Giant Cell Tumor Central Hospital Jakarta

GIANT CELL TUMOR OF BONEGIANT CELL TUMOR OF BONEIn Central General Hospital, JakartaIn Central General Hospital, Jakarta

Errol HutagalungErrol Hutagalung

Orthopaedic Oncology ServiceOrthopaedic Oncology ServiceFaculty of Medicine, Univ. of IndonesiaFaculty of Medicine, Univ. of Indonesia

Central General Hospital, JakartaCentral General Hospital, Jakarta


• Giant Cell Tumor (G.C.T.) of bone is a benignGiant Cell Tumor (G.C.T.) of bone is a benign bone tumor which contain giant cellsbone tumor which contain giant cells

• Benign lesion with giant cells : Benign lesion with giant cells : - A.B.C.- A.B.C.- S.B.C.- S.B.C.- Chondromyxoid fibroma- Chondromyxoid fibroma- Non ossifying fibroma- Non ossifying fibroma


• Lichteinstein & Jaffe (1940) : Lichteinstein & Jaffe (1940) : G.C.T. need a specific clinico-radiologic-G.C.T. need a specific clinico-radiologic- pathologic criteriapathologic criteria Others : Variant of G.C.T.Others : Variant of G.C.T.

• OriginOrigin : - Unknown : - Unknown - Cellular elements of bone marrow;- Cellular elements of bone marrow; Giant Cell : Fusion of mononuclearGiant Cell : Fusion of mononuclear cellscells


Material :Material :

• 32 cases of G.C.T., ’90 – ’97 in Central General32 cases of G.C.T., ’90 – ’97 in Central General Hospital, JakartaHospital, Jakarta• Same period : 246 cases of bone tumorSame period : 246 cases of bone tumor

Result :Result :

• Incidence : 13% of all bone tumorIncidence : 13% of all bone tumor• Duration of complaint :Duration of complaint : - 1 – 6 months : 14 cases- 1 – 6 months : 14 cases - 6 – 18 months : 15 cases- 6 – 18 months : 15 cases - > 18 months : 3 cases ( 2 years, 3 years &- > 18 months : 3 cases ( 2 years, 3 years & 15 years)15 years)


Result :Result :

• Sex : Male : 20 casesSex : Male : 20 cases Female : 12 casesFemale : 12 cases

• Age : 11 – 20 years : 2 casesAge : 11 – 20 years : 2 cases 21 – 30 years : 13 cases 21 – 30 years : 13 cases 31 – 40 years : 15 cases31 – 40 years : 15 cases > 40 years : 2 cases> 40 years : 2 cases


Result :Result :• Location : Location :

- Proximal tibia- Proximal tibia : 11 cases: 11 cases- Distal radius- Distal radius : 10 cases: 10 cases- Distal femur- Distal femur : 4 cases: 4 cases- Distal ulna- Distal ulna : 2 cases: 2 cases- Proximal humerus- Proximal humerus : 2 case: 2 case- Distal humerus- Distal humerus : 1 case: 1 case- Vertebra (cervical)- Vertebra (cervical) : 1 case: 1 case- Proximal femur- Proximal femur : 1 case: 1 case

• Staging : Staging : - Stage 2 / active- Stage 2 / active : 10 cases: 10 cases- Stage 3 / aggressive- Stage 3 / aggressive : 22 cases: 22 cases


Treatment :Treatment :

• Curette and bone graft Curette and bone graft : 3 cases : 3 cases• Curette & bone graft & bone cement : 1 caseCurette & bone graft & bone cement : 1 case• ResectionResection : 2 cases : 2 cases• Resection & arthrodesis of the kneeResection & arthrodesis of the knee (Juvara procedure)(Juvara procedure) : 8 cases : 8 cases• Resection & reconstruction w. fibulaResection & reconstruction w. fibula : 7 cases : 7 cases



• Resection & reconstruction Resection & reconstruction with prosthesiswith prosthesis : 1 case: 1 case

• Resection & centralization of ulnaResection & centralization of ulna : 3 cases: 3 cases• Curette & decompression & Curette & decompression &

vertebral stabilizationvertebral stabilization : 1 case: 1 case• AmputationAmputation : 3 cases: 3 cases• Refused treatmentRefused treatment : 3 cases: 3 cases


Follow up :Follow up :

- - 6 months – 2 years post operative6 months – 2 years post operative -- 29 cases underwent surgical treatment 29 cases underwent surgical treatment

20 cases could be followed up20 cases could be followed up 11 cases with recurrence11 cases with recurrence

• 20 cases with follow up : 8 cases with stage 220 cases with follow up : 8 cases with stage 2 12 cases with stage 312 cases with stage 3• 8 cases stage 2 8 cases stage 2 recurrent : 2 casesrecurrent : 2 cases• 12 cases stage12 cases stage 33 recurrent : 9 casesrecurrent : 9 cases


