vol 10 ppt
TRANSCRIPT
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Giant cell tumor of bone-------Case 207-213 & 1040-1093
Volume 10
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Giant Cell Tumors
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Giant Cell Tumor of Bone
There are numerous primary tumors of bone with giant cell or
or macrophage activity seen within the tumor under the microscope.
These include the aneurysmal bone cyst, chondroblastoma, solitary
bone cyst, osteoid osteoma, osteoblastoma, fibrous dysplasia and
osteogenic sarcoma, hemorrhagic type. Some pathologists classify
these tumors as variants of the true giant cell tumor making it almost
a diagnosis of exclusion if none of the above diagnoses can be
established histologically. The clinical entity known as the benign
giant cell tumor of bone is seen typically in young adult females
between the ages of 20 and 40 years. It is less common in males. The
lesion is usually found in the ends of long bones, most commonly
about the knee joint where 50% of the lesions will be seen. The next
most common locations are the sacrum and distal radius. The other
epiphyseal tumor seen in children is the chondroblastoma that also
has giant cell activity in the tumor. Even the so-called brown tumor
of hyperparathyroidism has excessive macrophage activity but is a
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pseudotumor induced by parathormone producing lesions such as
parathyroid adenomas and secondary hyperparathyroidism seen in
renal failure disease.
Currently most experts feel that the giant cell tumor is a low-grade,
benign mesenchymal tumor with a fibro-osteoblastic stem cell with a
molecular genetic defect similar to the stem cell of the osteosarcoma
but with a greater degree of molecular genetic stability. The giant cell
seen in this tumor is simply an immune response by the host in an
attempt to remove the neoplastic fibro-osseous tissue. Giant cell
tumors account for between 5-10 per cent of all benign tumors of the
skeletal system. They are usually associated with pain in the adjacent
joint involved, such as the knee joint, which may cause an effusion.
radiographically, the lesion is very characteristic because of its purely
lytic nature that can be very geographic in nature, located in the
epiphyseal-metaphyseal location of a long bone, frequently coming in
direct contact with the subchondral bone of the adjacent joint. In more
aggressive cases, the lesion can break through the adjacent metaphyseal
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cortex and gain access to the subperiosteal space and take on the
appearance of a more malignant process, such as a hemorrhagic
osteosarcoma.
Even though this condition is considered benign with a very low
mitotic index seen in the stromal cells, one or two per cent of the
tumors can metastasize to the lung as a benign process. There is an
excellent prognosis for cure with simple surgical resection in 80% of
the cases. Treatment usually consists of an aggressive curettement
of the tumor followed by a packing of the defect with either bone
graft, in smaller lesions, or more typically with bone cement in
larger lesions which gives a better chance of a permanent cure with
about a 5 to 10% recurrence rate with the cementation technique. In
more aggressive lesions located in the sacrum or anterior portion
of the spinal column, surgical resection is very difficult because of
the adjacent nerve roots or spinal cord, in which case occasionally
local radiation is used. However, in about 5% of cases, this can
convert the tumor into a high-grade tumor sarcoma at a much later
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date. The tumor also has the potential for spontaneous conversion
to a high grade tumor, such as an osteosarcoma or a malignant
fibrous histiocytoma, in about 1% of cases.
Giant cell tumors that have a local recurrence have a greater
potential for pulmonary metastasis, running as high as 6% and, for
this reason, chest x-rays should be obtained periodically for a
period of approximately three years after the primary treatment of
the tumor.
