Giant Cell Tumor of Bone: The Hands

Between 2%-4% of giant cell tumors of bone affect the hand, with the majority of these involving the metacarpals.

Compared to patients with giant cell tumors in more common locations like the distal femur, proximal tibia, and distal radius, patients with giant cell tumors of the hand:

• tend to be slightly younger,
• are more likely to have higher grade lesions, with 60% presenting as Campannaci grade 3, and
• are more likely to have multicentric disease,

Radiographic findings are similar to giant cell tumor elsewhere in the body: Expansile, lytic lesion involving the epiphysis and metaphysis. Pseudotrabeculations can be seen peripherally. About 10% have a sclerotic border

In contrast to lesions elsewhere, giant cell tumors in the hand tend to be higher grade, with more than half demonstrating cortical destruction. They are also more likely to be central in location (85%), likely due to the smaller volume of the involved bone.

MRI findings are similar to giant cell tumors elsewhere. In more than 50% of cases, MRI will show very low signal intensity on all pulse sequences due to chronic hemosiderin deposition, but the appearance is variable. Fluid-fluid levels can be seen in about 15% of cases, and a low signal intensity rim can be seen in some cases. Early enhancement and washout are typical.

Differential considerations include:

• Enchondroma: Usually asymptomatic. Commonly have a sclerotic border. Stable over time. More likely to occur in the phalanges (unlike giant cell tumors, which tend to occur in the metacarpals).
• Aneurysmal bone cyst: More common in skeletally immature patients.
• Giant-cell reparative granuloma: May also be expansile and lytic with cortical destruction.
• Sarcoidosis:
• Brown tumor: Can histologically mimic giant cell tumor of bone. Look for other radiographic evidence of hyperparathyroidism.
• Fibrous dysplasia: Usually polystotic in the hand.
• Osteomyelitis: Especially tuberculosis with the spina ventosa appearance.

References

James SL, Davies AM. Giant-cell tumours of bone of the hand and wrist: a review of imaging findings and differential diagnoses. Eur Radiol. 2005 Sep;15(9):1855-66.