Giant Cell Tumors of Bone in Patients Aged 18 Years Old or Younger: Imaging Features and Tumor Characteristics

Figures & data

Table 1 Location of Giant Cell Tumors (GCTBs) in 57 Patients 18 Years of Age and Younger

Location	Number of Cases(%)	Proximal	Distal
Long tubular bone	34(59.6%)
Tibia	13	11	2
Femur	7	7
Radius	7		7
Fibula	5	5
Humerus	2	2
Short tubular bone	4(7.0%)
Metacarpal	2	1	1
Phalanx(finger)	1	1
Metatarsus	1	1
Pelvis	8(14.0%)
Sacrum	6
Acetabulum	1
Ischium	1
Patella	4(7.0%)
Vertebral body	2(3.5%)
Cervical spine	1
Lumbar spine	1
Femoral head	1(1.8%)
Sternum	1(1.8%)
Scapula	1(1.8%)
Calcaneus	1(1.8%)
Multifocal disease(proximal and distal tibia, distal femur and talus)	1(1.8%)
Total	57

Figure 1 The distribution of age in 57 patients with giant cell tumors 18 years of age and younger.

Figure 2 A skeletally mature 16-year-old girl with GCTB in the distal femur. Plain radiographs (A and B) of the knee demonstrate an eccentric expansile osteolytic lesion involving the distal femoral epiphysis and metaphysis. The lesion is well defined with a narrow zone of transition (arrow). CT (C and D) showed focal loss of bone cortex and adjacent soft tissue extension (arrow).

Table 2 Patient Characteristics and Imaging Features of Pediatric (18 Years of Age and Younger) and Adult (Over 18 Years) Patients with GCTB Occurring in Long Tubular Bones

Parameters	Pediatric GCTB Patients(%)	Adult GCTB Patients(%)	P value
Sex			0.504
Male	14 (42)	60 (48)
Female	20 (58)	66 (52)
Extent of involvement of bones	34	126	0.009
Metaphysis and epiphysis	31 (91.2)	126 (100%)
Metaphysis without epiphysis	3 (8.8)	0
Location			0.609
Tibia	13	41
Femur	7	41
Radius	7	16
Fibula	5	6
Humerus	2	6
Ulna	0	16
Tumor length
LR diameter(cm)	4.0 ± 1.2	3.8±1.2	0.519
SI diameter(cm)	6.6±2.7	4.8±1.3	0.005
LR diameter/ SI diameter	0.64±0.17	0.80±0.16	0.001
Expansion, n (%)			0.294
Yes	18(52.9)	54(42.5)
No	16(47.1)	72(57.5)
Peripheral rim of sclerosis, n (%)			0.860
Yes	14(41.2)	54(42.9)
No	20(58.8)	72(57.1)
Cortical bone destruction, n (%)			0.504
Yes	20(58.8)	66(52.5)
No	14(41.2)	60(47.5)
Periosteal reaction, n (%)			1.000
Yes	3(8.8)	13(10)
No	31(91.2)	113(90)
Soft tissue extension, n (%)			0.156
Yes	10(29.4)	54(42.5)
No	24(70.6)	72(57.5)
Cystic change, n (%)			0.672
Yes	20(58.8)	69(55)
No	14(41.2)	57(45)
Fluid–fluid level, n (%)			0.457
Yes	6(17.6)	16(12.5)
No	28(82.4)	110(87.5)
Pathologic fracture			1.000
Yes	4(11.8)	13(10)
No	30(88.2)	113(90)

Abbreviations: LR, left and right; SI, superior and inferior.

Table 3 Evaluation of Skeletal Maturity of GCTB Patients 18 Years of Age and Younger

	Number(%)	Age Range (Median)	Sex (M/F)	Epiphysis Involvement n (%)
Patients with open physes	6(17)	9–16(13)	5/1	3(50)
Patients with closed growth plates	30(83)	14–18(17)	11/19	30(100)

Abbreviations: F, female; M, male.

Table 4 GCTBs in Patients 18 Years of Age and Younger: Extent of Involvement of the Lesions in Long and Short Tubular Bones

Extent of Involvement	Number of Patients(%)	Age Range (y)	Median Age (y)
Metaphysis and epiphysis	33(92)	13–18	17
Metaphysis without epiphysis	3(8)	9–13	11
Epiphysis	0

Figure 3 A skeletally immature 9-year-old girl with GCTB in the proximal tibia. Plain radiograph (A) demonstrates an osteolytic lesion (white circle) centered in the metadiaphysis, sparing the epiphysis (arrow in a). Coronal fat-suppressed T₂ (B), sagittal T₁ (C), and axial fat-suppressed T₂ (D) show a solid lesion (white circle) in the proximal tibial metadiaphysis with sparing of the epiphysis (arrow in b). The lesions were mainly solid, with a few cystic components (arrows in c and d). Adjacent soft tissue edema were shown on coronal and axial T₂WI (thick arrows in b and d).