A 35-year-old presents with a lytic lesion at the distal femur epiphysis. X-ray shows a well-defined 'soap bubble' lytic lesion extending to the subchondral bone without crossing the joint. Biopsy shows giant cells scattered uniformly in a mononuclear stromal background. Campanacci grading Grade III giant cell tumor (GCT) is best managed by:
- A Curettage and bone cement (PMMA) filling
- B En bloc resection and reconstruction with endoprosthesis ✓
- C Curettage, high-speed burr, adjuvants (phenol/liquid nitrogen), and cementation
- D Denosumab (RANK-L inhibitor) monotherapy without surgery
Explanation
Campanacci Grade III GCT has extensive soft tissue extension beyond the cortex, making it locally aggressive. En bloc resection with wide margins followed by prosthetic reconstruction is recommended for Grade III to achieve an adequate surgical margin and acceptable local recurrence rates (<10%). Grades I and II are typically managed with extended curettage (including high-speed burr, phenol adjuvant, and cementation) with local recurrence rates of 15–25%. Denosumab (anti-RANKL) is used for unresectable or recurrent GCT, or as neoadjuvant therapy to shrink the lesion but is not monotherapy for resectable Grade III disease.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.