Giant Cell Tumour-Vyom Gyanpuri

8/9/2019 Giant Cell Tumour-Vyom Gyanpuri

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GIANT CELL TUMOUR

TUMOUR

STAGES

DIFFERENCES

GIANT CELL GIANT CELL TUMOR

OF BONE

ATHOLOGY

CLINICAL FEATURE

SYMPTOM

DIAGNOSIS MANAGEMENT

NON SURGICAL

SURGICAL PHYSIOTHERAPY

MANAGEMENT RESEARCH ARTICLE PURPOSE METHOD

RESULT

CONCLUSION

An abnormal mass of tissue that results from

excessive cell division .

That is uncontrolled and progressive, also called a

neoplasm.

They may be either benign (not cancerous) or

malignant.

A neoplasm is an abnormal proliferation of

tissues, usually caused by genetic mutations.

Most neoplasms cause a tumor, with a few

exceptions like leukemia.

There are of two types:-

Benign:- A Benign tumor arising from the fibroblastic

cell is called fibroma.A cartilaginous tumor is a chondroma.

A tumor of osteoblasts is an osteoma.

Malignant:- Malignant tumor arising in mesenchymaltissue are usually called sarcomas.

Slow growing

Well circumscribed

Non- invading

No or few symptoms

Do not metastasise

Do not cause death of the patient

Rapidly growing

Not well circumscribed

Invading

Associated with pain anddisability

Metastasises

May cause death of the

patient

A giant cell is a mass formed by the union of several distinct cells (usually macrophages).

Giant cell tumors are named for the way they look

under the microscope. Many "giant cells" are seen.

They are formed by fusion of several individual

cells into a single, larger complex.

First described- Cooper 1818Lebert - microscopic description 1845

A giant cell tumor is one that is made up of a

large number of benign (non-cancerous) cells

that form an aggressive tumor - usually near

the end of the bone near a joint.

Giant cell tumors most often occur when

skeletal bone growth is complete.

Giant cell tumors of bone occur spontaneously.

They are not known to be associated with trauma,environmental factors, or diet.

They are not inherited.

In rare cases, they may be associated with

hyperparathyroidism.

The location of a giant cell tumor is often in the

knee, but can also involve the bones of the arms

and the legs, or the flat bones such as thesternum (breastbone) or pelvis.

Giant cell tumor of bone occurs almost

exclusively in the end portion of long bones nextto the joints (epiphysis). In rare cases, this tumor

may spread to the lungs.

A mixture of four components can be

distinguished: -

Spindled - shaped and rounded multinucleatedcell.

Osteoclastic - type giant cells and small blood

vessels.

CLINICAL FEATURES

Age 20 40 yrs

Sex females>males 1.5 : 1

Occur around the knee joint in the lower end of

the femur or the upper end of the shinbone.

Wrist (lower end of the lower arm bone),The hip (upper end of the thighbone),

The shoulder (upper end of the upper arm bone),

Lower back (connection of the spine and pelvis).

Pain at the adjacent joint

A visible mass (tender)

Swelling (smooth)

Bone fracture (pathological)

Limited movement in theadjacent joint

Fluid accumulation in the joint

adjacent to the affected bone

The first symptom most patients notice is pain inthe area of the tumor.

There may be pain with movement of a nearby

joint. Pain generally increases with activity and decreases

with rest.Pain is usually mild at first, but it progressively

increases.Occasionally the bone weakened by the tumor may

break and cause sudden onset of severe pain.Sometimes patients will notice a mass or swollen

area that may not be painful.

STAGES STAGES I STAGES II STAGES III

Patient % 10-15% 70% 10-15%

Symptoms Asymptomatic pain pain

Radiograph Sclerotic rim Expandedcortex

Cortical perforation

Histology Benign Benign Benign

CT scanMRIBone scanBiopsyBlood examination

-rays demonstrated ageographic, expansile lesionof the head of the fibula.

There was a surrounding eggshell rim of calcificationindicating the periosteum wasintact.

The lesion was expansile anddisplaced the peroneal nerveand popliteal blood vessels.

The entire head of the fibula

was destroyed by theneoplasm.

CT scan shows a thin corticalshell around the tumorindicating the periosteum is

intact and the tumor is likelybenign.

There was no ossification or

calcification within thetumor indicating that thetumor was probably not abone or cartilage producing

tumor.

The MRI findings were

not specific for aparticular type of

neoplasm or infection.

There were no fluid-

fluid levels thatwould indicate cystic

changes.

A procedure in which tissue samples are removed(with a needle or during surgery) from the body forexamination under a microscope; to determine if

cancer or other abnormal cells are present.

The nuclei of the mononuclear cells resembled thenuclei in the giant cells.

There were no granulomas.

Cultures were negative.

