7. Site
55% AROUND THE KNEE
10% in the distal radius
6% in the proximal humerus
SPINE rarely involved (commoner in the
sacrum)
In the head and neck region the maxilla and
mandible are more commonly involved
8. GIANT CELL TUMOUR
INTRA ARTICULAR EXTENSION- 10%
TRANS OSSIOUS EXTENSION- 5%
Common sites
Wrist
Ankle & foot
Forearm
Leg
11. Pathology
GROSS End of bone is expanded.
Eccentric lesion at the epiphyseometaphyseal region.
Thin periosteum.
Fleshy dark brown, soft, friable
mass.
Cystic spaces seen.
15. Grading
Jaffe,Lichenstein and
Portis(1940)
GRADE 1o Conventional GCT
o Stroma is inconspicuous
o Giant cells dominate the field
o No atypism of stromal cells and are
loosely arranged
o Stromal cells are predominantly
spindle shaped
16. Grading
GRADE 2o Boderline tumours
o Stromal cells are prominent and tightly
packed
o Giant cells are less in number compared to
grade 1 and their nuclei may show
atypism
o Stromal cells show atypism
o These tumours have a strong chance for
recurrence and some may undergo
malignant change
17. Grading
GRADE 3o Sarcomatous type of stroma
o Frequently metastase
o Stromal cells abundant and closely
compacted and present an irregular
whorled arrangement
o Nuclei are unusually large, irregular and
atypical
o Giant cells are few in number and atypical
18. Modified grading
Sannerkin et al(1980)
Malignant GCT- with frank
sarcomatous changes and full
metastatic potential
Borderline GCT- without sarcomatous
changes but with abnormal mitoses
or vascular permeation or both
Conventional GCT- without features
of any of the above two types
19. No correlation exists
between histological
grading and clinical
behavior of the tumour.
Hence grading not widely
accepted.
20. GIANT CELLS in
Giant cell tumor
Numerous
nuclei(15-150)
Centrally placed
uniform size nuclei
Tuberculosis
Number of nuclei
are less
Peripherally placed
nuclei
21. Enneking staging for GCT
Stage 1-(10-15%)
Patients asymptomatic
Discovered incidentally
May cause pathological fracture
Has sclerotic rim on x-ray or CT
Relatively inactive on bone scans
Histologically benign
22. Enneking staging for GCT
Stage 2-(70%)
Symptomatic
Often associated with path: fracture
Has expanded cortex but no break through
Is active on bone scans
Histologically benign
23. Enneking staging for GCT
Stage 3-(10-15%)
Symptomatic
Rapidly growing mass
Has cortical perforation with
accompanying soft tissue mass
Activity on bone scan extends beyond
the lesion in x ray
Shows intense hypervascularity on
angiogram
Histologically benign
51. Metastasis
Benign pulmonary metastasis seen in 2% of patients
unpredictable course
Some spontaneously regress
Others treated by pulmonary wedge resection
25% mortality
Other sites
Lymph nodes, mediastinum ,pelvis.