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Findings 128

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Findings:
Here is an entirely lytic lesion arising eccentrically in the distal tibia. The lesion has its epicenter in the metaphysis but has expanded through the epiphyseal region to involve the subarticular cortex. The lesion is interesting in that it is geographic with a narrow zone of transition but does not have a sclerotic margin. CT was performed (though not required for diagnosis or treatment in this case). The CT (Films .3 and .4) demonstrates that the lesion had been slightly expansile with thinning of the overlying cortex. The overlying cortex was thinned to the point where in some portions of the CT the rim is no longer seen. However, extrapolating from the remaining rim, there is no soft tissue mass extending beyond the expanded portion of the lesion. This confirms the expansile but only mildly aggressive nature of this lesion. CT confirms the absence of matrix calcification.

Category:
Tumor

Region:
Ankle

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  1. Jun 28, 2011

    It is helpful to use the Campanacci grading system for GCT and other benign tumors.  Based on just plain films it is easier and more convenient than the similar Enneking system.  Both systems use increasing Arabic numbers to identify more aggressive disease.  Campanacci grade 1, (Enneking stage 1) - indolent, intraosseous lesions,  Campanacci grade 2- active lesions that thin or expand the cortex, and Campanacci grade 3-aggressive lesions that break through the cortex and may involve soft tissue. This case would be grade 3.  The systems help identify the extent of disease and may direct treatment options, but they don't correlate with recurrence rates. While most GCT are benign, ~3%  will metastasize, and 2-9% are histologically malignant. Thus long term follow up of the local site and distant sites such as the lung in particular, is needed.

    1. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987 Jan;69(1):106-14.

     2. Eckardt JJ, Grogan TJ. Giant cell tumor of bone. Clin Orthop Relat Res. 1986 Mar;(204):45-58.
    3. Domovitov SV, Healey JH. Primary malignant giant-cell tumor of bone has high survival rate.Ann Surg Oncol. 2010 Mar;17(3):694-701. Epub 2009 Nov 10.

    4.Siebenrock KA, Unni KK, Rock MG. Giant-cell tumour of bone metastasising to the lungs. A long-term follow-up.J Bone Joint Surg Br. 1998 Jan;80(1):43-7.