'Giant Cell Tumour' of the radius in a child

Clinical History

14-year-old girl presented with painful right wrist acutely after falling over. The closed injury was neurovascularly intact. Initial radiographs were taken and the patient treated in cast. No history of bony tenderness was elicited pre-injury. Patient received curettage and cementation and was followed up over 5 years.

Imaging Findings

A 2.7cm x 2.5 cm septated, expansive lytic lesion is seen in the subarticular region of the right distal radius with an associated fracture [Fig. 1]. Follow up post immobilisation radiographs 4 weeks later show healing with callus formation [Fig. 2]. No evidence of recurrence on the follow up radiographs after treatment with curettage and cementation [Fig. 3].

Discussion

Giant Cell Tumours (GCT) are locally aggressive neoplasms of the bone typically occurring at the epiphysis of long bones in skeletally mature patients of 20 to 40 years. This presentation in a child of 14 is therefore unusual [1, 2, 5].

GCT account for 5% of the bone tumours with a slight female predilection. In the Chinese population, GCT has a higher prevalence of 20% of bone neoplasms. The incidence of GCT in the radius is 10-12% [2] making it the third most frequent site after the distal femur and proximal tibia [1, 2, 3, 4].

Although they tend towards the benign end of the spectrum, there is a tendency to recur locally and may undergo sarcomatous transformation or metastasise to the lungs in 1-9% of cases [2, 4].

They usually present with pain and swelling of the affected area or as in this case, a post traumatic pathological fracture.

They usually present as a lytic epiphyseal lesion, extending to the subchondral bone without surrounding sclerosis. 93% of cases showed bony expansion with cortical destruction in 65% [James et al]. Internal septations vary from fine striations to coarse trabeculation. The Campanacci system of grading maybe used to characterise plain radiographs [Fig 4].

MRI can be used for pre-operative local evaluation and to assess the extra osseous component. The lesion usually returns a low to intermediate signal on T1 (best to appreciate the intra medullary component) and T2 weighted images (fluid levels, and low signal due to haemosiderin deposition [2]) with significant enhancement of the solid component after contrast. An MRI was not obtained in this instance.

The usual treatment is curettage with or without bone graft and cement. Follow up is by plain radiographs, usually over 5 years due to the high rates of local recurrence which may be up to 88.9% in some studies [5]. An alternative option to reduce disease recurrence has been to reconstruct the distal radius with vascularised fibula graft in advanced GCT [6].

Differential Diagnosis List

Final Diagnosis

Giant Cell Tumour

URL:	https://www.eurorad.org/case/10122
DOI:	10.1594/EURORAD/CASE.10122
ISSN:	1563-4086