ACTA SCIENTIFIC PAEDIATRICS (ISSN: 2581-883X)

Volume 2 Issue 12 December 2019

Case Report

A Case Report of Giant Cell Rich Osteosarcoma

Fathi Afshin1, Maskani Reza1* and Hosseini Anbaran Sonia2

1
Pediatric Department, Bouali Children’s Hospital, Ardabil University of Medical Sciences (ARUMS), Iran
2
Department of Medical, Ardabil Branch, Ardabil University of Medical Sciences (ARUMS), Iran
*Corresponding Author: Maskani Reza, Pediatric Department, Bouali Children’s Hospital, Ardabil University of Medical Sciences
(ARUMS), Iran.
Received: October 11, 2019; Published: November 04, 2019

DOI: 10.31080/ASPE.2019.02.0177

Abstract
Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone tumor of young adults. It typically presents as a large lytic
mass at the end of the epiphysis of long bones. Grossly it is comprised of cystic and hemorrhagic areas with little or no periosteal
reaction (1) Giant cell tumor of talus is a rare entity. In contrast to GCT of long bones, most cases occur in a younger age group and
tend to be multicentric (2) we report one case of giant cell rich osteosarcoma of talus bone in a 11 years old Iranian girl in December
2017 that presented with tenderness of the left ankle after a minor trauma with a tumoral lesion in Tc99m-MDP scan. Biopsy of talus
lesion reported a giant cell tumor with focal atypical chondroid and osteoid differentiation highly suggestive of a low grade giant cell
rich osteosarcoma. Neoadjuvant chemotherapy with cisplatin 80mg and Adriamycin 50mg was begin for her.
Keywords: Giant Cell Tumor; Bone; Osteosarcoma

Introduction are noted (Figure 2) The patient was undergoing surgery and his-
The giant cell tumor of bone (GCTB) is a benign but locally ag- topathology report of the lesion was suggestive for solitary bone
gressive bone tumor of young adults of 20–40 years of age. It con- cyst with reparative changes following fracture.3 months after sur-
stitutes about 4–5% of all bone tumors and about 18% of all benign gery the patient's symptoms returned again.in new radiographies
bone tumors. It is slightly more common in females [1] Radiologi- showed a cystic lesion in the left ankle (Figure 1).
cally, it is usually lytic and expansile without prominent peripheral
sclerosis and periosteal reaction. Some pathologists consider it a
low grade or potentially malignant neoplasm. The tumor is locally
aggressive and destructive, and it tends to recur after simple cu-
retting [1]. GCTB is generally considered a true neoplastic condi-
tion with well-defined clinical, radiological and histopathological
features [3,4] Giant cell tumor of talus is a rare entity. In contrast
to GCT of long bones, most cases occur in a younger age group and
tend to be multicentric [2].

Case Presentation
A 11-year-old girl presented in December 2016 with one-month
history of left ankle pain after a minor trauma. Radiographs from
an outside institution showed a cystic lesion in the left ankle (Fig-
ure 1). Ankle MRI reported a homogenous well-defined speculated
cystic mass measuring 25*15mm in posterior site of talus with nar-
Figure 1
row trainsitional zone. Mild joint effusion and soft tissue edema

Citation: Maskani Reza. “A Case Report of Giant Cell Rich Osteosarcoma”. Acta Scientific Paediatrics 2.12 (2019): 11-13.
A Case Report of Giant Cell Rich Osteosarcoma

12

Figure 2 Figure 4

New MRI reported lateral superior part of talus is dark due

After that whole body scan with injection of the 20mCi Tc99m-
to previous surgery, metallic artifact and sement application. En-
MDP for patient Was requested and the report was this: the scan
hanced distal tibia and talus body and proximal calcaneum are
finding is suggestive of tumoral lesion in the posterior process of
seen as osteitis but no suggestive tumoral tissue is seen (Figure 3).
left talus. Increased uptake in the trochlea and neck of left talus can
be due to surgical manipulation or extension of tumor. New pathol-
ogy reported Giant cell tumor with focal atypical chondroid and os-
teoid differentiation highly suggestive of a low grade giant cell rich
osteosarcoma, pending clinico-pathologic and radiologic correla-
tion. Finally giant cell osteosarcoma was diagnosed for patient and
neoadjuvant chemotherapy with cisplatin 80mg and Adriamycin
50mg was begin for her last radiography is showed in (Figure 1).

Discussion
Giant cell-rich osteosarcoma is a rarer variant that has very
close resemblance to giant cell tumour. Patients usually present
nonspecific symptoms of pain and palpable mass. It usually shows
an osteolytic lesion with locally spared new bone formation in the
metaphysis and/or metaepiphysis on imaging. Histologically, the
atypical tumour cells with osteoid formation and multinucleated
giant cells are the key factor in the diagnosis and differential di-
agnosis [5]. Giant cell rich osteosarcomas, histological variant of
conventional osteosarcomas account for 3% of all cases of osteo-
Figure 3
sarcomas and most of them are arise from the appendicular skel-

Citation: Maskani Reza. “A Case Report of Giant Cell Rich Osteosarcoma”. Acta Scientific Paediatrics 2.12 (2019): 11-13.
A Case Report of Giant Cell Rich Osteosarcoma

13

eton [6]. Giant cell-rich osteosarcomas are sometimes difficult to 7. Nagata S., et al. “Giant cell-rich osteosarcoma of the distal fe-
distinguish from giant cell tumors by age, location, magnetic reso- mur: radiographic and magnetic resonance imaging findings”.
nance imaging findings, and pathology. Radiography may be use- Radiation Medicine 24 (2006): 228-232.

ful in the diagnosis of giant cell-rich osteosarcoma [7]. Malignant 8. Bertoni F., et al. “Malignancy in giant cell tumor”. Skeletal Radi-
giant cell tumor of bone has become a confusing term because of ology 32 (2003): 143-146.
the inclusion of many giant cell-rich sarcomas not related to giant
cell tumor of bone (GCT) The term “malignancy in giant cell tumor”
Volume 2 Issue 12 December 2019
may overcome this problem in semantics Malignancy in GCT can
© All rights are reserved by Maskani Reza.
be classified as primary when it arises in juxtaposition to a benign
giant cell tumor (synchronous malignancy) or secondary when
it arises at the site of a previously treated GCT (secondary meta-
chronous malignancy). Most malignancies in GCT are secondary,
usually after previous radiation therapy and less commonly after
a latent period and previous curettage [8]. In our case, the radio-
logical fining presenting an osteolytic lesion that the scan finding
is suggestive of tumoral lesion and highly suggestive of a low grade
giant cell rich osteosarcoma. Chest radiography reported no mass
lesion and mediastinum, heart shadow size and shape, bone and
ribs were normal and patient will be follow after 3 week for second
chemotherapy session.
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Citation: Maskani Reza. “A Case Report of Giant Cell Rich Osteosarcoma”. Acta Scientific Paediatrics 2.12 (2019): 11-13.