Giant cell tumor (GCT) Specialist Surgeon Singapore

Aggressive Curettage and Joint Preservation Strategies

We manage Giant Cell Tumors (GCT) through a protocol of "aggressive preservation." Under the clinical direction of Dr. Saminathan Suresh Nathan, we utilize thirty years of data to navigate the transition between intralesional clearance and structural stability. By employing high-speed burring, cryosurgery for biological sterilization, and subchondral reconstruction, we aim to prevent recurrence while preserving the mechanical integrity of the native joint. 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.

Surgical Considerations

• Biological Sterilization: Utilization of cryotherapy or chemical adjuncts within the tumor bed to minimize local recurrence rates.

• Subchondral Support: Strategic use of bone cement (PMMA) or structural bone grafts to provide immediate mechanical support for the articular surface.

• Recurrence Surveillance: Rigorous clinical and radiological monitoring protocols designed for the specific biological behavior of aggressive GCT.

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.