MANAGEMENT

Patient age, overall health, and medical history

Extent of the disease

Patient tolerance for specific medications,

procedures, or therapies

Expectations for the course of the disease

Patient opinion or preference

To remove the tumor and prevent damage to theaffected bone. Treatment may include:

I. Surgery (to remove the tumor and any damagedbone)II. Bone grafting - a surgical procedure in which

healthy bone is transplanted from another part of

the patient's body into the affected area.III. Bone reconstructionIV. Amputation (may be required in severe cases)V. Physical therapy (to regain strength and mobility

to the affected area)

Radiation therapy is a nonsurgical treatment

option that has proven effective.

However, this can result in the formation of

cancer in as many as 15 percent of patientswho receive it.

Therefore, radiation therapy is used only in the

most difficult cases where surgery cannot be

performed safely or effectively.

Some centers have reported successful

treatment of giant cell tumors withembolization.

A process where the blood vessels supplyingthe tumor are occluded by means of a catheter

threaded through the main arteries. Blockingthe blood supply to the tumor can cause it to

shrink and even disappear because the tumor

loses its source of nutrition.

Clinical trials of a drug called interferon are

currently underway.

This drug works by interfering with the ability

of the tumor to grow new blood vessels.Because tumors require an ever-increasing

blood supply to grow, interferon may alsocause the tumor to shrink or even disappear.

Excision is the best treatmentfor giant cell tumor.

This is the treatment of thechoice when the tumor affects

a bone whose removal doesnot hamper with functionse.g. fibula and lower end of ulna.

When the excision of atumor at some site mayresult in significant

functional impairment , thedefect created by excisionis made up, usuallypartially, by some

reconstructive procedure.

Arthodesis by Turn-o-plasty Arthrodesis by bridging

Arthroplasty

Scooping out the tumor(curettage) is generallyperformed.

This techniques cause ahole in the bone that canbe filled with a bonegraft.

The bone may be takenfrom other parts of thepatient's own body(autograft) or from a

cadaver (allograft).

If treatment is limited to curettage and bone

grafting alone, the tumor may come back(recur) up to 45 percent of the time.

The use of bone cement rather than bone

graft results in a lower rate of recurrence

Where the liquid nitrogen

is used to produce a

freezing effect and thuskill the residual cells.

Thermal burning of the

residual cell usingcauterization of the wall

of the tumor.

In later stage , the thermal effect of bone

cement has been used .

The cavity is filled with Bone cement which

by the heat it produces while setting kills theresidual cells.

For more aggressive tumors or following

reccurence ,amputation may be necessary

The basic aim of physiotherapy is toprovide optimal functionalefficiency to the operated part to

facilitate functional independence.

MEASURE TO CONTROL DEPRESSION

Psychological reassurance

Counseling

Rehabilitation program

Functional use of the limbs is initiated at the

earliest

MEASURE TO CONTROL LIMB OEDEMA

Limb elevation

Intermittent compression

Active movements of the affected joints

MEASURE TO IMPROVE MUSCLE STRENGTH

Passive range of motion exercise

Active assistive exercises

Active exercises

Resistive exercises

RESEARCH ARTICLE STUDY

Giant cell tumour of bone with late

presentation: review of treatment and

outcomeES Ng, A Saw, S SenguptaDepartment of Orthopedic Surgery, University

Malaya Medical Center, University of Malaya, KualaLumpur, Malaysia

AR Nazarina, M Path

Department of Pathology, University MalayaMedical Center, University of Malaya, Kuala Lumpur,Malaysia

Purpose.

To review cases of giant cell tumour of boneor osteoclastoma managed at the University

Malaya Medical Center, University of Malaya,

Kuala Lumpur, from January 1990 toDecember 1999.

Methods

Medical records of all patients withmusculoskeletal tumours were reviewed.

Demographic data, clinical presentation,

surgical management, and clinical outcomeswere reviewed retrospectively.

Most of the 31 patients who were treated f orgiant cell tumour of bone presented late on the basisof the duration of their symptoms and radiological

features.

Five of the patients had been referred for localrecurrences.

26 patients were treated f or primary tumours: 18 needed wide excision, 7 curettage,and one amputation.

The joint could not be preserved and

arthrodesis was performed for 11 patients.

Three (12%)of the 26 patients had local

recurrence during a mean follow-up of 60months, including one (6%) who had recurrence

after wide excision and 2 (29%) after curettage.

Pulmonary metastasis was noted in 4 cases,

2 of which were confirmed histologically.

Even in an advanced stage of disease,good

clinical outcomes can be achieved with

adequate excision and appropriatereconstruction.

For lesions around the knee, autologous

rotational grafting is a good alternativemethod of reconstruction.

ESSENTIAL ORTHOPAEDIC - J. maheshwari

ESSENTIAL OF ORTHOPAEDIC FOR

PHYSIOTHERAPIST - John ebnezar APPLIED PHYSIOTHERAPY - Jayant joshi

Giant cell tumour of bone with late

presentation: review of treatment andoutcome - S Sengupta

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