling, no sclerosis of the edges, no reactive new bone formation, thinning of the cortex of the lesion, and a soap bubble-like change. Accompanied by pathological fracture, due to osteolytic destruction, usually no displacement.

Giant cell tumor of bone diagnosis

The main points of diagnosis of giant cell tumor of bone are:

1. Clinically there is joint pain. When the tumor approaches the joint cavity, swelling, pain and dysfunction appear.

2. The X-ray showed that the lesion was located at the metaphysis, showing eccentric, osteolytic, and swollen bone destruction, with clear borders, and sometimes a soap bubble-like change, with obvious cladding.

3. Pathological examination revealed that the tumor was composed of a dense, uniformly sized mononuclear cell population. A large number of multinucleated giant cells were distributed in various parts, and there were spindle fibroblast-like and round histiocyte-like cells in the matrix.

Differential diagnosis of giant cell tumor of bone

The disease should be distinguished from diseases such as bone cysts, chondroblastomas, and aneurysmal bone cysts.

Giant cell tumor of bone treatment

The treatment of giant cell tumor of bone is mainly based on surgical resection, incision and scraping plus inactivation, and implantation of autologous or allogeneic cancellous bone or bone cement. The recurrence rate of this disease is high. For those who relapse, resection or segment excision or prosthesis implantation should be performed. Those who belong to G1-2T1-2M0 should be extensively or radically removed. This disease is ineffective for chemotherapy. For those who have difficulty in surgery (such as spine), radiotherapy can be performed, and sarcoma is prone to occur after radiotherapy.

Local resection

After the giant cell tumor of the bone is removed, if it has little effect on the function, it can be completely removed, such as the upper end of the fibula, the lower end of the ulna, the upper end of the radius, the hand bone, and the foot bone.

2. Scrape plus adjuvant therapy

This therapy can not only reduce the recurrence rate of tumors, but also retain the function of the limbs. Chemical methods can use phenol solution or absolute ethanol to smear the inner surface of the tumor cavity after scraping. Cytotoxic substances can be used on locally recurring surfaces. Physiotherapy includes cryotherapy or heat therapy. When the bone cavity is used to fill the cavity remaining in the tumor, the heat generated can prevent recurrence, that is, the bone cement's pyrogenic reaction causes local fever, necrosis of the remaining tumor tissue, but does not damage normal tissue and avoid complications.

3. Removal or amputation

If giant cell tumor of bone is malignant and has a large range, with soft tissue infiltration or recurrence after surgery, local excision or amputation should be considered according to the specific situation. After resection of the tumor, the joint becomes ineffective (such as the femoral neck), and artificial joints or joint fusion can be considered.

4. Radiation therapy

Giant cell tumors of bone are not easy to operate during surgery, or those whose function is greatly affected after resection (such as giant cell tumors of vertebral bone) can be treated with radiation with certain effects. A small number of patients can develop malignant changes after radiotherapy. Patients undergoing surgery or radiotherapy should follow up for a long time, paying attention to local recurrence, malignant changes and lung metastases.