Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313, USA.
Radiographics. 2013 Jan-Feb;33(1):197-211. doi: 10.1148/rg.331125089.
Giant cell tumor (GCT) of bone is generally a benign tumor composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but nonsclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. However, GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. Rarely, GCT is associated with histologically benign lung metastases or undergoes malignant degeneration. In the past, the mainstay of treatment was surgical, primarily consisting of curettage with cement placement, with recurrence rates of 15%-25%. Recurrence is suggested by development of progressive lucency at the cement-bone interface. Other complications include pathologic fracture and postoperative infection. Denosumab, a monoclonal antibody that targets the osteoclastic activity of GCT, has produced 90% tumor necrosis in early studies, results indicative of promise as a potential adjuvant therapy.
骨巨细胞瘤（GCT）通常是一种良性肿瘤，由单核基质细胞和特征性多核巨细胞组成，具有破骨细胞活性。它通常发生在长骨，但也可能发生在不寻常的部位。典型的表现是溶骨性病变，边界清晰但非硬化，位置偏心，靠近关节面延伸，发生在骨骺闭合的患者中。然而，GCT 可能具有侵袭性特征，包括皮质膨胀或破坏伴软组织成分。14%的病例可见液-液平面，符合动脉瘤样骨囊肿的继发性形成。GCT 在影像学评估和组织学分析中既可以模拟其他良性或恶性病变，也可以被其他良性或恶性病变模拟。罕见情况下，GCT 与组织学良性肺转移有关或发生恶性转化。过去，主要的治疗方法是手术，主要是刮除并用水泥填充，复发率为 15%-25%。水泥-骨界面逐渐出现透光提示复发。其他并发症包括病理性骨折和术后感染。地舒单抗是一种针对 GCT 破骨细胞活性的单克隆抗体，在早期研究中产生了 90%的肿瘤坏死，这表明它有望成为一种潜在的辅助治疗方法。
