Clinical Scenario and Imaging with Illustrations of Giant Cell Tumor of Bone: A Retrospective Analysis

Abstract

Background: The giant cell tumour of the bone has a spectrum of clinical-radiological presentation. This study aims to describe this varied presentation in our institution.

Methods: This retrospective study was conducted on twenty-nine pathologically labelled cases of giant cell tumours of the bone. The medical records for their clinical presentation and diagnostic imaging studies were studied and evaluated.

Results: Mean age of the patients at presentation was 35.3±12.9 years. Pain, local swelling and restricted joint function were seen in 93 %, 58.6 % and 52 % patients, respectively. The cortical breach was seen in 15 (51.7 %) and 22 (75.9 %) lesions on plain radiographs and CT images, respectively. 14(48.3 %) cases had soft tissue invasion on MRI at presentation. 26 (89.7 %) lesions were located within 1 cm from the articular cartilage. The solid tumour component was hypo to iso-intense in signal intensity in 27 (93.1 %) lesions in T1 weighted and 21 (72.4 %) in T2 weighted images. 14 (48.3 %) had hyperintense cystic areas, and fluid-fluid levels, suggestive of aneurysmal bone cysts, were seen in 4 (13.8 %) cases on T2 weighted images. Hypo-echoic nodular areas in solid tumour component, suggestive of hemosiderin deposits, were present in 3 (10.3 %) lesions on T1 and T2 weighted images.

Conclusion: The tumour classically presents as an epiphysial-metaphyseal, eccentric, expansile, lytic lesion in a skeletally mature patient. The MRI picture is variable and the surgeon should have a sound knowledge of these variations to obtain a biopsy sample from a proper site of the lesion and to avoid misdiagnosis especially of a primary ABC.

Keywords: ABC; Fluid-Fluid; Giant-Cell; Hemosiderin; Soap-Bubble.

Figure 1

(a, b) Relation of tumour axis (white line) with the long axis of the bone (black line). (a) Centric lesion. (b) Eccentric lesion. (c) Expansile remodelling (arrow) of lateral condyle of the tibia. (d) Cortical thinning (stars) of the medial cortex. (e, f) GCT of the proximal tibia. (e) Radiograph showing lytic lesion (arrows) in metaphysis with intact cortices. (f) CT axial and sagittal cut sections showing breach in the anterior cortex (star) with soft tissue extension (arrow)

Figure 2

(a) Well defined sclerotic rim (white arrows). (b) Hardly visible fine hairline (black arrows) like sclerosis. (c) Well marked demarcation (white arrow) between normal bone and lesion but no sclerotic rim. (d) Permeative lesion with a wide zone of transition (inside the rectangle)

Figure 3

(a) Expansile lesion with cortical scalloping and pseudo-trabeculation of the lytic lesion (soap bubble appearance). (b) GCT of the proximal tibia with associated pathological fracture

Figure 4

(a) Axial and coronal MRI sections showing soft tissue invasion (black stars) of GCT through a breach in the anterior cortex of the tibia. (b) MR axial cut section of GCT of lateral femoral condyle showing the distorted contour of patella-femoral joint (arrow). (c) GCT proximal tibia with depression (arrow) of part of the lateral tibial articular surface. (d, e) GCT of the distal radius. (d) MRI showing tumour invasion of soft tissue and wrist joint. (e) Clinical picture showing tumour mass at the radial styloid

Figure 5

(a, b) Coronal cut MRI images showing GCT of the lateral tibial condyle. (a) T1 weighted image showing iso-intense signal of the lesion with respect to the muscle. (b) T2 weighted image showing hyper-intense signal of the lesion. (c) Sagittal cut section MRI (T2 image) with a heterogeneous signal with predominant hyper-intense cystic lesions

Figure 6

(a, b) GCT of the proximal tibia. (a) Iso-intense signal (star) on T1. (b) T2 weighted cross-sectional image showing heterogeneous signal intensity with multiple cysts and fluid-fluid levels (black arrow). (c, d) MR sagittal cut sections of GCT of the proximal tibia. (c) T1 weighted image with hypoechoic nodular lesions (star) suggestive of hemosiderin deposits. (d) T2 weighted image with similar hypoechoic nodular lesions of hemosiderin deposits

Figure 7

(a, b) GCT of the distal ulna with lung metastasis at presentation. (a) Radiograph showing destruction of the distal half of ulna with diverging cortices (black arrows) suggestive of an expansile lesion. (b) Metastatic lung nodule (black star)