Giant cell tumors
Giant cell tumors (tumours) are aggressive lesions of the bone. Although they are benign they are known to embolize to the lungs giving the appearance of malignancy. Nevertheless, there are malignant forms of the disease recognised. They typically happen in the first third and fourth decades of life and are more common in females. Treatment involves the use of surgery intra-lesional methods with an adjuvant like cryotherapy . Radiation is not usually necessary. Increasingly the use of anti- osteoclast therapy in the form of denosumab or bisphosphonates are used especially for recurrent disease.
Figure 1. The first two curves from the top represent the survival curves of the giant cell tumor. The gold curve is for the malignant variant and the green the benign variant. Two points should be clear. Firstly, these two seem to have the same survival rate. This underscores the difficult in grading these tumors and so this practice of grading giant cell tumors is not uniformly practiced by all pathologists. Secondly, while giant cell tumors are supposed to be benign they do have about a 5% mortality rate underscoring that in a small percentage these tumors can be malignant.
Figure 2. This 30 year-old lady had pain in the knee that was neglected for a long time. By the time she was referred to me for excision and cryosurgery it had grown very large. We were able to keep her knee and preserve her bone and she walked well for a number of years after that.