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GCT Final
GCT Final
TUMOR, OSTEOSARCOMA,
EWING SARCOMA
Dr. Vivek k. Gautam
Junior resident
Orthopaedics – SNMC, Agra.
History
• William Enneking : Father of orthopaedic oncology.
• Staged bone tumors :
• Benign
• Malignant
Enniking Classification
Benign Malignant
1. Latent I. Low grade A- intracompartmental
B- Extra compartmental
2. Active II. High grade A- intracompartmental
B- Extra compartmental
3.Aggresive iii. metastasis
GIANT CELL TUMOR
• It is one of the most common bone tumors encountered.
• Though benign tumor, it is locally aggressive and has malignant
potential.
• They have significant bone destruction ,local recurrence and
occasional metastasis
DEFINITION
• Distinct neoplasm arising from non-bone forming supportive
connective tissue of marrow with network of stromal cells regularly
interspersed with giant cells.
• Tumor is called GCT because Giant cells are found.
• These Giant cells resemble osteoclasts…..hence called as
OSTEOCLASTOMA
EPIDEMOLOGY
• Only 5% of PRIMARY bone tumors & 20% of benign bone tumors.
• Almost affects skeletally mature patients in the age group of 15 to 40
with peak incidence in later half of 3rd decade
• Female to male ratio -----1.5 : 1
• But malignant GCT more common in MALES .
SITE OF INVOVLMENT
• Usually SOLITARY lesions 1-2% may
be multi-centric !!
• Seen at
• distal end of femur
• proximal end of tibia
• distal end of radius
• upper end of humerus
• lower end of tibia
• i.e., cancellous disposed bone ends
which are sites of high bone turn over
and osteoclastic activity
• Others like hand , spine and pelvis
CLINICAL FEATURES
SWELLING
• An epiphyseo-metaphyseal , eccentric swelling is seen at the ends of
long bones
• Overlying Skin is stretched & shiny but no engorged veins.
• On palpation, swelling is warm ,tenderness present with bony
consistency
• EGG SHELL CRACKLING may be elicitable when there is too much
thinning of cortex/pathological fracture.
CLINICAL FEATURES
PAIN
• Vague persistent pain at the end of long bones in relation to activity of
the joint
• Pain may increase after a pathological fracture
• Limitation of joint movements due to mechanical block
• Pathological fracture : usually uni-cortical than a complete fracture
• Neurological deficit may be seen in cases involving the spine and
sacrum.
• Metastasis is present in 1-5% cases. most common site being lung..k/a
LUNG IMPLANTS
INVESTIGATIONS
• Blood
• serum calcium
• phosphorus
• ALK.PHOSPHATASE
To rule out hyperparathyroidism
PLAIN RADIOGRAPHS
• Epiphyseo-metaphyseal in location
• Expansible lesion
• Eccentrically situated
BIOLOGIC
• AUTOGRAFT ARTHRODESIS
• LIVE MICROVASCULAR FIBULAR GRAFT
• OSTEO-ARTICULAR ALLOGRAFTS
• ILIZAROV METHOD
ENDOPROSTHETIC JOINT REPLACEMENT
• eg: custom mega prosthesis
EMBOLISATION
• Trans-catheter Embolisation of blood supply of Certain un-resectable
tumors like sacrum & pelvic
• M: F
1.3 <10yrs
1.6:1>10yrs
Routes of Spread
• Direct Extension- into adjacent bone or soft tissue.
• Metastasis generally spread through blood stream.
• Nearly all patients have micromets at diagnosis, so all need chemo.
CYTOGENETICS
• t(11;22) , t(24;12) presents in 90-95% .
• C-myc protooncogene is frequently expressed in Ewing’s.
• PAS +ve.
THANK YOU