What is a giant cell tumour?

giant cell tumour is a tumour that arises in connective tissue such as bone, muscle or around sinews. 

We distinguish between giant cell tumours of the bone and giant celltumors in the weekly parts. 

To know with what kind of giant celltumor you have to deal with, is tissue examination is needed. So, in addition to imaging studies (scans), it is usually necessary to take a sample of the tumour, a biopsy. 

Connective tissue

Connective tissue is the body's support tissue and has the following functions: protection of vital organs, strengthening of the body (bones or bone), shock absorber in joints (cartilage), insulation of the body (fatty tissue) and movement (muscles and tendons). Blood vessels and nerves are also partly composed of connective tissue.

What is a giant cell tumour of the bone?

This tumour is also called a osteoclastoma mentioned. A giant cell tumour of the bone consists of oval cells with so-called giant cells between them (large cells with very many nuclei - where a cell normally has only one nucleus), hence the name. This type of tumour can affect the bone very severely and grows on into the surrounding area with fine offshoots (infiltrative growth), so it can rapidly recur if not completely removed. This is a benign tumour, meaning that in principle it does not spread to other sites. Nevertheless, metastases are seen in about 2% of patients origin in the lungs on average after 3 to 4 years. These metastases usually grow very slowly.

What is a giant soft tissue cell tumour?

The correct English term is Giant cell tumour or tendon sheath, the Dutch-language name is Giant cell tumour of the tendon sheath. Other names are tenosynovial giant cell tumour, pigmented villonodular synovitis. 

These tumours are subdivided according to  

  • the place where they occur: inside or outside a joint 
  • their growth pattern: localised (a nicely rounded bulb) or diffuse (scattered, without a nice capsule around it).

The localised form is most common. 

Tumours are composed of small cells with giant cells (=cells with very many nuclei, where an ordinary cell has only one nucleus) next to them. Other cells are also mixed in the tumour. These tumours are benign, meaning they will not spread to other parts of your body. However, they can have an aggressive behaviour locally, where they also start to grow into nearby soft tissue and/or bone. They continue to grow into the surrounding area with small outgrowths, making them relatively likely to return after surgical treatment. 

Where and in whom do giant cell tumours occur?

This giant cell tumour is very rare, less than 2 people per million people per year develop such a tumour. The giant cell tumour represents about 20% of all benign tumours of the bone. Typically, patients are affected between 20 and 45 years of age, and about 10-15% are seen in adolescents with a mature skeleton. 

Giant cell tumours usually occur at the ends of the long pipe bones, mostly around the knee (distal femur and proximal tibia), at the level of the wrist (distal radius) and at the level of the shoulder (proximal humerus). A giant cell tumour is in many cases located just below the cartilage of a joint, and can sometimes grow into the joint itself. Sometimes the spine is affected.

The giant cell tumour can occur at any age, but is most commonly seen between the ages of 30 and 50, more in women than in men.  

This localised form is most commonly diagnosed in the hand (85%), but also in the wrist, ankle and foot, and knee. It is very rarely seen in the elbow and the hip. 

The diffuse type giant cell tumour is most commonly seen in the knee (75%) and hip (15%), but can also occur in the ankle, the elbow and the shoulder. Very rarely, the tumour is also found in the jaw joint or the small joints of the vertebrae (facets). This type giant cell tumour can also develop outside the joints, in the muscles or in the lower skin, and usually around the knee, in the thigh or in the foot. 

What is the cause of a giant cell tumour?

The cause of the emergence of a giant cell tumour in the bone is not known. 

Also in soft tissue tumours, there is no single cause. Mand suspects That it could be a consequence of a combination of genetic factors and possibly an inflammatory response at As a result of trauma. 

What symptoms does it cause?

You usually experience pain and see swelling. The pain may occur at rest (e.g. at night) or after loading. The more the bone is affected by the tumour, the more pain you will experience because the bone can no longer handle the load. Sometimes a spontaneous fracture of the bone occurs because the bone is so fiercely weakened. Deformities in a joint may make it harder for you to move this joint. 

If it is a localised form, you usually see a painless swelling. This swelling grows slowly over a period of several years.  

The diffuse form gives rise to pain, swelling or reduced mobility. If the tumour is in a joint, it may give rise to bleeding or up-and-down swelling of this joint. The deterioration of the bone may also cause premature wear and tear of the joint. These symptoms are usually present for several years.