Giant Cell Tumor

It is a locally aggressive benign bone tumor. It is the common benign tumor to affect the bone, it accounts for 25% of the benign bone tumors

Cause of Gaint cell tumor- the exact cause of giant cell tumor is not known. It is due to overactivity of bone destroying cells.

Age- 30 -40 years

Sex- Female > Male

Symptoms – Bone swelling, Persistent bone pain, Fracture following trivial fall

Common site – Around the knee, proximal humerus, distal radius

The investigation required – 1) X-ray, 2) MRI 3) Most important is Biopsy

Note- Biopsy is done as a day care procedure under local anesthesia or rarely under general anesthesia. Usually, a biopsy procedure takes 10-15 mins. Tumor does not spread with biopsy and biopsy is not a complicated surgical procedure.

Treatment:

Extended curettage – It includes making an adequate window in the bone. Scooping out the tumor, use a high-speed burr to break the septae and 1-2 mm of normal bone. Varies adjuvants like hydrogen peroxide, phenol, liquid nitrogen, argon bean laser are used to clear residual disease. The bone defect can be filled with bone cement and bone graft.  This procedure helps to save the joint completely so patients will have excellent function and perform all the regular activities.

1. Giant cell tumor of the thigh ( femur) bone
2. An adequate window is made, to visualize the tumor completely
3. The tumor was scooped out of the cavity
4. High-speed burr and adjuvants are used to perform extended curettage
5. The cavity filled with bone cement or bone graft

Wide local excision – If the tumor is very big and has destroyed the bone completely, we have to excise the involved bone completely and replace the defect with artificial metallic bone or biological reconstructions using fibula bone, allograft ( Other patient bone)

Injection Denosumab can be used in selective cases to facilitate curettage or excision of the tumor

The course of GCT- It is not cancer so the majority of the time it won’t affect life or limb. The chance of recurrence has dramatically reduced to 10-20% after the extended curettage with a better understanding of the disease and extended curettage in trained hands.

Early diagnosis and management at a specialized bone cancer center will reduce the chance of disease recurrence and gives excellent function.

Dr.Suman Byregowda  | Consultant Musculo-Skeletal Oncosurgeon | Mazumdar Shaw Narayana Hrudhalaya Cancer Center, Bangalore