Musculoskeletal Imaging

Giant cell tumour

a locally aggressive neoplasm composed of connective tissue, giant cells and stromal cells. Earliest manifestations include pain, local swelling, limitation of motion and pathologic fractures. The sites affected most frequently are the long tubular bones, bones about the knee, spine, and innominate bone. The epiphyses of the tubular bones will have been involved extensively by the time of diagnosis, although the tumour may originate in the metaphysis. Metaphyseal location is especially noted in children and adolescents. In other bones (sternum, clavicle, scapula, ribs) the tumour is present in subchondral regions. Giant cell tumours may also arise within a tendon sheath, especially in the fingers and wrist, or from joint capsules or ligaments.

On radiographs, the long and short tubular bones reveal eccentric osteolytic lesions extending to the subchondral bone (Fig.1). A delicate trabecular pattern results from subsequent cortical thinning and expansion. Violation of the cortical surface and spread into contiguous soft tissues is striking evidence of the aggressiveness of some giant cell tumours. Tumours involving the flat bones may also be osteolytic; vertebral collapse may occur if the spine is affected.

Other imaging techniques that are helpful in diagnosing giant cell tumours are bone scintigraphy, CT scanning, angiography and MR imaging. With MR imaging, intraosseous fluid levels may be seen. Recurrence is common, and the tumour may spread passively by vascular transport to a distant site, particularly the lungs, in a manner distinct from malignant metastasis. In some cases, however, malignant transformation may occur. Giant cell tumours may be associated with Pagets disease. In this disorder, the bones affected are always those that are also involved in Paget's disease (skull, facial bones).

Giant cell tumours of a tendon sheath represent a nodular lesion of a tendon sheath in the hand or foot, which may sometimes be confused with pigmented villonodular synovitis because of similar histologic features (Fig.2).

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Fig.1

a, b. AP (a) and lateral (b) radiographs of the knee demonstrate an eccentric osteolytic lesion in the proximal tibia. The lesion has a non-sclerotic border and abuts the articular surface of the tibia. c. Sagittal T1-weighted MR image of the knee demonstrates the low signal intensity mass in the proximal tibia. d. Fat-suppressed T1-weighted MR image after gadolinium adminstration demonstrates enhancement of the mass in the proximal tibia. (Courtesy of Guerdon Greenway, MD; Dallas, Texas)
Giant cell tumour, Fig.1 (a)
Giant cell tumour, Fig.1 (b)
Giant cell tumour, Fig.1 (c)
Giant cell tumour, Fig.1 (d)
Giant cell tumour, Fig.2 (a)
Giant cell tumour, Fig.2 (b)
Giant cell tumour, Fig.2 (c)