A 35-year-old presents with a lytic lesion at the distal femoral epiphysis. X-ray shows a 'soap bubble' appearance with a transphyseal extension into the metaphysis and a thin sclerotic rim without periosteal reaction. Biopsy shows giant cells and mononuclear stromal cells. The Campanacci grade 3 (aggressive) giant cell tumor is treated with:

• A Observation alone as GCT is always benign
• B Radiation therapy alone
• C Wide en-bloc resection as the only acceptable treatment for grade 3 GCT
• D Extended curettage with high-speed burr, adjuvant (phenol, cryotherapy, argon beam), and polymethylmethacrylate (PMMA) cement or bone graft packing ✓

Explanation

Giant cell tumor (GCT) of bone is treated with extended intralesional curettage (using high-speed burr to remove tumor at periphery beyond visible margin) plus chemical (phenol) or physical (cryotherapy, argon beam) adjuvants to reduce local recurrence, followed by PMMA cement packing (provides heat kill of residual cells and allows immediate weight bearing) or bone graft. Campanacci grade 3 GCTs (aggressive, cortical breach, soft tissue extension) have higher recurrence (25-35%) but local curettage plus adjuvants remains first-line for most sites. Denosumab (anti-RANKL) is used as neoadjuvant therapy for unresectable or sacral GCTs. En-bloc resection increases function loss without significant recurrence benefit in accessible long bone sites.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.