Primary bone tumors are rare and are

usually discovered incidentally when patients undergo imaging studies.

Radiologic approach to bone tumors consists of analyzing the lesion in an organized manner. It should answer the following basic questions:

Location? Size ? Degree of involvement ? Number ? Metastasis ?

Osteoclastoma

Department of Radiology

Patients’ Profile

• 28 year old male Filipino• Came in due to pain and deformity of

the right knee

• 4 mos. PTA• Onset swelling and tenderness• Limitation of movement

Patients’ Profile

• 3 mos. PTA• Admitted due to persistent pain• Increased in size, 3 x 3 inches• Arthrocentesis

• 1 mo. PTA• Admitted for work-up• X-ray, MRI• Core needle biopsy

Patients’ ProfileMRI: heterogenous septated ill-defined mass in the medial

femoral condyle measuring 49 x 55 x 68 mm with an associated joint effusion with gross bone destruction in the femoral condyle. Findings is suspicious for malignancy.

Patients’ Profile

• 3 weeks PTA• Cracking sound• Pathologic complete fracture at

medial condyle of the right femur• Right knee was immobilized

• 1 week PTA• Visited AP’s clinic after completing

home medications• Agreed of biopsy and curettage

Patients’ Profile

• Physical Examination:• Firm mass, 5 X 5 cm

slightly above the patella on posteromedial aspect of the right knee

Hospital Stay

• Labs taken: Bleeding parameters were normal

• CXR taken• Pre-op meds given

Hospital Stay

• Labs taken: Bleeding parameters were normal

• Pre-op meds given

• Open biopsy with frozen section, Curretage and Resection of tumor

• Procedure was uneventful• Post-op antibiotics and

other meds given• Recovery at par

Discussion

• Osteoclastoma / Giant cell Myeloma / Giant cell tumor

• Often solitary and slow growing• Frequently seen in young adults• Affecting usually the knee and arms• Pain and limited range of motion• Presence of Multinucleated Giant

Cells

Discussion

• 18.2 % of all benign tumors• Benign with aggressive traits• No definitive cause• Areas usually affected

1. Distal femur

2. Proximal tibia

3. Proximal humerus

Discussion

• Xray- Lucent and

eccentrically located with no sclerotic borders and narrow zone of transition

- Meta - Epiphyseal regions

Discussion

•Well-defined margin•Intact cortex

Grade 1 (latent)

•Relatively well-defined margin but no radiopaque rim•Cortex is thinned and moderately expanded

Grade 2 (active)

•Indistinct borders•Cortical destruction

Grade 3 (aggressive)

Campanacci Grading System

Discussion

• CT-scan• Best for defining degree of bone

destruction• Presence of pathological fracture• Critical in surgical planning

Discussion

• MRI• Best method to assess the extent

of involvement• Low signal intensity on T1-

weighted images• Intermediate signal intensity on T2

weighted images

Discussion

T1-weighted T2 weighted

Discussion

• Radionuclide Bone Scans• Technetium Tc 99-methylene

Diphospate• Important for detecting metastatic

or multifocal lesions

Discussion

• Angiography• No role in diagnosis• Sensitive test for

assessing response to pre-operative chemotherapy

Discussion

Gross examination• appear as chocolate brown, soft,

spongy and friable lesion.• Variable degree of cortical

expansion

DiscussionMicroscopically

• presence of Multi-nucleated Giant cells on a background of network of Stromal Mononuclear Cells

Discussion

• Treatment• Curretage with Bone Grafting

• Recurrence rate is 45 %• Curretage with Bone Grafting Plus

Liquid Nitrogen or

Phenol or

Hydrogen Peroxide or

Bone Cement• Recurrence rate is 17 %

Discussion

• Treatment• Curretage with Bone Grafting Plus

Phenol Plus Bone Cement• Recurrence Rate is 3 %

• Radiation is restricted to difficult cases

Discussion

Discussion

Prognosis• Mortality rate is 4 %• Post-treatment: serial radiographs• Tumor recurrences are frequent• Long Term observation is

recommended

Differential Diagnosis

OSTEOSARCOMA CHONDROSARCOMA FIBROSARCOMA

20 – 40 years old 30 – 60 years old 30 – 50 years old

Tubular bones Tubular bones Tubular bones

Metaphyseal area Meta – Epiphyseal area More metaphyseal

Pain, swelling, LOM Pain, swelling, LOM Pain, swelling, LOM

Both bone formation & destruction

Lobulated appearance with mottled calcification

Eccentric with permeative lytic destruction

Spindle shaped cells in lace-like pattern

Large chondrocytes with abundant cytoplasm

Plump fibroblast with deeply staining nuclei arranged in inter-twining whorls

Differential Diagnosis

Osteosarcoma

Differential Diagnosis

Chondrosarcoma

Differential Diagnosis

Fibrosarcoma

Conclusion

• Osteoclastoma are benign with aggressive traits

• Curretage paired with adjuvant treatment decreases the incidence of recurrence

Thank You.