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CLASSIC
Case #207
23 year female with
GCT proximal tibia
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Rapid progression
5 months later
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Tumor breaking thru periostium of tibia
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Curettement of tumor thru cortical window
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Photomic showing giant cells
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Appearance of tumor cavity following curettement
femoral
condyle
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Light coming thru tibial plateau articular cartilage
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Cleaning up tumor cavity with high-speed burr
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Further clean up with waterpic lavage
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Lysis of remaining
tumor cells with
3% hydrogen peroxide
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Washing tumor cavity with peroxide
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Tumor cavity clean ready for cementation
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Placement of large threaded Steinman pins
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2 stage cementation completed
cement
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Placement of autogenous cancellous graft
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Immediate post op
radiograph
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18 months later
without recurrence
bone
graft
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16 years later came
to a routine TKA
old cement
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AP view
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Case #207.1
43 year old male with knee pain for 4 months
GCT tibia
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CT scan
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Cor T-1 T-2 Gad
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Sag T-1 T-2 Gad
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Axial T-1 T-2
Gad
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Two stage cementation procedure
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Post op x-ray
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Case #208
28 year male
GCT distal radius
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Coronal T-1 MRI
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Axial T-2 MRI showing multiple hemorrhagic cysts
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X-ray following wide resection and transpostion of the distal ulna with it’s blood supply and fixed with plates
and fused to carpus
ulna radius
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Case #208.1 GCT radius
67 year old female with wrist pain 6 months
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Coronal T-1 T-2 Gad C+
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Sagittal T-1 T-2 Gad C+
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Axial T-1 T-2
Gad
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Axial T-1 T-2
Gad
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Post op x-ray following curettage and cementation
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Case #209
59 year female with GCT sacrum
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CT scan
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Bone scan
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9 years post curettement and radiation
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Lateral view at 9 years and no recurrence
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Case #209.1 CT scan
Bone scan
47 year old male with LBP 3 months
GCT sacrum
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Axial T-1
T-2
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Case #210
49 year male 10 yrs
post op bone graft
plus radiation therapy
for GCT with current
radiation sarcoma
old
graft
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Coronal T-2 MRI
showing high signal
sarcoma
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Amputation specimen cut in path lab
graft
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Photomic showing pleomorphic sarcoma cells
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Case #211
45 year male with spontaneous conversion of GCT
to OGS 15 yrs post curettement without RT
radius
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Sagittal T-1 MRI
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Axial T-1 MRI
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Case #212
25 year male
aggressive GCT
proximal humerus
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Case #212.1
22 year old female with
shoulder pain for 3 months
GCT
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Cor T-1 T-2
Gad
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PO #1 PO #2
PO #2
3 mos
PO #3
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Case #213
Sagittal proton density
MRI of a 19 year
female with GCT T-1
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Biopsy photomic
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Sagittal T-1 MRI
2 years post op anterior
interbody fusion
without recurrence
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Sagittal proton density
MRI one year later
showing recurrence and
cord compression
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Coronal post gad contrast MRI
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Surgical decompression and reconstruction
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Anterior reconstruction
with bone cement and
titanium screw
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Post op sagittal T-1 MRI showing cord decompression
cement
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CT scan of chest shortly after spinal surgery
showing multiple pulmonary mets
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Photomic showing benign GCT met in lung
tumor
lung tissue
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Sagittal T-1 MRI
1 year later showing
recurrent tumor and
cord compression
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Biopsy photomic showing OGS
osteoid
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Case #1040
35 year male with
path fracture lateral
femoral condyle thru
GCT
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Lateral view
