GIANT CELL TUMOR

Riske Kharisma Putri 1310311079

PRESEPTOR:
Dr. dr. Roni Eka Saputra, Sp. OT (K) Spine
 Background
Giant Cell tumor (GCT) merupakan tumor jinak
dengan potensi keganasan dan kemampuan
untuk metastasis.
Meskipun di klasifikasikan sebagai tumor
tulanng jinak, sebagian pasien yang menderita
tumor ini berkembang menjadi progresiv
metastasis ke paru dengan prognosis buruk.

Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD •

Dakshesh B. Patel, MD • Eric A. White, MD • George R. Matcuk, Jr, MD,
Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1
www.rsna.org/rsnarights.2016
 Definition
GCT secara umum merupakan tumor jinak
tulang yang terdiri dari sel stromal
mononuclear dan merupakan multinukleat
giant cell yang bersifat ekshibisis aktivitas
osteoklas.

Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD •

Dakshesh B. Patel, MD • Eric A. White, MD • George R. Matcuk, Jr, MD,
Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1
www.rsna.org/rsnarights.2016
 3 type sel histologis GCT
Osteoclast like multinucleated giant cell
The spindle shaped
Fibroblast like mesenchimal stromal cell

Zhenhua Zhou1, Yan Li2, Xudong Wang1, Jingjing Hu3, Muyu Kuang4, Zhiwei Wang5, Song Li1,
Weidong Xu5 and
Jianru Xiao1, ALCAM+ stromal cells: role in giant cell. The Author(s) 2018
tumor of bone progression
 Epidemiology

80% kasus
usia 20-50 th

20% dari
semua
tumor tulang
primer

13% kasus <3%kasus

pada usia pada usia
>50 th <14 th

Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD • Dakshesh B. Patel, MD • Eric A. White, MD • George R.
Matcuk, Jr, MD,.Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1 .www.rsna.org/rsnarights.2016
 PATOFISIOLOGI

Yuhree Kim, MD, Saqib Nizami, BS, Hana Goto, MS, Francis Y. Lee, MD, PhD. Modern Interpretation of Giant CellTumor of Bone:
Predominantly.Osteoclastogenic Stromal Tumor. Department of Orthopaedic Surgery, Columbia University Medical Center, Columbia University,
New York, USA. Clinics in Orthopedic Surgery 2012;4:107-116 • http://dx.doi.org/10.4055/cios.2012.4.2.107
 LOKASI

75-90% Tulang Panjang

50-65% Tulang Betis

Umumnya : Distal femur, Distal

Radius, Proximal Tibiasakrum
Jarang pada Pelvis

Anshul Sobti, D.N.B; Pranshu Agrawal, MS; Sanjay Agarwala, MS; Manish Agarwal, MS
Research performed at Department of Orthopaedics, P.D Hinduja National Hospital and Medical
Research Centre, Mahim, Mumbai, India
 Classification

Enneking
• Berdasarkan radiograpiyang berhuungan
dengan lokal agresivitas, resiko kekambuhan.
Stage I-Latent, Stage II-Active, Stage III-
Agressive
Cappaanaci
• Grade I, Grade II, Grade II with fractur, Grade III
Anshul Sobti, D.N.B; Pranshu Agrawal, MS; Sanjay Agarwala, MS; Manish Agarwal, MS
Research performed at Department of Orthopaedics, P.D Hinduja National Hospital and Medical
Research Centre, Mahim, Mumbai, India
 Enneking Staging

Stage 1 Stage 2 Stage 3

Pt % 10-15% ~70% 10-15%

Symptoms asymp pain pain

Radiograph sclerotic expanded cortical

rim cortex perforation
Histology benign benign benign
 Campanacci
Grade I

• 1-Batas tegas, penipisan kortek minimal

Grade II

• 2-Penyebaran lebih luas, penipisan kortek

sedang sampai brat. Grade II lesi dengan fraktur

Grade III

• 3-Sudah terjadi destruksi dari kortek, batas

sudah kabur
 Etiology and Risk Factor
Pada tikus dengan immunodefisiensi tidak
ditemukan adanya metastasis ke paru:

GCTB tinggi kekambuhan dan rendah metastasis

dihubungkan dengan pertumbuhan nya
sesuai pada lingkungan mikro tulang.

