A 40-year-old man has a lytic lesion in the epiphysis of the distal femur extending to the subchondral plate. MRI shows a well-circumscribed lesion with 'soap-bubble' appearance. Biopsy reveals osteoclast-like multinucleated giant cells on a mononuclear stromal background. The most appropriate initial treatment for this locally aggressive (Campanacci Grade 3) lesion is:
- A Curettage and bone grafting alone
- B Wide en-bloc resection with prosthetic reconstruction
- C Extended intralesional curettage with phenol cauterization/argon beam and cementation ✓
- D Radiation therapy as the primary modality
Explanation
Giant cell tumour (GCT) of bone is treated primarily by extended intralesional curettage (high-speed burr, extending 5–10 mm beyond visible margins), followed by adjuvant cauterisation (phenol, argon beam coagulator, or liquid nitrogen cryotherapy) to destroy residual tumour cells, and cementation with polymethylmethacrylate (PMMA). PMMA provides immediate mechanical stability and its exothermic polymerisation kills residual cells. Wide resection is reserved for Grade 3 lesions with extensive soft-tissue extension where joint reconstruction is unavoidable, or for expendable bones. Curettage alone has >20% recurrence. Radiation is avoided as GCT is not radiosensitive and carries a risk of sarcomatous transformation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.