BOOKS AND LINKS USED FOR

PRESENTATION:
• Robins and cotran book of pathology.
• Amboss
• https://www.sciencedirect.com/scienc
e/article/abs/pii/S0046817718302296
• https://orthoinfo.aaos.org/en/diseases
--conditions/giant-cell-tumor-of-bone/

GIANT CELL TUMOR

SUBMITTED TO: MAAM SANA.
SUBMITTED BY: ZAINA TARIQ.
SECTION A - 2103
INTRODUCTION OF GIANT CELL TUMOR
[TUMORS OF UNKNOWN ORIGIN]
• A giant cell tumor is a benign, locally aggressive tumor with bone
destruction and with malignant potential.
• Giant cell tumors occur more in females and usually occur in skeletally
mature patients.
• Giant cell tumors occur more in the distal femur,
• but they can occur in the proximal tibia, distal radius, proximal humerus,
hand, spine and the sacrum
• giant cell tumors are not cancerous, they are aggressive and can destroy the
surrounding bone
 PATHOGENESIS:
• osteoblast precursors, which are the minority in the tumor,
are actually the neoplastic cells. These cells express
Receptor activator of nuclear factor kappa-B ligand
( RANKL). RANKL results in recruitment of monocyte
precursors and also promotes the formation of osteoclast
like giant cells.
• neoplastic cells express high levels of RANKL, which
promotes the proliferation of osteoclast precursors and
their differentiation into mature osteoclasts via RANK
expressed by these cells.
• However, the feedback between osteoblasts and
osteoclasts that normally regulates this process during
bone remodeling is absent. What results is a localized but
highly destructive resorption of bone matrix by reactive
osteoclasts.
 MORPHOLOGY:
• Histologic feature is the presence of numerous
multinucleate  osteoclast like giant cells scattered
throughout the  mononuclear cells in the stroma.
1. The mononuclear cells are the tumor cells. These are
uniform cells, plump spindle to round to oval cells
with the presence of large nuclei with prominent
nucleoli. The cytoplasm if scanty.
• The biological behavior of the tumor is
determined by the histologic appearance of these
tumor cells. Mitotic activity can be seen.
2. Multinucleated giant cells: these are osteoclast like
giant cells with more than 100 nuclei in many of
these cells.
• Stroma may show cystic changes in the form of
presence of macrophages. Areas of hemorrhage
and necrosis can be seen.
 CLINICAL FEATURES:
• PATIENTS PRESENT WITH:
• SWELLING AND PAIN IN THE JOINTS
• SPECIALLY ON WEIGHT BEARING AND
ON MOVEMENT .
• PATHOLOGICAL FRACTURES CAN BE
RARELY SEEN.
• ON EXAMINATION, THE SWELLING WILL
USUALLY EB SOFT IN CONSISTENCY WITH
A FEELING OF “EGG SHELL CRACKLING”.
CLINICAL COURSE OR TREATMENT:
• Medical treatment consists of bisphosphonate and denosumab
(will act on the RANK pathway).
• Denosumab is a human monoclonal antibody that is used in
recurrent disease and when wide resection may cause significant
morbidity.
• Denosumab is used in unresectable Giant Cell Tumors or when
there is recurrence, or when the tumor is aggressive.