HPI
• 48 yo F comes to the clinic complaining
of left knee pain
What questions would you like to ask?
HPI
• 2 month history of L knee pain, worse with ROM
• Reports noticeable L knee “stiffness”
• Recently noticed a “bump” behind the left knee
• - history of recent falls or trauma to the knee
• Denies other joint pain/discomfort
PMH: HTN, DM
PSH: cholecystectomy
Family Hx: colon cancer
Social: social drinker, ½ pack/day smoker, denies illicits
Meds: HCTZ, lisinopril
Allergies: none
Differential Diagnosis?
Differential Diagnosis
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Osteoarthritis
Baker’s cyst
Rheumatoid arthritis
Ligamentous, meniscal injury
Soft tissue/ bone tumor
PE
• Vitals: AVSS
• CV, Pulm, Abd: WNL
• Musc: Left knee exam:
• Fixed solid mass palpated over the posterior
knee. No warmth, erythema appreciated. No
joint line tenderness. Tender to palpation over
posterior aspect of the knee. Decreased ROM (090 degrees). Negative anterior/posterior drawer.
Negative Mcmurray’s. Neurovascularly intact
distal to R knee.
Labs:WNL
Xray (AP)
Xray (Lateral)
MRI (T1)
Coronal
MRI Sagittal
Histology
Histology
Giant Cell Tumor
• benign but aggressive tumor primarily found in the epiphysis
of long bones
• Epidemiology
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Predominance in females
ages 30-50 years
50% occur around the knee (distal femur or proximal tibia)
10% in sacrum and vertebrae (sacrum is most common site in
axial skeleton)
• distal radius is third most common location
• Presentation: pain, decreased range of motion at the affected
joint
• Malignant Potential: Metastatic to the lung in 2-5%
• Hand lesions have greater chance of metastasis
1.
2.
Orthobullets.com/pathology
Miller’s review of orthopaedics
Characteristic Features
• Xray
• eccentric lytic epiphyseal/metaphyseal lesion that often extends
into the distal epiphysis and borders subchondral bone
Characteristic Features
• MRI
• clear demarcation on T1 image between fatty marrow and tumor
Characteristic Features
• Bone scan is very “hot”
Characteristic Features
• Histology
• Characteristic cell is the mononucleur stromal cell
• hallmark giant cells are numerous
• nuclei of giant cell appears same as stromal cells