Zhenhua Zhou1, Yan Li2, Xudong Wang1, Jingjing Hu3, Muyu Kuang4, Zhiwei Wang5, Song Li1,
Weidong Xu5 and
Jianru Xiao1, ALCAM+ stromal cells: role in giant cell. The Author(s) 2018
tumor of bone progression
 Clinical Manifestation

•Desktruksi •Progresivitas
tumor

Fraktur
Nyeri
Patologis
Sanganagouda Patil, Kunal Chandrakant Shah, Shekhar Yeshwant Bhojraj, Abhay Madhusudhan Nene ..Recurrent Spinal
Giant Cell Tumors: A Study of Risk Factors and Recurrence Patterns . . Received May 24, 2015; Revised Jun 13, 2015;
Accepted Jun 28, 2015
Cory J. Broehm, MD,1 Carrie Y. Inwards, MD,1 Alyaa Al-Ibraheemi, MD,1 Doris E. Wenger, MD,2Sarah M. Jenkins, MS,3 Long
Jin, MD,1 Andre M. Oliveira, MD,1 Riyam T. Zreik, MD,4 Jodi M. Carter, MD,1.Jennifer M. Boland, MD,1 and Karen J. Fritchie,
MD1. Giant Cell Tumor of Bone in Patients 55 Years and Older. Am J Clin Pathol March 2018;149:222-233
Pan Hu1, Liming Zhao2,3, Huilin Zhang2,3, Xiuchun Yu4, Zhen Wang5,
Zhaoming Ye6, Sujia Wu7,
Shibing Guo8, Guochuan Zhang9, Jinghua Wang10, Xianjia Ning10,
Yongcheng Hu2 &
Yingze Zhang1. Recurrence Rates and Risk Factors
for Primary Giant Cell Tumors
around the Knee: A MulticentreRetrospective Study in China. received:
18 March 2016
accepted: 13 October 2016.Published: 09 November 2016
 Diagnosis
• Lesi litik
• Sekitar epiphisis
• Eksentrik atau sentral

Radiology
• Batas tegas
• Penipisan kortek
• Expansile
• Tidak terdapat batas sklerotik

• Fibrohistiocytic origin
• Multinucleated giant cells
• Mononuclear stroma

Hystology
• Round / ovoid / spindle
• Mitosis
• Giant cells 20 fusion stromal cells
• Fokus hemorrhage atau nekrosis
 Diffrential Diagnosis

Brown Aneurysm Telangiecta

Tumor of tic malignant
al bone fibrous
Hyperparat osteosarco
yroidsm
cyst histocytoma
ma
Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD • Dakshesh B. Patel, MD • Eric A. White, MD • George R.
Matcuk, Jr, MD,.Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1 .www.rsna.org/rsnarights.
Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD • Dakshesh B. Patel, MD • Eric A. White, MD • George R.
Matcuk, Jr, MD,.Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1 .www.rsna.org/rsnarights.
Corey J. Chakarun, MD • Deborah M. Forrester, MD • Christopher J. Gottsegen, MD • Dakshesh B. Patel, MD • Eric A. White, MD • George R.
Matcuk, Jr, MD,.Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment1 .www.rsna.org/rsnarights.
 Treatment

Reseksi & Radioterapi

Biphosphonate
Kuretase &kemotherapi

Anti-RANKL
Embolisasi
Terapi

Anshul Sobti, D.N.B; Pranshu Agrawal, MS; Sanjay Agarwala, MS; Manish Agarwal, MS
Research performed at Department of Orthopaedics, P.D Hinduja National Hospital and Medical
Research Centre, Mahim, Mumbai, India
 kuretase

