Original Contribution
Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India

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Abstract

Over 20 years, 470 cases of giant cell tumor of bone diagnosed at a tertiary cancer hospital were analyzed. Male predominance (57%), predilection for bones around the knee joint (42%), and occurence in the 21- to 30-year-old age group (49.1%) with 6% being in the immature skeleton are well known facts. Accurate diagnosis was possible in 66% and 88% of cases on radiology and biopsy, respectively. Tumors measured 6 to 20 cm and, in 402 cases, showed “usual” histology comprising uniformly scattered multinucleate giant cells amidst mononuclear stromal cells, together imparting a syncitium-like appearance. Presence of osteoid, hemorrhage, and aneurysmal bone cyst–like areas; spindle cells in sheets (devoid of giant cells); or storiform pattern and intravascular osteoclasts were less common. The less common histologic features posed diagnostic difficulty in the setting of a small biopsy. Treatment included intralesional curettage (33.19%), marginal excision (4.2%), wide excision (31%), or radical surgeries (14.25%). Recurrences seen in 170 cases were multiple in 47 cases. Metastases largely to the lung were recorded in 24 cases. The histology of all the tumors, namely, primary, recurrent, or metastatic was identical. Statistical analysis using the computer software SPSS (SPSS Inc, Chicago, Ill)was performed with particular reference to the unusual histologic features vs recurrence and metastasis by χ2 test. The only statistically significant factors were occurrence in the axial skeleton vs appendicular skeleton (P = .001) and primary treatment elsewhere vs at this hospital (P = .045), each of these being associated with increased frequency for local recurrence but not metastasis.

Introduction

Nearly 200 years since its first description, giant cell tumor (GCT) of bone remains an enigmatic entity [1], [2]. Over the years, the clinical, radiological, and histologic characteristics of GCT have been well described [1]. However, even today, neither any objective histologic nor molecular criteria exist for stratifying the risk for recurrence and/or metastasis, thus sustaining the interest in GCT [3].

Herein, the clinical profile and the histopathology features of 470 GCTs of bone diagnosed over 20 years are described. This analysis from a tertiary cancer referral center in western India most likely represents one of the largest series hitherto described.

Section snippets

Materials and methods

A total of 587 cases of GCT were diagnosed amongst 7500 bone tumors accessioned between 1987 and 2006; of these, 101 were referred for pathology consultation only (without clinicoradiological details); in another 16 cases, the diagnosis was revised on histology review as: aneurysmal bone cyst (ABC) (3 cases), giant cell reparative granuloma (5 cases), osteosarcoma (2 cases), brown tumor of hyperparathyroidism (5 cases), and giant cell tenosynovitis (1 case); all these 117 cases were excluded.

Clinical summary

The 470 GCTs constitute 6.2% of bone tumors diagnosed and treated at this institute in a 20-year period (1987-2006). Almost half (n = 231, 49.1%) of these were in the 21- to 30-year-old age group; 14.6% of patients were older than 40 years, the oldest patient being 76 years old (GCT of proximal phalanx), and 6% of the tumors were observed in immature skeleton, the youngest patient being 10 years old (GCT of cuboid bone).

There were 268 men (57%), 202 women (43%) (male-female ratio, 1.32:1), and

Discussion

Although the tumor derives its name from the more striking giant cells, the stromal cells constitute the neoplastic component [5]. The GCT owes its importance to the following facts: (i) from a clinicians perspective, it is one the few “primary” bone tumors that a general orthopedic surgeon is likely to encounter and tackle; (ii) from a pathologists viewpoint, the ubiquitous presence of giant cells in several other unrelated entities and the presence of osteoid make diagnosis of this seemingly

Summary and conclusion

This study on GCT emphasizing histologic factors spans 2 decades. It highlights that not much has changed on the clinicopathologic front. However, the less common features enlisted in this article need to be particularly studied, as today, the pathologists are required to offer a final diagnosis on needle core biopsies.

It is unfortunate that the excitement associated with the discovery of several molecular events documented in the case of bone and soft tissue tumors has bypassed this enigmatic

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