Giant Cell Tumour - Subchondral
Giant Cell Tumour - Subchondral
Clinical Scenario
A 32-year-old woman presents with 6 months of progressive knee pain. X-rays show an eccentric lytic lesion in the proximal tibia extending to the subchondral bone. MRI shows no matrix mineralisation, no periosteal reaction, and the lesion abuts the articular surface. She is skeletally mature.
Questions & Model Answers
What is the diagnosis and what features distinguish this from other lesions?
Describe your treatment approach.
What is the role of denosumab and what are the concerns?
What is the Campanacci classification and how does it guide treatment?
How do you manage pulmonary metastases from GCT?
How do you manage local recurrence of GCT?
Exam Tips
Opening Statement: This is a classic giant cell tumour - eccentric metaphyseal-epiphyseal lesion extending to subchondral bone in a skeletally mature patient around the knee. I would treat with extended curettage, adjuvants, and cavity filling.
Common Pitfalls:
- Always biopsy before denosumab
- Protect articular cartilage - subchondral graft consideration
- Pulmonary metastases occur in 2-3% - staging CT