Giant cell-rich osteosarcoma simulating giant cell tumor of bone

Abstract

A seventeen-year-old boy was referred to our hospital, complaining of continuous pain of his left wrist joint. Plain roentgenogram showed an osteolytic lesion at the distal end of the radius. An operation in which the tumor was curetted was performed suspecting giant cell tumor. Pathological diagnosis was of a giant cell tumor. One month after the operation, radiological findings showed local recurrence with an expanded lysis. Wide resection of this tumor followed by a vascularized fibular graft was performed. Six months after the second operation, soft part swelling suggesting local recurrence was again prominent. Upper arm amputation was performed because of the bad local condition. The pathological diagnosis of these operative specimens was of giant cell tumor similar to that of the initial specimen. Multiple metastases appeared eight months after the third operation. In spite of intensive treatment, the patient died of respiratory failure. Autopsy revealed that pathological features from metastatic specimens were similar to those of osteosarcoma, not giant cell tumor. When we encounter patients presenting with a giant cell tumor, especially when they are younger than the age at which such lesions usually occur, we should bear in mind the possibility of an osteosarcoma and perform intensive chemotherapy and surgery.