Memiliki
hasil yang
lebih
bagus
CPC

Akihiko Takeuchi MD, PhD1 | Prakrit Suwanpramote MD2 |Norio Yamamoto MD, PhD1 | Toshiharu Shirai MD, PhD3 |Katsuhiro Hayashi
MD, PhD1 |Hiroaki Kimura MD, PhD1 |Shinji Miwa MD, PhD1 | Takashi Higuchi MD, PhD1 |Kensaku Abe MD, PhD1 | Hiroyuki Tsuchiya
MD, PhD1. Mid- to long-term clinical outcome of giant cell tumor ofbone treated with calcium phosphate cement following.thorough
curettage and phenolization.. Accepted: 7 December 2017
Yuhree Kim, MD, Saqib Nizami, BS, Hana Goto, MS, Francis Y. Lee, MD, PhD. Modern Interpretation of Giant CellTumor of Bone:
Predominantly.Osteoclastogenic Stromal Tumor. Department of Orthopaedic Surgery, Columbia University Medical Center, Columbia University,
New York, USA. Clinics in Orthopedic Surgery 2012;4:107-116 • http://dx.doi.org/10.4055/cios.2012.4.2.107
 Tidak ada
korelasi dengan
histologi

Ekspresi ALCAm
Tidak ada
yang tinggi
korelasi dengan
radiologi
klasifikasi
Prognosis berhubungan
dengan
keganasan

Berhubungan
dengan
tindakan
kuretasi dan
lokasi tumor

Pan Hu1, Liming Zhao2,3, Huilin Zhang2,3, Xiuchun Yu4, Zhen Wang5, Zhaoming Ye6, Sujia Wu7,Shibing Guo8, Guochuan Zhang9, Jinghua
Wang10, Xianjia Ning10, Yongcheng Hu2 &Yingze Zhang1. Recurrence Rates and Risk Factorsfor Primary Giant Cell Tumors,around the Knee: A
MulticentreRetrospective Study in China. received: 18 March 2016, accepted: 13 October 2016.Published: 09 November 2016
 12%
kekambuhan
post reseksi

27%
kekambuhan
post
kuretase

Risiko kekambuhan
post kuretase pada
lokasi fibula proximal

Pan Hu1, Liming Zhao2,3, Huilin Zhang2,3, Xiuchun Yu4, Zhen Wang5, Zhaoming Ye6, Sujia Wu7,Shibing Guo8, Guochuan Zhang9, Jinghua
Wang10, Xianjia Ning10, Yongcheng Hu2 &Yingze Zhang1. Recurrence Rates and Risk Factorsfor Primary Giant Cell Tumors,around the Knee: A
MulticentreRetrospective Study in China. received: 18 March 2016, accepted: 13 October 2016.Published: 09 November 2016
 Prognosis
Histologi tidak mempengaruhi tingkat
kekambuhan dan metastasis
Klasifikasi Campanacci dan enneking pun tidak
berhubungan dengan prognosis

Ekspresi ALCAM mempengaruhi prognostik:

semakin tinggi ALCAM semakin tingggi risiko
menjadi ganas
Zhenhua Zhou1, Yan Li2, Xudong Wang1, Jingjing Hu3, Muyu Kuang4, Zhiwei Wang5, Song Li1,
Weidong Xu5 and
Jianru Xiao1, ALCAM+ stromal cells: role in giant cell. The Author(s) 2018
tumor of bone progression
 Prognosis
• Sifat GTC tergantung pada lokasi, ukuran dan
tampilan histologi

MAITHILI M KULKARNI, AVINASH R JOSHI, VINOD PATIL, TABASSUM ANSARI.Department of

Pathology, Shrimati Kashibai Navale Medical College and. 2016 Journal of Cytology | Indian
Academy of Cytologists | Published by Wolters Kluwer - Medknow
 BAB 1
PENDAHULUAN
 KESIMPULAN
GCT
• Secara umum jinak (benign)
• Potensial menjadi :
• Ganas
• Berulang
• Metastasis Pulmonal

Jarang pada sekeletal immature

Sekitar Epiphysis
• Nyeri kalau sudah ada penekanan
• Bengkak
• Ganguan gerak sendi
• Masa
• Fraktur Pathologis
• Gangguan Neuro (spine / sacrum)

DD
• Pertimbangkan: Umur dan lokasi
• Fibrogenic/Telangiectatic Osteosarcoma
• Chondroblastoma
• ABC (Aneurysma Bone Cyst
• Chondromyxoid fibroma (jarang)
• Mets / Myeloma
TERIMAKASIH 