Giant Cell Tumor of Bone

  • What are giant cell tumors of bone?

    Giant cell tumors of bone (also known as osteoclastomas) are rare, abnormal growths of body tissue. While usually benign, giant cell tumors of bone are aggressive and can become cancerous.

    Typically occurring between age 20 and 40, giant cell tumors of bone are more frequently diagnosed in women. They are rarely seen in children.

    Giant cell tumors of bone usually occur in the end portion of long bones — the legs or arms — near the joint to another bone. If they become malignant, giant cell tumors of bone can invade surrounding body structures, including the lungs.

  • Causes

    Giant cell tumors of bone occur spontaneously and may be associated with hyperparathyroidism, an overactivity of the parathyroid glands. Parathyroid glands regulate calcium in your child's body so the nervous and muscular systems can operate properly.

  • Signs and symptoms

    Symptoms of giant cell tumors of bone can include:

    • Pain
    • Swelling
    • Fracture of the bone
  • Testing and diagnosis

    Diagnosing giant cell tumors of bone in children can be challenging because many of the symptoms mimic that of other tumors such as malignant fibrous histiocytomas, chondroblastomas, brown tumors of hyperparathyroidism and aneurysmal bone cysts.

    At The Children’s Hospital of Philadelphia, our clinical experts perform a careful and complete medical workup and examination of your child.

    Diagnostic testing may include:

    • Radioisotope bone scan, which can help locate an area of abnormal bone growth. 
    • X-rays, which produce images of bones and internal organs on film.
    • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
    • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to produce cross-sectional images ("slices") of the body.
    • EOS imaging, an imaging technology that creates 3-dimensional models from two planar images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.
  • Treatments

    Giant cell tumors of bone grow rapidly, so quick diagnosis and treatment is essential to produce the best outcome for your child.

    The location of the giant cell tumor of bone will help guide which treatment will be recommended for your child.

    Surgery

    Surgically removing the tumor is often the recommended treatment for giant cell tumors of bone in children. At Children’s Hospital, we use a surgical procedure called intralesional curettage, to scrape the bone to completely remove the tumor and fill the space with a synthetic material such as methyl methacrylate cement or diluted phenol. Curettage is often followed by bone grafting, which means transplanting bone (from another part of your child’s body or from donated bone) into the area that was scraped out or removed.

    Though surgery is highly effective, we understand that any surgery can be a stressful experience for your child and family. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

    Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Safety in surgery is a top priority.

    Radiation

    Radiation therapy may be used alone to treat your child's giant cell tumor of bone, or in conjunction with surgery to shrink or destroy the tumor.

  • Follow-up care

    At CHOP, we offer ongoing support and services for patients and families at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and referring physicians to provide the most current, comprehensive and specialized care possible for your child.

    If your child had surgical treatment for a giant cell tumor of bone, he or she will return for check-ups one to two weeks after surgery, then again at three months, six months, one year and two years post-surgery. If your child was treated with radiation, ongoing monitoring is also important.

    Whichever treatment your child received, he or she should be followed up for at least five years, because giant cell tumors of bone have a high probability of recurrence — sometimes many years after the initial treatment.

    During follow-up visits, your child’s physician will likely perform a physical exam and order X-rays of the affected area and the chest to ensure the giant cell tumor of bone has not spread to the lungs.

  • Outlook

    Outcomes for children treated for giant cell tumors of bone are generally good, but depend largely on how much the tumor has spread and whether it recurs or becomes cancerous. Continued clinical monitoring is vital for the best outcome.

Reviewed by John P. Dormans, MD, FACS, Jason L. Katz, PA-C, MHS, ATC-R on May 19, 2014