Images of Musculoskeletal Oncology

Giant Cell Tumor - Distal Femur
A 25 year old female has had intermittent pain, limp and knee swelling for six months. Prior biopsy and partial curettage of a giant cell tumor (performed elsewhere) two months ago.

Our initial radiographs of her knee revealed a large osteolytic lesion of her distal femur involving both condyles from subchondral cortex to the metaphysis.
Review of prior biopsies and high power photomicrographs reveal two cell populations, the obvious multinucleated giant cells and the background of mononuclear stromal cells. This represents an active giant cell tumor which does not appear to be malignant.





A thorough excision of the prior surgery soft tissue and surgical scar was performed, followed by a meticulous curettage and mechanical burring. Through a large bony window, the large bony defect was then packed with bone cement.
The patient has done remarkably well, without recurrence or metastasis, with quite good function and with a full range of knee motion.
Learning Issues:

1. An osteolytic lesion in the epiphysis of a young adult is often due to a giant cell tumor of bone.

2. Cementation of even a large epiphyseal defect is compatible with quite good long range function.


Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics