J Korean Orthop Assoc.  2015 Jun;50(3):225-231. 10.4055/jkoa.2015.50.3.225.

Giant Cell-Rich Osteosarcoma: A Tumor Simulating Borderline Lesion

• Song WS
• Jeon DG
• Cho WH
• Koh JS
• Kong CB
• Choi SW
• Lee SY
• Kim BS
• Lee SY

• KMID: 1851956
• DOI: http://doi.org/10.4055/jkoa.2015.50.3.225

Abstract

PURPOSE
Giantcell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma. We reviewed; 1) radiological finding of GCRO and clinical impression-related diagnostic workup at referral center, 2) diagnostic delay until a proper diagnosis is made, 3) impact of diagnostic delay on the oncologic outcome.
MATERIALS AND METHODS
We reviewed 17 patients with GCRO. We investigated the plain radiographic finding, tumor size and location, presence of pathologic fracture, clinical impression and pathological diagnosis at referral center, diagnostic delay, definitive treatment, local recurrence, metastasis, and survival rate.
RESULTS
Eleven cases (64.7%) showed a plain radiographically, purely osteolytic pattern while 6 cases (35.3%) showed mixed osteolytic and sclerotic lesion. Diagnosis at primary center was osteosarcoma in 7 (41.2%), giant cell tumor in 7 (41.2%), and benign bone tumor in 3 (17.6%). Six patients (35.3%) experienced diagnostic delay. Mean diagnostic delay was 3.1 months (1 to 8). At final follow-up 5-year actuarial survival rate of 17 patients was 65%+/-25%. Although 11 patients without diagnostic delay showed a tendency of high survival over 6 patients with diagnostic problem, there was no statistical significance (p=0.14).
CONCLUSION
GCRO is a rare subtype of osteosarcoma simulating giant cell tumor both pathologically and radiologically. Careful diagnostic approach is required in order not to misdiagnose this malignant tumor.

Keyword

giant cell rich osteosarcoma; giant cell tumors; diagnostic errors

MeSH Terms

Diagnosis
Diagnostic Errors
Follow-Up Studies
Fractures, Spontaneous
Giant Cell Tumors
Humans
Neoplasm Metastasis
Osteosarcoma*
Recurrence
Referral and Consultation
Survival Rate

Figure

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  Figure 1 Plain radiograph of a 13-year-old female shows a mixed osteolytic and sclerotic lesion in the distal metaphysis of the femur (Case 4).

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  Figure 2 Twelve-year-old female with giant cell rich osteosarcoma in the metaphysis of the distal radius (Case 2). (A) Initial radiograph shows a purely osteolytic lesion with cortical destruction. (B) During diagnostic delay of 2 months, the lesion showed marked progression.

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  Figure 3 Twenty-one-year-old male showing a huge scapula mass (Case 9). (A) Plain radiograph shows a purely osteolytic lesion in the scapula with a huge soft tissue shadow. (B) T1-weighted post-enhancement axial magnetic resonance imaging shows destruction of the scapula and marked extra-osseous mass formation.

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  Figure 4 Five-year continuous disease free and actuarial survival of 17 patients with giant-cell rich osteosarcoma.

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  Figure 5 Continuous disease free survival of patients with adequate and inadequate diagnosis (p=0.14).

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  Figure 6 Actuarial survival of patients with adequate and inadequate diagnosis (p=0.14).

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