GIANT CELL TUMOURS. A REVIEW OF EXPERIENCE OVER THE LAST 19 YEARS

Abstract

Introduction and Objectives: Giant cell tumour (GCT) of the bone is an “aggressive tumor characterized by highly-vascularized tissue consisting of ovoid or fusiform cells and the presence of numerous gigantic osteoclast-like cells distributed uniformly throughout the tumor tissue” (WHO). The aim of this report is to present our experience over the past 19 years (1983–2002) with GCT of the bone treated in our unit.

Materials and Methods: From January 1983 to January 2002, we have treated 67 cases of GCT of the bone, excluding all cases with less than 12 months of follow up. Age at presentation ranged 10 to 17 years. There was a higher incidence from 20 to 40 years of age. There was a moderately higher rate in women compared to men (1.5:1). The most common locations were the distal epiphysis of the femur, proximal epiphysis of the tibia, and the distal end of the radius. This type of tumour generally localises to the epiphysis and subsequently invades the metaphysis. Localization to the axial skeleton is rare. Radiologic diagnosis was achieved by simple local radiology, CT scan, and MRI. Histopathologic diagnosis was done by means of biopsy using a trocar guided by an image intensifier. In cases of central localization, we obtained the sample by CT-guided biopsy. The treatment of choice is aggressive curettage (high-velocity burr) and filling with frozen cancellous chips. Radiation therapy is useful in cases of localization that are not accessible by surgery.

Results: GCT of the bone possesses several unique characteristics, which make it different from other intermediate tumors: a high rate of recurrence (up to 50%), the possibility of sarcomatous degeneration, and the possibility of pulmonary metastasis (even in non-malignant cases). We believe the ideal treatment is resection of the bone where the tumour is located (useful on the head of the fibula, distal end of the ulna, ribs, some bones of the hand and feet, and the patella). In view of its usual localization near the knee (50%), our usual treatment is aggressive curettage (high-speed burr) and filling with frozen cancellous chips. We have treated 26 recurrent cases out of 67 patients treated in our unit (38.8%). Of these, approximately 50% were referred from other centres. Treatment of recurrence has generally been aggressive curettage and addition of allografts. Sarcomatous degeneration occurred in 3 cases (4.5%), all of which were high grade sarcomas of the malignant fibrous histiocytoma type. One case survived following amputation of the extremity, and the other 2 cases died as a result of pulmonary metastasis.

Discussion and Conclusions: Alternative local treatment methods exist for GCT of the bone such as cryosurgery, phenolization, and cementing. However, we cannot comment on these methods due to a lack of experience with them. The aim of all these methods is to cauterize the tumour bed. We prefer aggressive curettage and filling with cancellous bone in an attempt to use a more biological treatment.