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Coronal T-1 MRI
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Axial T-1 MRI
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Sagittal T-1 MRI
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Sagittal T-2 MRI
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Coronal gad contrast MRI
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Surgical specimen with resection distal femur
fracture
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Tumor breaking thru the back of lat fem condyle
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Photomic
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Compress system used for reconstruction
anchor
spindle
taper
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Disarticulated Compress device
Anchor plug Belleville washers
spindle
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Belleville washers
compression nut spindle
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Placement of anchor plug pins thru guide
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Cementing tibial
component
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Completed rotating hinge TKA
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2 months post op
anchor
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Lateral view
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Case #1041
20 year female with
path fracture thru GCT
lateral femoral condyle
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Oblique view
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Lateral view
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Photomic
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Photomic showing foam cells
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Fracture reduced and fixed with 1st batch of cement
Steinman pins
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Second batch of cement
fracture line
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1 year post op with
normal knee function
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Lateral view
![Page 100: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/100.jpg)
Case #1042
35 year male with GCT
distal femur
![Page 101: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/101.jpg)
Surgical exposure of tumor
![Page 102: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/102.jpg)
Curetted specimen
![Page 103: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/103.jpg)
Photomic showing neoplastic osteoid formation
![Page 104: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/104.jpg)
Tumor cavity following aggressive curettement
![Page 105: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/105.jpg)
Completion of a 2 stage cementation
cement
![Page 106: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/106.jpg)
4 years post op showing
radiolucent cement and
Steinman pins
![Page 107: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/107.jpg)
12 years and working
full time as electrician
![Page 108: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/108.jpg)
26 years and shows
early signs of DOA
![Page 109: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/109.jpg)
Lateral view
![Page 110: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/110.jpg)
Case #1043
32 year male with GCT distal femur
![Page 111: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/111.jpg)
Sagittal T-1 MRI
![Page 112: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/112.jpg)
Axial T-2 MRI
![Page 113: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/113.jpg)
Case #1044
17 year female with
GCT lateral femoral
condyle
![Page 114: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/114.jpg)
Lateral view
![Page 115: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/115.jpg)
CT scan
![Page 116: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/116.jpg)
1 year PO excisional
arthrodesis with titanium
spacer & cancellous
allograft
![Page 117: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/117.jpg)
Case #1045
20 year female with
GCT distal femur
![Page 118: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/118.jpg)
1 year after cementation
procedure
![Page 119: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/119.jpg)
4 years later with normal
function of knee
![Page 120: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/120.jpg)
6 mos following a traumatic
fracture of tibia and again
normal knee function
![Page 121: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/121.jpg)
Case #1046
37 year female with prior
cementation procedure for
GCT followed later with
a recent removal of cement
and replacement with present
cancellous allograft
![Page 122: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/122.jpg)
1 year later with collapse of
patellofemoral joint and loss
of active knee extension
![Page 123: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/123.jpg)
Lateral view showing
patella collapsed into
tumor cavity
![Page 124: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/124.jpg)
Patellar-femoral view
![Page 125: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/125.jpg)
Sagittal T-1 MRI
![Page 126: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/126.jpg)
Axial T-1 MRI
showing anterior
collapse of lateral
femoral condyle
![Page 127: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/127.jpg)
Surgical exposure at time of patellofemoral reconstruction
with early findings of degenerative osteoarthritis
![Page 128: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/128.jpg)
Removal of cancellous allograft placed over one year ago
![Page 129: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/129.jpg)
Placement of Steinman pins ready for cementation
![Page 130: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/130.jpg)
Completion of patellofemoral arthroplasty
![Page 131: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/131.jpg)
One year later with
near normal ROM
of knee
![Page 132: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/132.jpg)
Lateral view
![Page 133: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/133.jpg)
Case #1047
45 year female with
GCT lateral femoral
condyle
![Page 134: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/134.jpg)
Lateral view
![Page 135: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/135.jpg)
CT scan
![Page 136: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/136.jpg)
Immediate post op
X-ray following
cementation procedure
![Page 137: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/137.jpg)
