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Giant cell-rich osteosarcoma in long bones: clinical, radiological and pathological features

Osteosarcoma ricco in cellule giganti delle ossa lunghe: caratteristiche cliniche, radiologiche e patologiche

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
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The purpose of this study was to review the clinical presentation, imaging, pathology and outcome of patients with giant cell-rich osteosarcoma (GCRO) of long bones.

Materials and methods

Radiography (n=9), magnetic resonance imaging (MRI) (n=6), computed tomography (CT) (n=3) and clinical course of nine patients (five males and four females; mean age, 26 years) with pathologically confirmed GCRO were retrospectively reviewed. Specific imaging findings, including size, eccentricity, ossification, lysis, cystic change, expansile growth, periosteal reaction, cortical destruction, soft tissue extension and joint involvement were documented.


Presenting symptoms were pain in six patients and pain and palpable mass in three. An ill-defined margin surrounding a predominantly osteolytic lesion was detected at the proximal tibia (n=7) or femur (n=2) on imaging studies. Seven cases showed limited ossification. Three cases had tumours in the metaphysis and six in the metaepiphysis. The average maximum tumour dimension was 4.7 cm×5.2 cm×7.8 cm. Microscopically, tumours were composed of atypical cells with scanty osteoid formation and multinucleated giant cells. All patients received chemotherapy, and surgery was performed in eight patients. Three patients were dead and six were alive at the last follow-up.


GCRO is a rarer variant that has very close resemblance to giant cell tumour. Patients usually present nonspecific symptoms of pain and palpable mass. It usually shows an osteolytic lesion with locally spared new bone formation in the metaphysis and/or metaepiphysis on imaging. Histologically, the atypical tumour cells with osteoid formation and multinucleated giant cells are the key factor in the diagnosis and differential diagnosis.



Lo scopo di questo studio è stato di rivedere la presentazione clinica, le caratteristiche all’imaging, la patologia e gli esiti di pazienti con osteosarcoma ricco in cellule giganti delle ossa lunghe

Materiali e metodi

Radiografia (n=9), imaging con risonanza magnetica (MRI) (n=6), tomografia computerizzata (CT) (n=3) e decorso clinico di nove pazienti (cinque maschi e quattro femmine; età media 26 anni) con GCRO confermato anatomo-patologicamente sono stati esaminati retrospettivamente. Specifici rilievi di imaging, inclusi dimensione, eccentricità, ossificazione, lisi, evoluzione cistica, crescita espansiva, reazione periostale, distruzione corticale, estensione ai tessuti molli e coinvolgimento articolare sono stati documentati.


I sintomi di presentazione sono stati il dolore in sei pazienti e sia il dolore che la massa palpabile in tre pazienti. All’imaging è stato riscontrato un margine indefinito che circonda una lesione prevalentemente osteolitica a livello della tibia prossimale (n=7) o del femore (n=2). Sette dei casi hanno mostrato ossificazione limitata. In 3 casi il tumore era localizzato alla metafisi ed in 6 nella meta-epifisi. La massima dimensione tumorale è stata in media di 4,7 cm×5,2 cm×7,8 cm. Microscopicamente, i tumori erano composti di cellule tumorali atipiche con scarsa formazione di osteoide e cellule giganti multinucleate. Tutti i pazienti hanno ricevuto chemioterapia e un intervento chirurgico è stato eseguito su 8 pazienti. Tre pazienti erano morti e 6 erano in vita all’ultimo follow-up.


GCRO è una variante più rara che assomiglia molto al tumore a cellule giganti. I pazienti di solito presentano sintomi aspecifici come dolore e massa palpabile. Di solito si dimostra una lesione osteolitica con neoformazione ossea localmente conservata nella metafisi e/o meta-epifisi all’imaging. Istologicamente, le cellule tumorali atipiche con formazione di osteoide e le cellule giganti multinucleate sono i fattori chiave nella diagnosi e nella diagnosi differenziale.

