Giant cell tumour of the bone in children and adolescents: Report of 11 cases

Abstract

Background: Giant cell tumours (GCT) of the bone are benign and consist of aggressive local growth with rare metastatic disease. Its reported incidence in the immature skeleton is less than 10%, ranging from 1.8% to 10.6%. Few GCT series have been reported in the immature skeleton. In our ¿country?, the overall incidence and impact of GCT in these patients is unknown. A series of 11 cases is presented, demonstrating their demographic characteristics, treatment, and follow-up.
Methods: Between the year 2000 and 2014, out of a total of77 patients with GCT, 11 of them presented with skeletal immaturity at the time of diagnosis. These patients were treated and followed-up in our institution. A retrospective analysis was performed. All patients had histologically confirmed GCT, and in all cases a review was made of the X-rays, chest CT and, bone scans, and MRI scans of the compromised region. Skeletal maturity was determined if there was open physes at the time of diagnosis. The mean follow-up was 6.6 years (range 2 to 10 years)
Results: A total of 8 females and 3 males, with a mean age of 14.8 years at the time of diagnosis, presented with a GCT. The incidence of GCT in the skeletally immature patient was 7%. The compromised site was: around the knee in 8 cases, of which 4 were in the distal femur and 4 in the proximal tibia, with two in the proximal humerus and one in a metatarsal. All patients were treated with allografts. Nine received structural allografts and two osteochondral allografts. One patient received denosumab. Seven out of the 11 patients had no complications. Three did have complications. One had a local recurrence, one required removal of hardware material, and a third presented with a fracture. The patient treated with osteochondral allograft presented with a traumatic fracture, which consolidated without surgical management.
Discussion: GCT in the skeletally immature patient is rare, and poses a challenge for the surgeon. The impact on our practice is similar to that reported in the literature. In our series, successful reconstruction was achieved in the majority of patients, with one local recurrence. Allograft reconstruction is a good method of treatment, with successful results. The modality of our study limits our ability to assess effectiveness, and the low incidence in this age group limits the number of cases presented. A prospective study could further consider other aspects, such as length discrepancy and local recurrence, and functional scales could improve our knowledge about the impact of treatment in this population.
Evidence level: IV.