A 30-year-old woman has a painless, eccentric lytic lesion in the epiphysis of the distal femur extending to the subchondral bone. There is a 'soap bubble' appearance on X-ray. Biopsy shows multinucleated giant cells on a mononuclear stromal background. Which of the following best describes the appropriate management of a Campanacci grade III lesion?

• A Simple curettage and bone graft alone
• B Extended curettage with high-speed burr, local adjuvant (phenol or liquid nitrogen), and bone grafting/cementation ✓
• C Wide resection and megaprosthesis reconstruction
• D Radiotherapy alone as giant cell tumours are radiosensitive

Explanation

Giant cell tumour (GCT) is locally aggressive and typically affects the epiphysis of long bones in skeletally mature patients. Campanacci grade III denotes cortical breach or soft-tissue extension. The current standard is extended (intralesional) curettage using a high-speed burr to achieve wide margins within the cavity, followed by a local adjuvant (phenol, liquid nitrogen cryotherapy, or hydrogen peroxide) to devitalise residual tumour cells, then cementation or bone grafting. Wide resection and megaprosthesis is reserved for recurrent or skeletally unrestorable lesions.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.