4.5 years later with signs
of recurrent tumor at
upper pole of cement
![Page 138: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/138.jpg)
Lateral view
![Page 139: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/139.jpg)
CT scan showing recurrence of GCT
![Page 140: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/140.jpg)
Bone scan shows
recurrence also
![Page 141: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/141.jpg)
1 year following a redo
cementation procedure
with no recurrence
![Page 142: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/142.jpg)
Lateral view
![Page 143: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/143.jpg)
Case #1048
23 year male with recurrent
GCT following a prior
curettement and cementation
![Page 144: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/144.jpg)
AP view
cement
![Page 145: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/145.jpg)
Cut specimen in path
lab following wide
resection and rotating
hinge arthroplasty cement
recurrent
tumor
![Page 146: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/146.jpg)
Photomic
![Page 147: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/147.jpg)
Case #1048.1
29 year male with
knee pain 3 months
GCT 9/07
![Page 148: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/148.jpg)
Cor T-2 Gad 10/07
![Page 149: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/149.jpg)
Axial T-1 PD
Gad
![Page 150: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/150.jpg)
Sag T-2 Post op
10/07
![Page 151: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/151.jpg)
12/08
Recurrence 1 yr
later
![Page 152: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/152.jpg)
12/08
Axial T-1 T-2
![Page 153: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/153.jpg)
Recementation 12/08
![Page 154: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/154.jpg)
T-1 MRI showing soft tissue recurrence 2/2010
Axial T-1 Sag
![Page 155: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/155.jpg)
Wide resection and Compress reconstruction 2/10
![Page 156: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/156.jpg)
Case #1048.2
23 yr female with pain
R knee for 3 months
GCT
![Page 157: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/157.jpg)
Cor T-1 T-2
Gad
![Page 158: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/158.jpg)
Sag T-1 PD FS
![Page 159: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/159.jpg)
Axial T-2 Gad
![Page 160: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/160.jpg)
Post op x-ray
![Page 161: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/161.jpg)
Case #1049
50 year male with pain L knee 2 mos but normal x-ray
L R
![Page 162: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/162.jpg)
Lateral view shows questionable lysis distal femur
![Page 163: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/163.jpg)
4 months later with
obvious lytic changes
![Page 164: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/164.jpg)
Lateral view
![Page 165: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/165.jpg)
Coronal PD MRI
![Page 166: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/166.jpg)
Axial PD MRI
![Page 167: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/167.jpg)
1 year post op
with cementation
and side plate
![Page 168: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/168.jpg)
Case #1050
16 year female with
GCT distal femur
![Page 169: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/169.jpg)
2 mos post op bone
graft with recurrence
![Page 170: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/170.jpg)
4 mos post op and
even more signs of
recurrence
![Page 171: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/171.jpg)
Surgical curettement of recurrent tumor
![Page 172: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/172.jpg)
Photomic of recurrent tumor
![Page 173: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/173.jpg)
Higher power with osteoid formation
![Page 174: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/174.jpg)
Surgical appearance following curettement
![Page 175: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/175.jpg)
Placement of Steinman pins prior to cementation
![Page 176: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/176.jpg)
Cementation completed
![Page 177: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/177.jpg)
9 months post radiolucent
cementation and 6500
rads of RT
![Page 178: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/178.jpg)
13 years post op with
multiple path fractures
thru radiated bone with
multiple surgeries to fix
these fractures
![Page 179: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/179.jpg)
20 years after 1st surgery with continued stress fractures
![Page 180: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/180.jpg)
Shortly after last x-ray she developed pulmonary mets
2nd to radiation OGS seen in this photomic of lung biopsy
![Page 181: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/181.jpg)
Case #1051
19 year female with
GCT distal femur and
ABC proximal tibia
GCT
ABC
![Page 182: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/182.jpg)
Lateral view
![Page 183: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/183.jpg)
Coronal T-1 MRI
![Page 184: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/184.jpg)
Coronal T-2 MRI GCT
ABC
![Page 185: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/185.jpg)
Photomic from femoral biopsy showing GCT
![Page 186: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/186.jpg)
Case #1052
69 year male with prior
history of GCT distal
femur treated with curettement
and bone graft 35 years ago.
Now has a path fracture thru
OGS at the same site
old bone graft
![Page 187: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/187.jpg)
Biopsy photomic shows OGS
![Page 188: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/188.jpg)
CT scan shows metastatic OGS to inguinal lymph node
![Page 189: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/189.jpg)
Case #1053
31 year male with GCT
femoral neck
![Page 190: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/190.jpg)
Coronal T-1 MRI
![Page 191: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/191.jpg)
Axial T-2 MRI
![Page 192: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/192.jpg)
Axial T-2 MRI
at lower level
![Page 193: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/193.jpg)
Bone scan
![Page 194: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/194.jpg)
Biopsy photomic
