The differential should include active bone tumors that are likely to occur around the knee of an adult. Please click here to review the criteria for active tumors. The possibilities include aneurysmal bone cyst, eosinophilic granuloma, giant cell tumor, lymphoma, and infection. Tumors and lesions that might occur in this setting but are less likely include hyperparathyroidism, osteosarcoma, Ewing's sarcoma, myeloma, lymphoma, angiosarcoma, adamantinoma, and fibrous dysplasia.
The results of the biopsy are shown at right.
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The lesion is a giant cell tumor. Click here for a complete discussion.
The patient had complete curettage and burring of the lesion. The use of a high speed burr is thought to result in a decrease of the chance of a local recurrence, as might also be achieved with liquid nitrogen or phenol. Wide resection is indicated only for recurrent GCT's and lesions in expendable bones, such as the proximal fibula. In this case the lesion was packed with freeze-dried corticocancellous bone graft from the bone bank. Follow-up xrays are shown at right.
The patient is now three years post -op and he remains disease free.
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