Giant-cell tumor of a bone

Description:

Benign giant-cell tumor of a bone —  the benign, locally aggressive tumor consisting of layers of mononuclear cells of an ovoidny form and numerous osteoklastopodobny huge multinucleate cells. Makes about 5% of all primary bone tumors and 20% of benign primary tumors of bones.

Symptoms of the Giant-cell tumor of a bone:

Local pain of various intensity, pathological changes in 10% of cases.

Radiological — perhaps lytic defeat of cellular structure with a clear boundary; often there is no sclerous rim; the center is located subkhondralno, excentricly; periosteal reaction is absent. The cortical plate can be blown up, locally destroyed, spread of a tumor to soft tissues is observed.

Patomorfologiya.

Macroscopically on a section a soft tissue or crumbling, brown color with hemorrhages (the field of red color), yellow inclusions, with necroses and cysts. On a section the fields of a necrosis and space filled with blood are usually visible. Material after a curettage soft, crumbling, dark-brown color. The tumor extends to a joint cartilage, but the invasion of a cartilage and its germination is not characteristic of it.

Microscopy. Numerous multinucleate colossal osteoklastopodobny cells among mononuclear cells of an ovoidny form; mitoses can be numerous, however pathological mitoses do not come to light; products of a matrix are absent (cells of a tumor do not produce a bone or a cartilage); true vessels and a reactive osteogenesis are visible only in the regions of a tumor. Osteoklastopodobny cells of a nepatognomonichna for a giant-cell tumor of a bone as can be defined at various reactive, benign and malignant diseases of a bone. Reactive bone formation comes to light at pathological changes.

The classical picture of a giant-cell tumor is often modified due to secondary reactive proliferation of fibrogistiotsitarny fabric, hemorrhages, a necrosis, formation of a secondary anevrizmalny cyst of a bone. Reactive fibrous fabric with signs of moire and ksantogranulematozny reaction, at least locally, is identified in the majority of giant-cell tumors.

Reasons of the Giant-cell tumor of a bone:

Most often develops from epimetafiz of long bones around a knee joint (50% of cases), in a proximal part of a humeral and distal part of a beam bone (pelvic bones, a backbone, jaws, edges are surprised less often). In 75% of cases at sick 20–40 years (peak — 20–30 years), meets at males a little more often, develops after closing of an epiphyseal plate of growth. Very seldom giant-cell tumor of a bone meets at the age of less than 20 and more than 55 years.

Treatment of the Giant-cell tumor of a bone:

Regional resection of a bone together with a tumor with defect plastics. At localization of a tumor in the field of a metaepiphysis the so-called circumarticular resection which is a kind of a regional resection is made.

The outcome is rather favorable; the biological behavior of a tumor is unpredictable: sometimes proceeds it is good-quality, in other cases — with the expressed invasive and destructive growth, can metastasize in lungs (less than in 1% of cases), a recurrence — from 10% (en bloc resection) to 50% of cases (often develops at a bone scraping). Certain sites of a tumor can be exposed to an ozlokachestvleniye in 1,5–13% of cases.