Giant Cell Tumours of Bone

Giant cell tumor of bone (GCTB) is a primary bone tumor characterized by the presence of numerous multinucleated giant cells within a background of mononuclear stromal cells. Here's a detailed description:

  • Cellular Composition: The tumor consists of three main cell types: multinucleated giant cells, mononuclear stromal cells, and osteoclast-like giant cells. The multinucleated giant cells are the hallmark of GCTB and are scattered throughout the tumor mass. These cells are derived from the fusion of mononuclear cells and are responsible for the bone resorption observed in the tumor. Mononuclear stromal cells are spindle-shaped or round cells that produce a collagenous matrix. Osteoclast-like giant cells are another type of multinucleated cell found within GCTB, resembling osteoclasts in function.
  • Microscopic Features: Under the microscope, GCTB appears as a mixture of these cell types within a fibrous stromal background. The multinucleated giant cells are typically distributed irregularly and are surrounded by a matrix of spindle-shaped or round stromal cells. The stromal cells produce collagen fibers that contribute to the structural integrity of the tumor.
  • Radiographic Appearance: On radiographs, GCTB typically presents as a lytic lesion within the bone, often with well-defined margins. The extent of bone destruction can vary, and the lesion may exhibit a "soap bubble" or "honeycomb" appearance due to the presence of numerous cystic spaces filled with the tumor's cellular components.
  • Clinical Presentation: Patients with GCTB may experience localized bone pain, swelling, and limited joint mobility. Depending on the size and location of the tumor, it may lead to pathological fractures or impinge on adjacent structures.
  • Treatment: Treatment options for GCTB include surgical interventions such as curettage (scraping out the tumor), with or without adjuvant therapies such as bone cement, cryotherapy, or phenol to reduce the risk of recurrence. In cases of unresectable or recurrent tumors, denosumab, a monoclonal antibody targeting RANKL, may be used as a systemic therapy to inhibit bone resorption and tumor growth.

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