GIANT CELL TUMOR OF

THE CALCANEUS: A CASE REPORT

Presented by : Nugroho Sigit H.

nugroho_sigitdr@yahoo.com
INTRODUCTION
 Benign but locally aggressive and destructive
 GCT is located in the epiphysis with or without
extension to metaphysis long bone
 Soliter
 Potential to local recurrence and malignant
transformation
 Epidemiology
 5% of all primary bone tumors and 20%
of benign skeletal tumors
 Skeletally mature with peak incidence in
the third decade
 80% of cases occurring between 20 and
50 years of age
 The small bones of the hand and foot to
occur in a slightly younger
 Long bones 75%– 90%
 50%–65% occurring about the knee
 Small bones of the hand and foot <2%
Clinical & histological finding
◦ Localized pain & swelling
◦ Presenting :
 Following trauma
 Incidental finding
◦ Histologically:
 Multinucleated giant cells with a background
of mononuclear stromal cells.
 The multinucleated giant cells appear similar
to osteoclasts
 Ossification and osteoid production are
noted in soft tissue extensions
 Radiological imaging
- Geographical destruction, well-defined but non-
sclerotic margin
- Eccentric in location, extends to the subchondral
bone
- Narrow zone of transition
- Aggressive features such cortical thinning,
expansile, cortical bone destruction and an
associated soft-tissue mass
- Unilateral
- Soap-bubble‘ pattern of trabeculation (40%)
- Not contain calcification or ossification
- No visible periosteal reaction
 Giant…cont…
In aggressive lesions:
 Transition zone width
 Cortex is very thin
 The possibility of extending to soft tissue
 Can develop into giant cell osteosarcoma
 The presence of soft tissue mass does not
indicate sarcoma

Complication : fracture
Difficult to distinguish with :
◦ Aneurismal bone cyst
◦ Chondroblastoma
◦ Solitary bone cyst
CT
 Outlining tumor extent, especially its
extra-osseous portion and its relationship
to adjacent structures
 Cortical integrity
 Determination of tumor recurrence
 The expanded and thinned cortex and
the presence or absence of matrix
calcification
 Reactive changes and edema on the outer
cortical surface or the synovium
MRI
 Low signal intensity on T1WI and mixed
high and low (heterogeneous) intensity on
T2WI with FS.
The low signal on T2WI is usually due to
hemosiderin within the GCT
 Intramedullary tumor is best seen on
T1W, while its extraosseous portion is
best appreciated on T2W images
 GTC ;Aneurysmal bone cyst; Chondroblastoma

GTC Aneurysmal Condro- Solitary Bone

Bone Cyst blastoma Cyst
Age 20-40 years Before epiphyseal 10-30 years < 20 years
fusion (< 20 y)
Site Epiphysis Metaphysis Epiphysis long Metaphysis to
Around knee & bone, patella, tarsal diaphysis proximal
wrist humerus, femur

Radiological Osteolytic, Osteolytic, Osteolytic, Osteolytic,

geographic, well- geographic, geographic, geographic,
profile
defined but expansile, thin sclerotic margin, sclerotic margins,
nonsclerotic sclerotic matrix mild expansion
margin, eccentric, margins, formation, and cortical
narrow zone of ballooned, fluid benign periosteal thinning, fallen
transition, soap blood level reaction. Bone fragment
bubble marrow and soft
appearance tissue edema
CASE
Patient Identity
 Name : Tn N
 Sex : Male
 Age : 23 y
History
A 23-year-old male presented with right heel pain and
swelling. The pain was present since 18 months.
However, the swelling had appeared 12 months back.
There was no history of trauma or fall.
Plain radiograph and CT ankle and foot was taken
Plain radiograph 11/07 2018

 Bone destruction in the

right calcaneus, well
defined, non-sclerotic
margins, with intact
cortex but thinning out
 Narrow zone of
transition
 Not contain calcification
Multiloculated osteolytic lesion
Geographical destruction
with intact cortical margins,

6,4 x 4,5 x 4,6 cm, cortical

thinning

Non-sclerotic margins

Not contain calcification

Histology
Macroscopic Microscopic
- Irregular grey to Numerous osteoclast-
brown mass at the like giant cells
right calcaneous, uniformly distributed
measuring throughout tumor;
approximately 7 cm with numerous nuclei
in maximum suggestive of GCT
dimension.
- Lytic with multiple
septation
DISCUSSION
 23-year-old
 Geographical destruction, non-sclerotic
margins, expansive, cortical thinning
 Narrow zone of transition
 Not contain calcification
 Soap bubble app
 Not periosteal reaction
Suggestive of GCT
 Disc.... cont
DDx
Chondroblastoma
• 10-30 year-old
◦ Matrix chondroid
◦ Sclerotic rim
◦ Not expansive
Aneurysmal Bone Cyst
◦ Before epiphyseal fusion
◦ Thin sclerotic margins,
◦ MRI: Fluid blood level
 Chondroblastoma

Osteolytic, geographic, sclerotic margin, matrix

formation
 Aneurysmal Bone Cyst

Lytic mass lesion (arrow), cortical bone erosion,

expansion, and destruction
a) T1W and b) T2W sequences show heterogeneous hypointense sclerotic rim
(red arrow), hyperintense septae formations (green arrow). T2W sequence
shows blood level components (blue arrow). c) Image following intravenous
contrast media administration shows contrast enhancement surrounding the
lesion (red arrow) and in the septae formations (blue arrow).
SSolitary Bone
Solitary Bone Cyst

Osteolytic, geographic, sclerotic margins, mild

expansion and cortical thinning, fallen fragment
CONCLUSION
The calcaneus is a rare localization for an
giant cell tumor, it should be considered in
the differential diagnosis. For an appropriate
diagnosis, correlation of the age, clinical
presentation, anatomical localization,
radiological profile, and histological
evaluation are required.
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