Giant Cell Tumor - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of Giant Cell Tumor.
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A giant cell tumor is a benign, locally aggressive tumor with bone destruction and with malignant potential. Giant cell tumors occur more in females and usually occur in skeletally mature patients. Giant cell tumors occur more in the distal femur, but they can occur in the proximal tibia, distal radius, proximal humerus, hand, spine (vertebral body), and the sacrum. When a giant cell tumor occurs in the sacrum, it occurs in the Ala, which is different from chordomas which occur in the midline of the sacrum. A giant cell tumor is an eccentric lesion that is lytic or radiolucent, and lies within the epiphysis/metaphysis area of the bone.
Plain x-rays are usually diagnostic and the lesion is usually geographic. This rumor rarely extends to the articular cartilage; however, it can break through the cortex into the surrounding tissues. Pulmonary metastases occur in about 2% and theses lesions are usually benign. Get chest x-rays or Ct scans of the chest as part of the diagnostic workup.
In pathology, the giant cell tumor contains large multinucleated giant cells in addition to mononuclear stromal cells. The stroma cells look like the nuclei of the giant cells. The mononuclear stromal cells are the neoplastic cells. The giant cells are similar to osteoclasts and are directed through RANKL pathways to cause bone destruction. The tumor may have secondary Aneurysmal Bone Cyst (ABC) component.
The physician should rule out hyperparathyroidism or Brown Tumor. With multiple lesions (multiple giant cells) and in hyperparathyroidism, the serum calcium level is high. Giant cell tumors can appear in other pathological conditions, such as aneurysmal bone cysts, fractures, and chondroblastomas. If you see giant cells under the microscope, this does not mean that the patient has a giant cell tumor. Epiphyseal tumors such as chondroblastoma (young patients) and clear-cell chondrosarcoma (adult patients) should be ruled out as well. In the sacrum, you need to differentiate a Giant Cell Tumor from Chordoma. Chordoma will have a central location.
Primary malignant giant cell tumors have a greater chance of metastasis. This tumor behaves like an osteosarcoma with an abundance of giant cells (it is a different type of tumor). Metastasis can occur in about 5% of cases. Secondary malignant giant cell tumors can occur following radiation or following unsuccessful attempts at removal of the giant cell tumor with recurrence. When there is recurrence of the tumor, you will see the radiolucent zone and then biopsy the tumor again.
Medical treatment consists of bisphosphonate and denosumab (will act on the RANK pathway). Denosumab is a human monoclonal antibody that is used in recurrent disease and when wide resection may cause significant morbidity. Denosumab is used in unresectable Giant Cell Tumors or when there is recurrence, or when the tumor is aggressive. Aggressive curettage and the use of the adjuvant (can be phenol, hydrogen peroxide, or cryotherapy). The adjuvant decreases the microscopic disease and reduces the recurrence. After the aggressive curettage, the defect can be filled with bone graft or cement, plus or minus fixation. Resection and reconstruction is usually done in aggressive lesion if the tumor erodes or extends to the soft tissues, or in recurrent cases. Resection and reconstruction can also be done when there is involvement of the subchondral bone.

[@pengamalpertanianmy6435]

During 2018, i was a student who active in sport and academic at uni. One day, i lost ability to walk normally day by day. I felt something wrong with the bone. Went to hospital several time but the doctors said just muscle tears because im limping so bad. I know it something serious but xray shows nothing. Long story short, my neck of femur broke completely after i had an accident during class. I was send to specialist hosp for xray and mri, (my bone already eaten til thin and broke) then comfirm had GCT at head of my femur.. My surgery done feb 2019.. i hv iron cast femur now. Im just 25 at the time. Alhamdulillah, all this test is to make us learn to be strong and patient.

[@tomboytutorial8294]

Hi, ive been experiencing the same as you, i had my surgery july 11, 2020, I'm on my recovery stage now. How's your recovery? Can you walk normal as before? Does your cyst fully removed?

[@pengamalpertanianmy6435]

Tomboy Tutorial yes i walk normally, be strong!

[@semayahmed3057]

@@pengamalpertanianmy6435 Hi, I had my surgery just a week ago and they removed the tumor partially. How long it took for you to recover? Hope you are fine now.

[@pengamalpertanianmy6435]

@@semayahmed3057 for me its about 2 years.. the first 2-3 months after surgery u already can walk normally but still got pain for a long walk.

[@semayahmed3057]

@@pengamalpertanianmy6435 Thank you for sharing!

[@kathyhowarth2934]

I had a giant cell tumour 29 years ago,I live in the uk and had my operation done by mr benson in the uk at the John Radcliffe 2 hospital,the tumour was in my spine hip and pelvis,they removed my fibula and grafted it in my pelvis,it was a breakthrough operation at the time,and was recorded

[@mimferdous842]

Kathy Howarth You feel better. Somehow you feel any pain on this area.

[@stephenvjoseph]

I was diagnosed with a ginat cell tumour in around my wrist, i live and work in Uk. Could you provide me with the contact details of that doctor so that i can contact him for treatment ?

[@honeyb9373]

I have😐

[@stephenvjoseph]

@@honeyb9373 please share his number madam

[@rabinmukherjee100]

@@honeyb9373 Hi my name is Aparna Mukherjee I had GCT in my left knee 4years ago & am feeling normal after that surgery.

[@ErikaGarcia-ve3sj]

Very informative. I feel left out though as my GCT was in my left distal tibia, my ankle.

[@MurineMischief]

Exactly what I read about the rare occurring metastasis to Pulmonary system. I was just diagnosed with it in my hand, I will definitely tell them to look closely at my lung CT scan with contrast, due to me having chest pain and difficulty breathing. Jazakallahu Khairn

[@jameskirsch4429]

I have been in a clinical trial taking Denosumab every month since February 2009 until recently because of Covid-19. I am trying to get Denosumab locally

[@Checcles]

Another great video. Thank you for all you do and the time you spend on these. If possible, surgical approaches would be nice (Henry/Thompson/ilioinguinal/etc).

