Giant Cell Tumor
Original Editors - Michael Fogarty from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Giant cell tumors of the bone are benign multi-nucleated cell masses that are commonly found at the epiphyses and sometimes the metaphyses of long bones. These tumors get their name due to the large cell appearance they have when viewing them under a microscope.[1]
Giant cell tumors are a discrete and locally aggressive abnormal growth or tumor that can metastasize to other areas of the body. The metastatic forms of giant cell tumors are known as malignant sarcomas, though this form of giant cell tumor is very rare.[2] Giant cell tumors of the bone are one of the most challenging benign bone tumors due to resulting substantial bone damage, local reoccurrence, lung metastasis, metastasis to lymph nodes, and malignant transformation.[3]
Prevalence[edit | edit source]
Giant cell tumors of the bone are rare and occur in roughly one out of every million people per year.[4] In the united states 5% of all the primary bone tumors and 21% of all benign bone tumors present as a giant cell tumor.[3] Significantly higher incidence rates are observed in the Chinese population as compared to the western Caucasian population where giant cell tumors constitute up to 20% of the population being affected.[2]
The most common incidence for giant cell tumors is in skeletally mature patients between the ages of 20 and 55, with the maximum occurrence in the third decade of life.[2] Females are more likely to develop giant cell tumors than males with a 1.3-1.5: 1 ratio.[3]
These tumors most frequently involve the epiphyses ends of long bones with the femur, tibia, and distal radius most commonly involved.[1]. The most common locations of occurrence are around the knee which is involved in 60% of cases, the distal radius which is involved in about 10-12% of cases, and the sacrum which is much more rare but still the third most common location of involvement.[5]
Though metastasis to the lungs does occur it is very rare and only about 3% of cases will result in the tumor spreading to the lungs. When giant cells metastasize to the lung they appear as clusters that are located within the lung. Giant cell tumors metastasize at a slow rate and usually do not appear for 3-5 years after the patient has been diagnosed with their primary bone tumor, but this metastasis may go unidentified for up to 10 years or longer.[3]
Characteristics/Clinical Presentation[edit | edit source]
Every patient is going to experience the signs and symptoms of a giant cell tumor slightly different, and many of the symptoms may depend on the locality of the tumor. The following are the most common signs and symptoms that a patient may present with:
- Pain in the area of the tumor that progressively increases[1][4]
- Pain that increases with activity and decreases with rest[4]
- Decreased joint range of motion[1]
- Tender hard mass may be palpated[1]
- Muscle atrophy[1]
- Elevated temperature of the overlying skin[1]
- Mass or swollen area (may or may not be painful)[4]
If significant bone destruction occurs at the tumor site and the cortex layer of the bone is damaged a pathological fracture may develop. If the tumor is in a weight bearing bone the patient may present with significant pain upon weight bearing.[2]
When the sacrum is involved the patient may present with localized pain in the low back and sacrum that may radiate down one or both legs. Swelling may also be present in the location of the tumor. The patient may also state that they are experiencing abdominal discomfort and may present with neurological problems such as bowel and bladder dysfunction, sexual dysfunction, and numbness/weakness of the lower extremities.[5]
Associated Co-morbidities[edit | edit source]
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Etiology/Causes[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Children's Hospital boston. http://www.childrenshospital.org/az/Site960/mainpageS960P0.html. Accessed March 05, 2011.
- ↑ 2.0 2.1 2.2 2.3 Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd edition. St. Louis, Missouri: Saunders Elsevier; 2009.
- ↑ 3.0 3.1 3.2 3.3 Valerae LO. eMedicine from WebMD. Giant Cell Tumor. http://emedicine.medscape.com/article/1255364-overview. Updated April 02, 2009. Accessed March 05, 2011.
- ↑ 4.0 4.1 4.2 4.3 The American Academy of Orthopaedic Surgeons. Giant Cell Tumor of Bone. http://orthoinfo.aaos.org/topic.cfm?topic=a00080. Updated June 2010. Accessed March 05, 2011.
- ↑ 5.0 5.1 Goodman CC and Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th edition. St. Louis, Missouri: Saunders Elsevier, 2007.
