| Images of Musculoskeletal Oncology |
| Giant Cell Tumor |
| A 19 year old woman has had mild pain and swelling over the lateral aspect of her knee for two months. The head of her fibula was slightly swollen and tender. Function of the extremity was normal. |
| This radiograph demonstrates a lytic, expanded lesion involving the epiphysis and metaphysis of her fibula. |
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| The CT scan demonstrates the cortices of the fibular lesion as thinned and partially destroyed. The adjacent tibia appears normal. The differential diagnosis would include giant cell tumor and aneurysmal bone cyst. A core needle biopsy revealed benign stromal cells and multinucleated giant cells typical of an active giant cell tumor of bone. The marked thinning of cortex suggests an active neoplasm. A wide resection was performed. |
| The gross specimen was split, which reveals the lesion to be well contained by the soft tissue and bone. |
| Demonstrates the proximal fibula defect. Peroneal nerve function remained normal and the patient recovered nicely from surgery. She did not have metastasis or recurrence, and is now asymptomatic with normal function 20 years after surgery. |
| Learning Issues: 1. Osteolytic epiphyseal lesions in young adults are often giant cell tumors of bone. 2. Giant cell tumor in the proximal fibula is common. 3. When cortices are eroded significantly, the giant cell tumor should be considered to be possibly aggressive; and when feasible, wide resection should be considered as the best treatment. In this case a wide resection was done because of the location in the head of the fibula, where resection would not disturb function, and the marked thinning of the cortex could make recurrence of tumor a problem. |
| Images of Musculoskeletal Oncology |
| University at Buffalo Department of Orthopaedics |