Relationship between type of surgeryRelationship between type of surgerywith recurrence :with recurrence :

Stage 2 (8 cases) :Stage 2 (8 cases) : - Recurrence (-) : - Recurrence (-) : - Resection w/wo reconstruction : 5 cases- Resection w/wo reconstruction : 5 cases - Curette & bone graft & bone cement : 1 case- Curette & bone graft & bone cement : 1 case - Recurrence (+) :- Recurrence (+) : - 2 cases with curette & bone graft- 2 cases with curette & bone graft

Stage 3 (12 cases) :Stage 3 (12 cases) : - Recurrence (-) :- Recurrence (-) : - 3 cases with amputation procedures- 3 cases with amputation procedures - Recurrence (+) :- Recurrence (+) : - 9 cases with resection procedures - 9 cases with resection procedures


Discussion :Discussion :

• Incidence : 13% - Unni : 5% (Mayo Clinic)Incidence : 13% - Unni : 5% (Mayo Clinic) - Sung : 20% (China)- Sung : 20% (China)

• Age : 21 – 40 years : 87,5% Age : 21 – 40 years : 87,5% literature literature

• Sex : - Western literature : > womenSex : - Western literature : > women - Central Hospital : > men (62,5%)- Central Hospital : > men (62,5%)

Sung in Chinese peopleSung in Chinese people

• Location : Knee : 47%; literature : 50 - 60%Location : Knee : 47%; literature : 50 - 60%


• Site of predilection :Site of predilection : - - Literature : Literature : Distal femur, Proximal tibia, Distal radiusDistal femur, Proximal tibia, Distal radius

- - Central Hospital – Jakarta :Central Hospital – Jakarta : Proximal tibia, Distal radius, Distal femurProximal tibia, Distal radius, Distal femur

• Staging :Staging : -- Literature : Stage 2 : 70 – 80% Literature : Stage 2 : 70 – 80% Stage 3 : 10 – 20 %Stage 3 : 10 – 20 %

-- Central Hospital – Jakarta : - Stage 2 : 31 % Central Hospital – Jakarta : - Stage 2 : 31 % - Stage 3 : 69 %- Stage 3 : 69 % even stage 3 (+)even stage 3 (+)



• Depend on stageDepend on stage

• Literature : curettage in majority of casesLiterature : curettage in majority of cases

• Central Hospital – Jakarta mostly :Central Hospital – Jakarta mostly : Resection (60%) due to more cases in stage 3Resection (60%) due to more cases in stage 3

• Recurrence rate :Recurrence rate : - Literature 15 – 85%, depend on type of surgery- Literature 15 – 85%, depend on type of surgery curettage : curettage : 85% 85%


• To minimize risk of recurrence inTo minimize risk of recurrence in curettage : - thorough cleansing of the cavitycurettage : - thorough cleansing of the cavity - additional : thermal cauterization- additional : thermal cauterization with : - fenol 5% with : - fenol 5% - alcohol 70 – 90%- alcohol 70 – 90% - bone cement- bone cement - liquid nitrogen- liquid nitrogen recurrence rate become 20%recurrence rate become 20%

• To obtain better result without risk of To obtain better result without risk of recurrence recurrence > wider procedure such as > wider procedure such as resection resection 75% good result 75% good result


Literature :Literature :

3 cases in stage 3 3 cases in stage 3 amputation amputation recurrence (-) recurrence (-)

Campanacci : radical procedure in stage 3Campanacci : radical procedure in stage 3 recurrence (-) recurrence (-)

Over all recurrence rateOver all recurrence rate - Literature : 15 – 25%- Literature : 15 – 25% - Central Hospital : 55%- Central Hospital : 55% due to more stage 3 patientsdue to more stage 3 patients


Post operative radiation : ?Post operative radiation : ?- Difficult access (vertebra, pelvis)- Difficult access (vertebra, pelvis)- Recurrence (+)- Recurrence (+)

Complication :Complication :- Secondary malignant degeneration- Secondary malignant degeneration

10 – 30%, after 10 years10 – 30%, after 10 years

• To reduce complication : radiation < 4000 cGyTo reduce complication : radiation < 4000 cGy• Metastases : 2 – 3 % Metastases : 2 – 3 % benign histopathology benign histopathology


Conclusion :Conclusion :

1.1. G.C.T. of bone is a benign tumor, G.C.T. of bone is a benign tumor, which could act aggressively which could act aggressively give high give high rate of recurrencerate of recurrence

2. 2. Central Hospital JakartaCentral Hospital Jakarta Different result : Different result :

- Sex - Sex > male > male- Site of predilection- Site of predilection- Stage of patients - Stage of patients

Giant Cell Tumor Central Hospital Jakarta

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