[@nabilebraheim]

Christian E thank you

[@mdmonowar6368]

hallo sir im Bangladeshi i poblam gen call tumar i oprosns 5year thes bone grap place treatment you sagasoin

[@ve2430]

Mine was abc plus giant cell tumor in top of fibula from damage. Regret doing the surgery since my leg doesn't feel the same and I had no pain going into surgery.

[@rashaayman7798]

Thank you ,doctor.

[@arslanlashariarslanlashari7576]

Plezz mujh grant cell tumr haa

[@arslanlashariarslanlashari7576]

Mara 2 opration ho gya hn plezz help mee

[@hatemmaxmedica2162]

Nice presentation

[@abhishekbhatta2071]

Thank you sir for this video i got this video when i had it needed most.Please make more video on ortho ,i know it hard for making video for free and every student maynot have access to it.

[@farahrizvi9825]

Thanks for explaining in detail .

[@Ishatelefilms]

Hello sir.. this is my brother’s report- Focal lyric lesion measuring- 10.6 . 6.4 cm with sclerotic changes in upper shaft of left femur with involving greater trochanteric region with no cartical break and no periosteal reaction - ? Neoplastic ( ? Giant cell carcinoma )... .... is it cancerous condition ????

[@elyseenger-fq8ye]

My uncle had this in his foot. We called it Mr. Vile Moocher and would make jokes about it. One of my fave was “Mmm… roasted tumour… mmm.”

[@dr.raihanapraweenhaque815]

speechless thank you so much

[@ibrahimgouda2023]

Always helpful, Thanks prof

[@mitchellelisachikava6479]

Thank you so much

[@altheaannadmarco9916]

Most helpful, Thanks.

[@cristinepatao6201]

Thank u for sharing. Dr..

[@bjarneygrimsdottir2600]

I had in the distal fimur. In 2001 had surgery in 2002 never came back

[@TechnicalFinanceGuru]

Hello sir. My wife has giant cell tumor above the right hip. She treated with the doctor and he given xgeva Denosumab 5 injections in 45 days. This course we have done. Now would you tell that should we give again this injection and how long we should take it?

[@musahissifu7700]

I had gct on my proximal left tibia

[@anatomydepartment9764]

Very helpful 👏👏👏

[@gebrinarizkirhyomiakasibas6853]

I have a lot of questions about GCT recurrence... i had GCT and i had it removed and now the tumor back. Is bone replacement necessary in this case?

[@gebrinarizkirhyomiakasibas6853]

@@aliciam7774 Alicia M ive read about patients treated using denosumab. I have 2 options 1st one that im gonna have bone replacement and itll give me 98% that the tumor wont come back. 2nd is to have the same surgery like i had before. My doctor didnt mention anything about radiation, but i think he told me that i dont need that. And have something also in my right lung it could me metastatic lung disease from this GCT its about 1.5 cm. So i might gonna have 2 surgery at the same time. Im nervous. Still dont know what to do.. btw how can i contact you 😂

[@paul-beinetti]

​@@gebrinarizkirhyomiakasibas6853how did everything go??

[@vajirawitradman8980]

Thankss

[@dilekarathnayake154]

My friend was diagnosed with a giant cell tumor .

[@sharonrose6661]

I was diagnosed with a giant cell tumor. On my second and third vertebrae of my spine I have so many ? Im so scared can you please help me ?

[@honeyb9373]

I have too..

[@SaraGeis]

i have one. this is interesting

[@ASHRAFSURGERY]

Thank you Dr. But can this tumour present in proximal ulna in 57 y female and can this tumour be metastatic from other primery else where?

[@dr.aakanshabaruah]

This tumour is benign in nature

[@dr.asheralbert9446]

Locally aggressive with "malignant potential", so it is capable of metastasis.

[@thaslima8688]

No it's a primary tumor

[@incha8875]

Hello Dr., Is GCT the only type of tumor that occur in the ALA of sacrum or are there other type of malignant tumors that can occur there too? I have destructive tumor on Left side of sacrum at L 5 pushing on the nerve exit and resulting in cortical breakthrough. Thank you.

[@mohammadnaveed9317]

I had gct on my distal fibula

[@shivanityagi5786]

Excellent video...

[@shuvamkunti3044]

Denosumab can be used nowadys

[@kingddd7960]

I have one on my the side of my thumb

[@herthisis2973]

Me too, I had it removed in 2018

[@jandp2941]

@@herthisis2973 how are you feelinG? Any reoccurrence?

[@waelwael3734]

انا اعاني من هذه الاورام في الركبه

[@arslanlashariarslanlashari7576]

Sir ma docter sab melna chta ho mujh grand cell tumr haa plezz

[@sohailahmad3139]

I have gint cell tumor in spin

[@arslanlashariarslanlashari7576]

Plez help me mujh grant cell tumra ha 2 opration ho gya hn plezzz help mee

[@ameermoavia9738]

Hello

[@mangleshjayswal4867]

Hello bhai

[@PREETILAADgsMBAAB]

Really

[@MdRaihanMahmud-pz6nv]

আসসালামু আলাইকুম

[@betterbonesph]

:D

[@waelwael3734]

I have giant cell tumor in the knee

[@jayajohnson4976]

My sister also affected by this GCT

[@DinaAwd]

And I am studying...I wish you all get better soon

[@shafiqahmad2403]

same

[@bhoopramyadav694]

sell tomar ke u pay

[@qatarkapi]

Please sir give me a idea about.. osteosarcoma