Giant cell tumor

Case contributed by Dr Ammar Haouimi

Presentation

Pain of the left hip

Patient Data

Age: 40 years
Gender: Male
X-ray

There is a relatively well-defined eccentric osteolytic lesion of the left femoral neck, extending to the femoral epiphysis with paucity of the trabecular lines as compared to the normal opposite side, and thinning of the overlying cortex. No peripheral sclerotic rim is seen (type 1b according to Lodwick classification).

MRI

The previously described lesion appears lobulated of intermediate signal intensity on T1WI with a peripheral rim of low signal, inhomogeneous high signal intensity on T2WI with areas of low signal intensity (due to hemosiderin or fibrosis)  with intense and heterogeneous enhancement following IV contrast. A cortical rupture is noted at the anteroinferior aspect of the femoral neck with mild periosseous extension as well as adjacent bone marrow. mild joint effusion is noted. 

Case Discussion

This case illustrates the characteristic radiological features of a giant cell tumor (histologically proven)

AP radiograph:

-eccentric osteolytic lesion close to the articular surface

-well-defined with non-sclerotic margins (Lodwick type Ib)

-no matrix calcification/mineralization

-no periosteal reaction

-extension to the epiphysis

-thinning of the overlying cortex

MRI:

-peripheral low signal intensity rim on TWI

-heterogeneous high signal intensity on T2WI with central areas of low signal (hemosiderin or fibrosis)

-enhancement of the tumoral matrix

-bone marrow edema

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Case information

rID: 65763
Published: 23rd Jan 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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