![Page 195: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/195.jpg)
Post op curettement with cementation and pins
![Page 196: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/196.jpg)
Case #1054
34 year female with GCT
femoral neck 2 mos. PO
DHS fixation but no
removal of tumor
![Page 197: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/197.jpg)
3 months PO complete
curettement thru anterior
approach and cementation
with DHS screw
![Page 198: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/198.jpg)
5 years later with good
calcar hypertrophy and
normal hip function
![Page 199: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/199.jpg)
Lateral view
![Page 200: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/200.jpg)
Case #1055
39 year male with early GCT femoral head
![Page 201: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/201.jpg)
5 months later without treatment
![Page 202: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/202.jpg)
Coronal T-1 MRI
![Page 203: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/203.jpg)
Coronal T-2 MRI
![Page 204: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/204.jpg)
Post op x-ray showing bipolar prosthesis
![Page 205: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/205.jpg)
Case #1056
44 year male with GCT
proximal femur
![Page 206: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/206.jpg)
Coronal T-1 MRI
![Page 207: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/207.jpg)
Photomic
![Page 208: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/208.jpg)
14 months post op
cementation and pins
![Page 209: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/209.jpg)
Case #1057
tumor
46 year female with GCT pelvis
![Page 210: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/210.jpg)
CT scan
![Page 211: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/211.jpg)
Photomic
![Page 212: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/212.jpg)
6 months post op cementation with pins
![Page 213: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/213.jpg)
Lateral view
![Page 214: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/214.jpg)
Two years post op
![Page 215: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/215.jpg)
Case #1058
29 year female with GCT
supra acetabular area
![Page 216: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/216.jpg)
1 year later with central
fracture dislocation hip
![Page 217: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/217.jpg)
4 years post op Tronzo
THA
![Page 218: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/218.jpg)
Case #1059
73 year female with prior
GCT tibia treated with
curettage and cementation
![Page 219: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/219.jpg)
Shortly after she
developed this second
GCT in ilium
![Page 220: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/220.jpg)
CT scan
tumor
![Page 221: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/221.jpg)
Photomic showing tumor osteoid
![Page 222: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/222.jpg)
More tumor osteoid
![Page 223: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/223.jpg)
Later she developed a
recurrence in the tibia
which led to an AK amp
and then developed the
path fracture in femoral
stump seen here thru yet
another multifocal GCT
Later on she developed
benign pulmonary mets
and died 6 mos later while
on chemotherapy
![Page 224: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/224.jpg)
Case #1060
31 year male with GCT patella
![Page 225: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/225.jpg)
17 months following
curettage with recurrent
tumor
![Page 226: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/226.jpg)
Photomic
![Page 227: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/227.jpg)
Case #1061
30 year female with
path fracture thru GCT
lateral tibial plateau
![Page 228: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/228.jpg)
Lateral view
![Page 229: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/229.jpg)
Surgical specimen from prox tibial resection
![Page 230: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/230.jpg)
Surgical specimen showing lateral plateau fracture
![Page 231: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/231.jpg)
Cut specimen in path
lab showing plateau
fracture into tumor
![Page 232: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/232.jpg)
Photomic
![Page 233: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/233.jpg)
Reconstructed with cemented
long stem single axial long
stem Guepar knee prosthesis
placed upside down
cement
![Page 234: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/234.jpg)
Post op x-ray with
hinge prosthesis and
radiolucent cement
![Page 235: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/235.jpg)
Case #1062
35 year male with GCT
proximal tibia
![Page 236: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/236.jpg)
6 months post op
cementation with
painful chondrolysis
medial joint space
![Page 237: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/237.jpg)
Post op revision to a
unicondylar prosthesis
![Page 238: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/238.jpg)
Lateral view
![Page 239: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/239.jpg)
Case #1063
17 year female with
GCT proximal tibia
![Page 240: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/240.jpg)
Surgical curettement of tumor
![Page 241: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/241.jpg)
Curetted specimen
![Page 242: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/242.jpg)
Yellow portion of specimen showing foam cells
![Page 243: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/243.jpg)
Tumor cavity following aggressive curettement
and use of a high speed bur
burr
![Page 244: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/244.jpg)
Cementation completed
cement radiolucent
![Page 245: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/245.jpg)
2 year post op with
radiolucent cement
![Page 246: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/246.jpg)
Case #1064
27 year female with
GCT proximal tibia
![Page 247: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/247.jpg)
Lateral view
![Page 248: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/248.jpg)
Sagittal T-1 MRI
![Page 249: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/249.jpg)
Coronal T-2 MRI
![Page 250: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/250.jpg)
Case #1064.1
14 yr female with knee pain for 3 months
![Page 251: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/251.jpg)
Axial T-1 T-2 FS
Gad
![Page 252: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/252.jpg)
Sag T-1 STIR
Gad
![Page 253: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/253.jpg)
Cor Gad
![Page 254: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/254.jpg)
52 yr female with pain in knee for 1 yr
Case #1064.1 Geode in DOA GCT pseudotumor
![Page 255: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/255.jpg)
Cor T-1 T-2
![Page 256: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/256.jpg)
Sag T-1
Axial T-2
![Page 257: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/257.jpg)
Case #1064.2
61 year male with increasing pain in knee for 5 years
GCT pseudotumor - geode
![Page 258: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/258.jpg)
CT scan
![Page 259: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/259.jpg)
Cor T-1 T-2 Gad
![Page 260: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/260.jpg)
Sag T-1 T-2 Gad
![Page 261: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/261.jpg)
Axial T-1 T-2
Gad
![Page 262: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/262.jpg)
64 yr male with primary THA 15 yrs ago
Case #1064.3 Giant Cell Pseudotumor of Hip
![Page 263: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/263.jpg)
Periarticular biopsy
![Page 264: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/264.jpg)
69 yr male
TKA
Similar case
Pseudo tumor
of fibula
![Page 265: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/265.jpg)
Fibular head biopsy
![Page 266: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/266.jpg)
Polarized microscope
![Page 267: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/267.jpg)
![Page 268: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/268.jpg)
Case #1065
25 year female with
aggressive GCT
proximal tibia
![Page 269: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/269.jpg)
Lateral view prior to
wide resection and
Compress TKA recon
![Page 270: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/270.jpg)
Proximal tibial resection specimen
![Page 271: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/271.jpg)
Photomic
![Page 272: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/272.jpg)
Case #1066
28 year male with GCT
distal tibia
![Page 273: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/273.jpg)
Lateral view
![Page 274: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/274.jpg)
Immediate post op
cementation procedure
![Page 275: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/275.jpg)
9 months later with
tumor recurrence
![Page 276: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/276.jpg)
Post op cementation
revision procedure
![Page 277: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/277.jpg)
Case #1067
27 year female with
GCT distal tibia
![Page 278: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/278.jpg)
Lateral view
![Page 279: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/279.jpg)
Sagittal T-1 MRI
![Page 280: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/280.jpg)
Sagittal T-2 MRI
![Page 281: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/281.jpg)
Case #1068
42 year female with
GCT distal radius
![Page 282: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/282.jpg)
Post op cementation
with pins
![Page 283: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/283.jpg)
Lateral view
![Page 284: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/284.jpg)
Case #1069
19 year female with GCT distal radius
![Page 285: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/285.jpg)
Lateral view
![Page 286: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/286.jpg)
3 years later showing recurrent tumor
![Page 287: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/287.jpg)
Surgical resection specimen
tumor
![Page 288: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/288.jpg)
Allograft replacement fixed to side plate
![Page 289: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/289.jpg)
Allograft reconstruction completed
![Page 290: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/290.jpg)
Early post op x-ray
allograft
![Page 291: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/291.jpg)
4 years later showing collapse of allograft
![Page 292: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/292.jpg)
Case #1070
74 year female with
path fracture thru
GCT distal radius
![Page 293: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/293.jpg)
Resection of distal radius and ulna
![Page 294: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/294.jpg)
Distal face of radius engulfed with tumor
![Page 295: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/295.jpg)
Macro section of distal radius
![Page 296: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/296.jpg)
Photomic
![Page 297: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/297.jpg)
Surgical appearance prior to reconstruction
carpus
![Page 298: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/298.jpg)
Completion of cemented Volz total wrist arthroplasty
![Page 299: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/299.jpg)
Post op x-ray
![Page 300: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/300.jpg)
Lateral view
![Page 301: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/301.jpg)
Case #1070.1
X-ray of 40 year
male with wrist pain
for 4 months
![Page 302: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/302.jpg)
Axial T-1 Axial T-2
Gad C.
hemorrhagic
cysts
![Page 303: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/303.jpg)
Sagittal T-1
Sagittal T-2
![Page 304: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/304.jpg)
Post op x-ray
following curettment
and cementation with
a single Steinman pin
![Page 305: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/305.jpg)
Case #1071
22 year female with
GCT distal ulna
![Page 306: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/306.jpg)
Post op Darrach
resection distal ulna
![Page 307: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/307.jpg)
Case #1072
29 year female with
GCT distal ulna
![Page 308: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/308.jpg)
Case #1073
31 year male with GCT
distal humerus and
proximal ulna
![Page 309: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/309.jpg)
Lateral view
![Page 310: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/310.jpg)
Axial T-2 MRI
![Page 311: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/311.jpg)
Coronal T-2 MRI
![Page 312: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/312.jpg)
Post op x-ray with
Compress total elbow
arthroplasty
![Page 313: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/313.jpg)
Case #1074
42 year female with large aneurysmal GCT prox radius
![Page 314: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/314.jpg)
AP view
This huge benign tumor required an AE amputation
![Page 315: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/315.jpg)
Case #1075
31 year male with
prior history of GCT
prox ulna treated 5
years ago with bone
graft and radiation
Now we see x-ray
evidence of OGS
2nd to the radiation
![Page 316: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/316.jpg)
Photomic of benign GCT 5 yrs ago
osteoid
![Page 317: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/317.jpg)
Photomic of present biopsy showing OGS
![Page 318: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/318.jpg)
Numerous large
pulmonary mets seen
following AE amp
and chemotherapy
![Page 319: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/319.jpg)
Case #1076
62 year male with GCT proximal humerus
![Page 320: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/320.jpg)
Coronal T-1 MRI
![Page 321: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/321.jpg)
Axial T-1 MRI
![Page 322: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/322.jpg)
Coronal T-2 MRI
![Page 323: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/323.jpg)
Photomic
![Page 324: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/324.jpg)
Post op cementation
with pins one year later
![Page 325: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/325.jpg)
Case #1077
23 year female with
ABC arising from a
GCT of distal humerus
![Page 326: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/326.jpg)
Lateral view showing
aneurysmal appearance
![Page 327: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/327.jpg)
Sagittal T-1 MRI
![Page 328: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/328.jpg)
Sagittal T-2 MRI showing large hemorrhagic cysts
![Page 329: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/329.jpg)
Axial T-2 MRI showing fluid-fluid levels
![Page 330: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/330.jpg)
Post op cementation
with single pin
![Page 331: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/331.jpg)
Lateral view
![Page 332: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/332.jpg)
Case #1078
57 year male with GCT body of scapula
![Page 333: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/333.jpg)
Case #1079
33 year female with GCT 3rd metatarsal
![Page 334: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/334.jpg)
Case #1080
33 year female with
GCT 1st metatarsal
![Page 335: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/335.jpg)
Case #1081
10 year male with
path fracture thru a
giant cell reparative
granuloma of the
2nd metatarsal
![Page 336: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/336.jpg)
Case #1082
21 year male with
large GCT mid foot
![Page 337: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/337.jpg)
Laminogram x-ray
![Page 338: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/338.jpg)
Case#1083
26 year male with GCT great toe
![Page 339: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/339.jpg)
Case #1084
23 year female with GCT os calcis
![Page 340: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/340.jpg)
CT scan
![Page 341: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/341.jpg)
Case #1084.1
AP and lat x-ray of a 43 yr. female with GCT talus
![Page 342: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/342.jpg)
T-1 MRI
sagittal
coronal axial
![Page 343: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/343.jpg)
Sagittal T-2 MRI
![Page 344: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/344.jpg)
Sagittal & coronal Gad MRI
![Page 345: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/345.jpg)
Post op curettement and cementation
![Page 346: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/346.jpg)
Case #1085
31 year male with GCT 2nd metacarpal
![Page 347: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/347.jpg)
Case #1086
25 year female with
GCT middle finger
![Page 348: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/348.jpg)
Lateral view
![Page 349: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/349.jpg)
Case #1087
28 year male with GCT 5th metacarpal
![Page 350: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/350.jpg)
Case #1088
44 year male with GCT hamate bone
![Page 351: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/351.jpg)
Oblique view
![Page 352: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/352.jpg)
Coronal T-1 MRI
![Page 353: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/353.jpg)
Axial T-2 MRI
![Page 354: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/354.jpg)
Case #1089
35 year female with aggressive GCT finger
![Page 355: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/355.jpg)
photomic
![Page 356: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/356.jpg)
Pulmonary metastasis
![Page 357: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/357.jpg)
Photomic from pulmonary met
![Page 358: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/358.jpg)
Case #1090
26 year male with GCT body od L-2
![Page 359: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/359.jpg)
AP view
![Page 360: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/360.jpg)
Photomic
![Page 361: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/361.jpg)
Post op spine fusion
![Page 362: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/362.jpg)
Lateral view with posterior
Harrington rods and
anterior bone graft
![Page 363: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/363.jpg)
Case #1091
27 year male with
GCT lumbar spine
treated with anterior
bone graft and post
Harrington rods 6
years ago
![Page 364: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/364.jpg)
AP view
![Page 365: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/365.jpg)
Case #1092
52 year male with GCT T-1 vertebra
![Page 366: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/366.jpg)
R
Bone scan
![Page 367: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/367.jpg)
CT scan
![Page 368: Vol 10 ppt](https://reader035.vdocument.in/reader035/viewer/2022062220/555c123dd8b42ad27e8b4f7a/html5/thumbnails/368.jpg)
Case #1093
24 year female with GCT
C-spine 3 years post op
curettement and combined
anterior and posterior
spinal fusion