Images of Musculoskeletal Oncology

Giant Cell Tumor
A 35 year old woman with pain and wrist swelling for three months.

The radiographs reveal an osteolytic lesion in the distal epiphysis and metaphysis of her radius. This has the typical appearance of an active giant cell tumor, although other entities should be considered, such as aneurysmal bone cyst and chondromyxoid fibroma. Chest x-ray was normal, and bone scan demonstrated increased uptake only in the distal radius lesion. A carpal cyst of no significance was noted in the same side carpal navicular bone.
Open biopsy reveals a combination of multinucleated giant cells and mononuclear stromal cells typical of an active giant cell tumor of bone. Some reactive new bone is also noted, which suggests the presence of an undisplaced fracture with fractured callus. A thorough curettage was performed after the frozen section tissue analysis, and the resultant skeletal defect was filled with cortical and cancellous bone from her iliac crest; this was done because of the tumor's small size. There was no recurrence.

Complete healing occurred with eventual restoration of normal function years later. Other alternatives to fill the bone defect are the use of bone allografts or bone cement.
Learning Issues:

1. When the need for bone graft is to fill a small defect, it is often wise to use autografts, since symptoms from the bone graft site will be minimal and autogenous bone grafts are still the gold standard.

2. Carpal cyst present in the navicular bone can be recognized from the radiograph, and does not require special treatment.


Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics