Original ContributionClinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India
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
References (48)
- et al.
Giant cell tumor of bone
Radiol Clin North Am
(1993) - et al.
The proognostic significance of histomorphometry and immmunohistochemistry of giant cell tumors of bone
Hum Pathol
(1996) - et al.
Giant-cell tumors of the carpus
J Hand Surg [Am]
(2006) Giant cell tumour of bone: morphological, biological and histogenetical aspects
Int Orthop
(2006)Giant cell of bone
- et al.
Giant cell tumor of bone
Clin Orthop Relat Res
(1986) SPSS for windows [computer program]. Version 14
(2006)- et al.
The histogenesis of giant cell tumour of bone: a model of interaction between neoplastic cells and osteoclasts
Histol Histopathol
(2001) - et al.
Giant-cell tumor of bone
J Bone Joint Surg Am
(1987) - et al.
Report of bone registry, 1970-82 (A twelve year study)
Indian J Pathol Microbiol
(1987)