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  1. Fletcher CDM, Unni KK, Mertens F (2002) World Health Organization Classification of Tumours. Pathology and genetics of tumours of soft tissue and bone. IARC Press, Lyon, pp 264–286

    Google Scholar 

  2. Fu HH, Zhuang QW, He J et al (2011) Giant cell-rich osteosarcoma or giant cell reparative granuloma of the mandible? J Craniofac Surg 22:1136–1139

    Article  PubMed  Google Scholar 

  3. Bathurst N, Sanerkin N, Watt I (1986) Osteoclast-rich osteosarcoma. Br J Radiol 59:667–673

    Article  PubMed  CAS  Google Scholar 

  4. Verma RK Gupta G, Bal A, Yadav J (2011) Primary giant cell rich osteosarcoma of maxilla: an unusual case report. J Oral Maxillofac Surg 10:159–162

    Article  Google Scholar 

  5. Bertoni F, Bacchini P, Staals EL (2003) Giant cell-rich osteosarcoma. Orthopedics 26:179–181

    PubMed  Google Scholar 

  6. Shinozaki T, Fukuda T, Watanabe H, Takagishi K (2004) Giant cellrich osteosarcoma simulating giant cell tumor of bone. Kitakanto Med J 54:147–151

    Article  Google Scholar 

  7. Hong SJ, Kim KA, Yong HS et al (2005) Giant cell-rich osteosarcoma of bone. Eur J Radiol Extra 53:87–90

    Article  Google Scholar 

  8. Nagata S, Nishimura H, Uchida M et al (2006) Giant cell-rich osteosarcoma of the distal femur: radiographic and magnetic resonance imaging findings. Radiat Med 24:228–232

    Article  PubMed  Google Scholar 

  9. Kinoshita G, Yasoshima H (2006) Giant cell-rich tumor of the rib. J Orthop Sci 11:312–317

    Article  PubMed  Google Scholar 

  10. Sato K, Yamamura S, Iwata H et al (1996) Giant cell-rich osteosarcoma: a case report. Nagoya J Med Sci 59:151–157

    PubMed  Google Scholar 

  11. Gambarotti M, Donato M, Alberghini M, Vanel D (2011) A strange giant cell tumor. Eur J Radiol 77:3–5

    Article  PubMed  Google Scholar 

  12. Mirra JM (1989) Bone tumors: clinical, radiologic and pathologic correlation. Lea and Febiger, Philadelphia, pp 326–333

    Google Scholar 

  13. Unni KK (1988) Bone tumors. Churchill Livstone, New York, pp 117

    Google Scholar 

  14. Troup JB, Dahlin DC, Coventry MB (1960) The significance of giant cells in osteogenic sarcoma. Do they indicate a relationship between osteogenic sarcoma and giant cell tumor of bone. Proc Staff Meet Mayo Clin 35:179–186

    PubMed  CAS  Google Scholar 

  15. Huvos AG, Heilweil M, Bretsky SS (1985) The pathology of malignant fibrous histiocytoma of bone. A study of 130 patients. Am J Surg Pathol 9:853–871

    Article  PubMed  CAS  Google Scholar 

  16. Ballance WA Jr, Mendelsohn G, Carter JR et al (1988) Osteogenic sarcoma. Malignant fibrous histiocytoma subtype. Cancer 62:763–771

    Article  PubMed  Google Scholar 

  17. Link TM, Haeussler MD, Poppek S et al (1998) Malignant fibrous histiocytoma of bone: conventional X-ray and MR imaging features. Skeletal Radiol 27:552–558

    Article  PubMed  CAS  Google Scholar 

  18. Raymond AK, Murphy GF, Rosenthal DI (1987) Case report 425: Chondroblastic osteosarcoma: clearcell variant of femur. Skeletal Radiol 16:336–341

    Article  PubMed  CAS  Google Scholar 

  19. Bertoni F, Bacchini P, Staals EL (2003) Malignancy in giant cell tumor. Skeletal Radiol 32:143–146

    Article  PubMed  CAS  Google Scholar 

  20. Nascimento AG, Huvos AG, Marcove RC (1979) Primary malignant giant cell tumor of bone: a study of eight cases and review of the literature. Cancer 44:1393–1402

    Article  PubMed  CAS  Google Scholar 

  21. Janeway KA, Barkauskas DA, Krailo MD et al (2012) Outcome for adolescent and young adult patients with osteosarcoma: A report from the Children’s Oncology Group. Cancer 118:4597–4605; DOI: 10.1002/ cncr.27414

    Article  PubMed  Google Scholar 

  22. Goorin AM, Abelson HT, Frei E 3rd (1985) Osteosarcoma: fifteen years later. N Engl J Med 313:1637–1643

    Article  PubMed  CAS  Google Scholar 

  23. Glasser DB, Lane JM, Huvos AG et al (1992) Survival, prognosis, and therapeutic response in osteogenic sarcoma. The Memorial Hospital experience. Cancer 69:698–708

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Xiao-Yi Ding.

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Wang, CS., Yin, QH., Liao, JS. et al. Giant cell-rich osteosarcoma in long bones: clinical, radiological and pathological features. Radiol med 118, 1324–1334 (2013).

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