Giant cell tumor with pathological fracture

Case contributed by Ian Bickle
Diagnosis almost certain


Pain in the right knee following a relatively trivial fall.

Patient Data

Age: 35 years
Gender: Male

Mildly expansile lucent lesion in the meta epiphyseal region of the femur with a narrow zone of transition.

Cortical thinning, but no destruction.

Linear lucency through the lesion in keeping with a pathological fracture.

Small joint effusion.

Expansile T1 low/STIR high signal enhancing mass centered on the distal femoral metaphysis extending into the epiphysis.

Cortical thinning and minor cortical breech on the lateral femoral aspect with the mass extending into the intracondylar notch.

No intra-lesional fluid-fluid levels.

Pathological fracture through the lesion with a small lipohemarthrosis.

Case Discussion

Giant cell tumor (GCT) of the bone is a usually benign bone tumor which arises from the metaphysis and typically extends into the epiphysis of the long bones.

The commonest site representing more than half of cases is around the knee, as in this case.

On plain film the lesion is typical an expansile, lucent lesion without a sclerotic rim, but with cortical thinning and uncommonly periosteal reaction.  A pathological fracture is often present at presentation.

This case was referred to an out of country of residence hospital bone center, for further review and biopsy, the result of which is not currently known.

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