GIANT CELL TUMOUR

(OSTEOCLASTOMA)
Dr. Amelia Tjandra Irawan, SP.Rad (K) MSK

Hasyasya Furnita K
 Tumours and Tumour-Like Conditions of
Bone (2)

1. Bone Tumours Presumed To Arise From

Skeletal Tissues-Fibrous Tumor
• Fibrous cortical defect
• Non ossifying fibroma
• Desmoplastic fibroma
• Fibrosarcoma
• Malignant fibrous histiocytoma
• Adamantinoma of long bone
2. Bone Tumours Presumed To Arise From
Skeletal Tissues: Giant Cell Containing

• Giant Cell Tumour (Osteoclastoma)

• Aneurysmal Bone Cyst
 Introduction
First described by Cooper and Travers at 1818

Also known as osteoclastomas

Are relatively common bone tumours

Usually benign

Typically arise from the metaphysis of long bones and extend into the
epiphysis

With potential for aggressive behavior and capacity to metastasis

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
https://emedicine.medscape.com/article/1255364-workup.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733230/ .
Sutton, D. Textbook of Radiology and Imaging. 7th edition, Vol.2, London: Elsevier, 2003.
 Epidemiology

5% of all primary bone

Increased prevalence
tumors and 20% of
among females
benign skeletal tumors

Malignant transformation 80% of cases occurring

is far more common in between 20 and 50 years
men of age.

Source : https://pubs.rsna.org/doi/10.1148/rg.331125089
https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
Sutton, D. Textbook of Radiology and Imaging. 7th edition, Vol.2, London: Elsevier, 2003. p. 1292-1293
 Site of Involvement

< 1%

vertebral
body: 7%

sacrum:
4-9%

distal radius:
10-12%

distal femur and

proximal tibia: 50-
65%

< 1%

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
 CLASSIFICATION
Campanacci et al proposed a grading system for GCTs that is
based on the radiographic appearance of the tumors

A grade 1 lesion (latent) has a well-defined

margin and an intact cortex

A grade 2 lesion (active) has a relatively well-

defined margin but no radiopaque rim, and the
cortex is thinned and moderately expanded

A grade 3 lesion (aggressive) has indistinct

borders and cortical destruction

Source : https://pubs.rsna.org/doi/full/10.1148/radiographics.21.5.g01se251283.
Etiology & Pathogenesis

Over-expression in
RANK/RANKL The cause of giant cell
signalling pathway tumors is unknown
with resultant over- and not inherited.
proliferation of
osteoclasts

In rare cases ->

associated with
overactivity of the
parathyroid glands

Source : Grainger & Allison’s Diagnostic Radiology, A Textbook of Medical Imaging: 6th edition,. p. 1102-1103
https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
https://pubs.rsna.org/doi/full/10.1148/radiographics.21.5.g01se251283.
 Clinical features

The presentation is not

specific, typically
presents insidiously and
relates to bone pain, soft
tissue mass, swelling (3/4
patients)
Warm, interrupt ROM,
compression of adjacent
structures or acutely
with a pathological
fracture

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
 Histology

Characterised by
prominent and diffuse
osteoclastic giant cells and
mononuclear cells ( round,
oval, or polygonal and may
resemble normal
histiocytes).

Formed by the fusion of several cells, giant cells show multiple nuclei when viewed under a microscope.
Reproduced from Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ: Giant cell tumor of bone. J Am Acad Orthop
Surg 2013; 21: 118-126 3
 Pathology

Grossly, GCT of bone

appears brownish in
color and is usually
solid; however, some
tumors may have a
hemorrhagic, cystic
component

Intraoperative photograph shows complete destruction of the lateral margin of the lateral femoral
condyle and the presence of a soft-tissue mass (arrows).4

/
Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733230
 Pathology

Gross specimen of same giant cell Bisected gross specimen of giant cell Gross specimen of giant cell tumor
tumor in the distal femur as in tumor in preceding image reveals that fills entire distal radius. Despite
preceding image displays typical blood-filled cystic areas and inner cortical disruption, periosteum
chocolate-brown and spongy yellow and orange discoloration. remains intact (arrow). Once again,
appearance note blood-filled cystic areas and
areas of orange discoloration.

Source : https://emedicine.medscape.com/article/1255364-workup.
 Radiological Features

Classic appearance

• There are four characteristic radiographic

features when a GCT is located in a long bone:
• occurs only with a closed growth plate
• abouts articular surface: 84-99% come within 1
cm of the articular surface
• well defined with non-sclerotic margin (though
< 5% may show some sclerosis
• eccentric: if large this may be difficult to assess

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
 Radiological Features
Radiographically, giant cell tumors (GCTs) are lucent and eccentrically located within the bone. These
lesions can appear aggressive and are often characterized by extensive local bony destruction,
cortical breakthrough, and soft-tissue expansion

Giant cell tumor. Anteroposterior radiograph Giant cell tumor. Lateral radiograph of same
of distal femur reveals expansile lytic distal femur as in previous image reveals
metaphyseal-epiphyseal lesion. expansile lytic metaphyseal-epiphyseal lesion.
Source : https://emedicine.medscape.com/article/1255364-workup.
 Radiological Features

Giant cell tumor. Anteroposterior radiograph of Giant cell tumor. Lateral radiograph of same distal
distal radius reveals aggressive lesion radius as in previous image reveals aggressive
characterized by extensive local bony lesion characterized by extensive local bony
destruction, cortical breakthrough, and destruction, cortical breakthrough, and significant
significant soft-tissue expansion. soft-tissue expansion

