Medical history (history of illness) represents an important component in the diagnosis of giant cell tumor (osteoclastoma). Family history Are there any diseases in your family that are common? (Tumor diseases) Social anamnesis Current medical history/systemic history (somatic and psychological complaints). Do you suffer from persistent or increasing pain in the skeletal system for which … Giant Cell Tumor (Osteoclastoma): Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Hyperparathyroidism (parathyroid hyperfunction) – osseous manifestation of the disease: osteodystrophia cystica generalisata von Recklinghausen (hemorrhagic resorption cysts = brown tumors with irregularly distributed clusters of giant cells) (rather rare) Mouth, esophagus (food pipe), stomach, and intestine (K00-K67; K90-K93). Reparative giant cell granuloma – slow-growing lesion resulting in painless distension … Giant Cell Tumor (Osteoclastoma): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by a giant cell tumor (osteoclastoma): Musculoskeletal system and connective tissue (M00-M99). Restriction of movement due to limitation of joint activity. Secondary osteoarthritis (joint wear) – in osteoclastoma close to the joint surface. Neoplasms – tumor diseases (C00-D48) Malignant (malignant) degeneration … Giant Cell Tumor (Osteoclastoma): Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Mouth, teeth [due todifferential diagnosis: reparative giant cell granuloma (slow-growing lesion leading to painless distention of bone with tooth displacement and loosening)] Neck Extremities: [swelling? … Giant Cell Tumor (Osteoclastoma): Examination
Laboratory parameters of 1st order – obligatory laboratory tests. Biopsy (tissue sample) – for differential diagnostic reasons. Immunohistochemical detection of mutant H3.3 histone protein – for unclear cases. Parathyroid hormone – to exclude hyperparathyroidism, in the setting of which osseous manifestations of the disease may occur: Osteodystrophia cystica generalisata von Recklinghausen (bled resorption cysts = … Giant Cell Tumor (Osteoclastoma): Test and Diagnosis
Therapeutic targets Relief of pain Stabilization of bone sections at risk of fracture Removal of the tumor – see “Surgical Therapy“. Healing Therapy recommendations Analgesia according to WHO staging scheme: Non-opioid analgesic (paracetamol, first-line agent). Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic. High-potency opioid analgesic (eg, morphine) + non-opioid analgesic. Denosumab, a monoclonal antibody, … Giant Cell Tumor (Osteoclastoma): Drug Therapy
Obligatory medical device diagnostics. Conventional radiograph of the affected body region, in two planes – to assess the extent of tumor growth; characteristically, one: Epiphyseal/metaphyseal eccentric location of osteolytic areas (areas of bone dissolution), which may extend below the articular cartilage Chambered looking structure, usually no sclerosis, smooth marginal border. Magnetic resonance imaging (MRI; computer-assisted … Giant Cell Tumor (Osteoclastoma): Diagnostic Tests
The location and extent of giant cell tumor (osteoclastoma) usually require intralesional resection (excision): Procedure: Opening of the tumor → curettage → filling of the bone defect initially with bone cement → Advantage: The tumor cells of the marginal zones are killed by the polymerization heat of the cement. Recurrences (recurrence of the disease) at … Giant Cell Tumor (Osteoclastoma): Surgical Therapy
A giant cell tumor is usually asymptomatic and therefore usually an incidental finding on X-ray. The following symptoms and complaints may indicate a giant cell tumor (osteoclastoma): Main symptoms Joint pain, localized pain on exertion Local, visible swelling Restriction of mobility of the affected body part / joint Effusion in the adjacent joint Fractures (bone … Giant Cell Tumor (Osteoclastoma): Symptoms, Complaints, Signs
Pathogenesis (disease development) Giant cell tumor is one of the histiocytic bone tumors. It consists of large, multinucleated osteoclast-like giant cells, to which it owes its name. Between these giant cells lie the actual tumor cells, namely mesenchymal mononuclear fibroblast-like cells. The mononuclear cells produce large amounts of the so-called RANK ligand (Receptor Activator of … Giant Cell Tumor (Osteoclastoma): Causes
General measures Nicotine restriction (refraining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day). Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea). Aim for normal weight! … Giant Cell Tumor (Osteoclastoma): Therapy
