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Giant Cell Tumor (Osteoclastoma)

It is epiphyseal lesion seen most commonly around the knee joint.


Age group: most commonly seen after closure of physis (30 to 40 years).


Clinically egg shell cracking sensation is seen in late stage of tumor, sometimes it can present as pulsatile tumor.


Histopathological feature: tumor contains two type of cells. The tumor cell is mononuclear stromal cell. Another kind of cell seen is multinuclear giant cells (not true tumor cells).


Treatment: curretage is treatment of choice. Extended curretge is terminology used when curretage is followed up by addition of adjuvants like liquid nitrogen(crytherapy),phenol, bone cement(PMMA). Large tumors may requires excision, bone grafting, turn o plasty, rarely amputation.


Though radiotherapy is not used in benign tumors, in GCT sometimes in surgically inaccessible areas radiotherapy is used. (Other benign tumor exception where radiotherapy is used is Pigmented villonodular synovitis)

Giant cell variants

---------------------------- (Mnemonic: CCF BANTU)


C - Chondromyxoid fibroma


C - Chondroblastoma


F – Fibrous dysplasia


B – Browns tumor


A – Aneurysmal bone cyst


N - Non ossifying fibroma


T – Telan giectasias


U – Unicameral bone cyst


List of lesion also containing Giant cells: ( Mnemonic : OFC)

  1. Osteoblastoma,Osteosarcoma (telangiectatic type)
  2. Fibrosarcoma
  3. Chondroblastoma,Chondromyxoid tumor

Osteoclastoma radiologically presents as Eccentric and soap bubble appearance.

  1. Treatment of Osteclastoma (GCT)
    1. Curettage (intra lesional)
    2. Extended-Curettage chemical cautery by PMMA( & bone grafting),hydrogen peroxide, liquid nitrogen.
      1. Operation of choice for most small lesions of unresectable
    3. Excision/Complete resection
      1. Lower end of ulna
      2. Upper end of fibula
    4. Excision & replacement by vascularized bone graft
      1. Lower end of radius
    5. Turn - o plasty can be used in GCT of upper end tibia & lower end femur (rarely done)
    6. Excision & arthrodesis or prosthetic replacement
      1. Lower end femur & upper end tibia
    7. Amputation
      1. Malignant recurrent GCT of extremity
    8. Radiotherapy
      1. Spine (It is important to note that RT is a cause of malignant transformation of GCT).
    9. Newer Modality: Denusumab (Monoclonal antibody against RANK Ligand) is also useful in GCT because RANK-RANL mechanism of bone destruction is considered as an etiology for GCT.

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