Source : https://emedicine.medscape.com/article/1255364-workup.
 Radiological Features
When located in the epiphysis, GCTs generally extend to the articular surface

Giant cell tumor. Anteroposterior radiograph of Giant cell tumor. Lateral radiograph of same distal
distal tibia demonstrates extension of lesion to tibia as in preceding image demonstrates extension
articular surface. of lesion to articular surface

Source : https://emedicine.medscape.com/article/1255364-workup.
 Radiological Features
CT

• General radiographic features include:

• narrow zone of transition: a broader zone of
transition is seen in more aggressive GCTs
• no surrounding sclerosis: 80-85%
• overlying cortex is thinned, expanded or deficient
• periosteal reaction is only seen in 10-30% of cases
• soft tissue mass is not infrequent
• pathological fracture may be present
• no matrix calcification/mineralisation

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
 Radiological Features
Computed tomography (CT) scans of the lesion reveal an absence of bone and
intralesional mineralization

Giant cell tumor. CT scan of distal femur reveals

absence of matrix within lesion.

Source : https://emedicine.medscape.com/article/1255364-workup.
 Radiological Features
MRI
• Typical signal characteristics include:
• T1
• low to intermediate solid component
• low signal periphery
• solid components enhance, helping distinguish GCT with an aneurysmal bone
cyst (ABC) from a pure ABC
• some enhancement may also be seen in adjacent bone marrow
• T2
• heterogeneous high signal with areas of low signal intensity (variable) due to
haemosiderin or fibrosis
• if an aneurysmal bone cyst component present, then fluid-fluid levels can be
seen
• high signal in adjacent bone marrow thought to represent inflammatory
oedema
• T1 C+ (Gd): solid components will enhance, helping differentiate from
aneurysmal bone cysts

Source : https://radiopaedia.org/articles/giant-cell-tumour-of-bone.
 Radiological Features
Magnetic resonance imaging (MRI) often is performed to delineate the extent of the
neoplasm. In the typical GCT, the signal intensity is homogeneous, and the lesion is well
circumscribed. The lesions have low signal intensity on T1-weighted images and
intermediate signal intensity on T2-weighted images .

Sagittal T1-weighted MRI shows giant Sagittal T2-weighted MRI shows giant cell tumor with
cell tumor with low signal intensity. intermediate-to-high signal intensity.
Source : https://emedicine.medscape.com/article/1255364-workup.
 GCT ABC Chondroblastoma SBC

Patient age/sex F>M F>M F<M F<M

20-40 years < 20 years < 25 years < 20 years

Location Metaphysis extend to Metaphysis, Epiiphysis, Metaphysis,

epiphysis, Long bone (lower Long bone (humerus, Long bone (proximal
Around the knee limb) femur, tibia) humerus)

Clinical Not specific, bone pain, Pain, pathological Not specific, joint pain, pain, swelling and
Presentation soft tissue mass, fracture, with a muscle wasting, stiffness of the adjacent
pathological fracture palpable lump or with tenderness, and joint , pathological
restricted movement swelling/local mass. fracture

Cause Unknown Unknown Unknown Unknown

Radiographic Well-defined osteolitic Sharply defined, Well defined lucent well defined lucent
Features lession eccentric in expansile osteolytic lesions, with either lesions with a narrow
epiphysis lesions, with thin smooth or lobulated zone of
sclerotic margins margins and a thin transition, sclerotic
sclerotic rim, arising margin in the majority of
eccentrically in the cases with no periosteal
epiphysis of long tubular reaction or soft tissue
bone component
 References
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Imaging: 6th edition, Vol.1, London: Elsevier, 2015. p. 1102-1103
2. Bocklage TJ, Quinn RH, et al. Bone and Soft Tissue Tumors, A Multidisciplinary Review with Case
Presentations. London: JP Medical Publisher, 2014. p. 486-507
3. Brockman BS, Quinn RH. Giant Cell Tumor of Bone. https://orthoinfo.aaos.org/en/diseases--
conditions/giant-cell-tumor-of-bone/. October 2016
4. Chakarun CJ, Forrester DM, et al. Giant Cell Tumor of Bone: Review, Mimics, and New Developments
in Treatment. https://pubs.rsna.org/doi/10.1148/rg.331125089 . January 1, 2013
5. Haouimi A, Amini B, et al. Giant cell tumour of bone. https://radiopaedia.org/articles/giant-cell-
tumour-of-bone. July 2018
6. Lewis, Valerae O. Giant Cell Tumor Workup. https://emedicine.medscape.com/article/1255364-
workup. Jul 31, 2017
7. Murphey MD, Nomikos GC, et al. Imaging of Giant Cell Tumor and Giant Cell Reparative Granuloma
of Bone: Radiologic-Pathologic Correlation.
https://pubs.rsna.org/doi/full/10.1148/radiographics.21.5.g01se251283. September 1, 2001
8. O'Donnell, Patrick. Giant Cell Tumor. https://www.orthobullets.com/pathology/8046/giant-cell-
tumor. 2017
9. Sobti A, Agrawal P, Agarwala S, et al. Giant Cell Tumor of Bone - An Overview.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733230/ . January 2016
10. Sutton, D. Textbook of Radiology and Imaging. 7th edition, Vol.2, London: Elsevier, 2003. p. 1292-
1293
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