Learning objectives
This educational exhibit aims to:
Illustrate typical and less frequent imaging features of giant cell tumor of bone.
Highlight the role of magnetic resonance imaging in giant cell tumor of bone characterization,
staging and monitoring.
Describe magnetic resonance findings of giant cell tumor of bone and denote tumor modifications after medical therapy with Denosumab.
Background
Giant cell tumor (GCT) of bone is typically a benign neoplasm occurring primarily in long bones of skeletally mature individuals.
It is characterized by richly vascularized tissue,
containing proliferating mononuclear stromal cells and multinucleated giant cells uniformly distributed.
It was first described by Sir Astley Cooper in 1818 [1] and has previously been referred by numerous terms,
namely osteoclastoma due to the similar appearance of multinucleated giant cells and osteoclasts.
Despite the benign histological appearance,
some GCT may be locally aggressive and recur after surgical...
Findings and procedure details
Radiographic features
GCT almost exclusively occurs in patients with closed physes and typically presents as an eccentric meta-epiphyseal lytic lesion abutting the articular surface,
with a narrow non-sclerotic zone of transition (Fig.1a).
Rarely it may present sclerotic margins (Fig.1b) or a wide zone of transition (10%–20% of cases).
[1]
Thought it is usually eccentrically located,
large lesions and lesions located in small caliber bones can appear central in location.
GCT may show expansile bone remodeling (47%–60%) and have a multiloculated appearance due to pseudotrabeculation (33%–57%),...
Conclusion
GCT is typically a benign lesion,
frequently exhibiting aggressive imaging features.
Though radiographic findings usually suggest the diagnosis of GCT,
histological confirmation is mandatory and CT and/or MR are required for accurate tumor assessment.
MR imaging allows precise characterization,
staging and monitoring of GCT,
which are essential to patient management.
Typical MR features of GCT include hypointensity on T1WI,
heterogeneous hyperintensity on T2WI and avid enhancement after intravenous contrast administration.
Some tumors may also show low signal intensity on T2WI due to the presence of...
References
1.
Murphey MD,
Nomikos GC,
Flemming DJ,
Gannon FH,
Temple HT,
Kransdorf MJ.
From the archives of AFIP - Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation.
Radiographics 2001; 21(5):1283-309
2.
Chakarun CJ,
Forrester DM,
Gottsegen CJ,
Patel DB,
White EA,
Matcuk GR Jr.
Giant cell tumor of bone: review,
mimics,
and new developments in treatment.
Radiographics 2013; 33(1):197-211
3.
Greenspan A.
Orthopedic Imaging: a practical approach 4th ed.
Lippincott Williams & Wilkins,
2004
4.
Turcotte RE.
Giant cell...