Diagnosis

How is the type determined?

Initially, your doctor will not immediately know which tumour you are dealing with. The doctor will question and examine you. This examination, the doctor will already an indication can give about the goodness and the aggressiveness of the tumour, where exactly it is located and whether any causes can be found.  

Afterwards, a number of examinations (scans) happen to get an idea of what type of tumour it might be about.  

Since at giant cell tumours in the bone in very rare cases can metastasise to the lungs, a CT scan of the lungs planned to have a comparator for later examinations. 

What imaging is possible?

Radiography

A radiography is an examination that uses X-rays to image the inside of your body (mainly your bones). This examination is usually painless.

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When you receive an injection of contrast medium, you will feel a prick e.g. in a joint. Depending on the body part to be imaged, you will be asked to remove certain items of clothing and jewellery or other metal objects. You will then be taken to the table to make the images. You will be asked to assume certain positions; it is important to follow these instructions carefully and not to move during the recording. If certain positions do not work for you or are too painful, it is important that you tell the radiology nurse. After the recordings, you can get dressed again and go home. You will be given a code or report of the examination: keep this and give it to your doctor.

CT scan

A CT scan is an examination that uses X-rays to image the inside of the body. This examination is usually painless. When you receive an injection of contrast medium, you will feel a sting, for example in your hand or in a joint.

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Depending on the body part to be imaged, you will be asked to remove certain garments and jewellery or other metal objects. You will then be taken to the table to make the images. You will be asked to assume certain positions; it is important to follow these instructions carefully and not to move during the recording. If certain positions do not work for you or are too painful, it is important that you tell the radiology nurse. After the recordings, you can get dressed again and go home. You will be given a code or report of the examination: keep this and give it to your doctor.

MRI

An MRI scan is an examination that uses magnetic waves to image the inside of the body. This examination is usually painless. When you receive an injection of contrast medium, you will feel a sting, for example in your hand or in a joint.

Read more

Depending on the body part to be imaged, you will be asked to remove certain garments and jewellery or other metal objects. You will then be taken to the table to make the images. You will be asked to assume certain positions; it is important to follow these instructions carefully and not to move during the recording. If certain positions do not work for you or are too painful, it is important that you tell the radiology nurse. After the recordings, you can get dressed again and go home. You will be given a code or report of the examination: keep this and give it to your doctor.

How does the diagnosis progress?

Depending on which type of giant cell tumour suspected, the diagnosis will be slightly different.  

Several types of imaging are available for diagnosis. A plain radiograph will be taken. Furthermore, one will a MRI of the part of the body with the tumour to check the local extensiveness. By means of an MRI examination with contrast, a giant cell tumour can already be demonstrated with great certainty. Yet often a biopsy needed to make the diagnosis with absolute certainty. It is essential that these examinations may be done before cutting into the tumour so as not to distort the images, which may make it more difficult to characterise the tumour. Furthermore, doctors may see from the scan images along which pathway and where in the tumour it is best to take a tissue sample. This is then discussed at the multidisciplinary consultation (MOC consultation).

The doctor will have you undergo a number of tests, notably an ultrasound and a MRI examination with contrast. 

On this MRI, the diagnosis of a giant cell tumour of the soft tissues can be stated with high certainty by an experienced radiologist. The radiologist also looks at how extensive the local ingrowth is. Sometimes the radiologist is not 100% sure, and your treating doctor will suggest you have a biopsy performed to be absolutely certain of the diagnosis, so that you are sure to get the right treatment. It is essential that these examinations can be done before cutting into the tumour so as not to distort the images, which can make it more difficult to characterise the tumour. Furthermore, from the scan images, doctors can see by which route and where in the tumour it is best to take a tissue sample. This is then discussed at the multidisciplinary consultation (MOC consultation). 

How does the biopsy take place?

To determine the exact type of tumour involved, a fabric steel be examined by the anatomic pathologist. To obtain such a tissue sample, a biopsy is usually scheduled. A biopsy can be done open (a small operation) or closed (a puncture).

Does the biopsy carry any risks?

A biopsy is always a calculated risk. It is popularly said that once a tumour has 'seen air', the patient is lost. This is not true. A biopsy will prevent a tumour from spreading to other organs, but malignant cells may remain in the biopsy tract.

A biopsy should be performed on a correct manner to avoid problems later. The biopsy will also be removed when the tumour is permanently removed. Therefore, it is important for the doctor to already take into account the later surgery during the biopsy.

Inflammation of a biopsy wound should be avoided at all costs. An infection can give rise to deep inflammation, compromising the final surgery is brought. 

A giant cell tumour contains very many blood vessels therefore bleeding may occur during the biopsy or the wound suture may bleed. The doctor takes maximum precautions to prevent a large haemorrhage, for example by inserting a tube (a drain) that drains the blood out. A pressure bandage is often applied temporarily.

What happens after the biopsy?

The tissue sample is immediately sent to the lab sent. This examination is very extensive and can take up to 10 days before a final result is available. This period of waiting is a very stressful time for you and your loved ones because you do not yet know where you stand. This period is kept as short as possible but is necessary to be absolutely certain of the diagnosis.  

The results will be discussed again in the multidisciplinary team and a treatment plan will be drawn up. Your treating physician will discuss the results and treatment plan with you and your loved ones discuss. This plan is a proposal: it is intended that you as a patient will also have a say in the treatment. Feel free to ask for additional explanations or ask for a second appointment to the data obtained at process.