Giant Cell Tumors of Bone in Patients Aged 18 Years Old or Younger: Imaging Features and Tumor Characteristics

Xue-Ping Zhang,1,* Xin-Chang Lu,2,* Lin-Lin Wang,1 Jie-Qin Wei,3 Jing Yan,1 Xiao-Ning Shao,1 Ying-Yu Che,1 Jing-Liang Cheng1 1Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China; 2Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China; 3Department of Radiology, The First People’s Hospital of Nanning, Nanning, 530000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jing-Liang ChengDepartment of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, People’s Republic of ChinaTel +86 13603863860Email chengjingliang1868@163.comObjective: The majority of giant cell tumors of bone (GCTB) occur in adult patients, especially between the ages of 20 and 40. This study aims to investigate the imaging features of GCTBs in pediatric patients and compare their characteristics with adult cases.Methods: Fifty-seven cases of patients aged 18 years old or younger were retrospectively analyzed, accounting for 12.8% of GCTBs in the First Affiliated Hospital of Zhengzhou University from 2001 to 2019. One hundred twenty-six adult patients (19 years of age and older) with GCTB occurring in long tubular bones were also included in this study. The following clinical information was identified from the medical records: age, sex, and follow-up data. Imaging features were reviewed by two musculoskeletal radiologists. Patient characteristics and imaging features between the two groups were compared.Results: A total of 57 patients (32 females, 25 males) were included in the study. The patients’ ages ranged from 9 to 18 (median = 17 y). The majority of tumors occurred in tubular bones (n = 38, 66.7%) and the pelvis (n = 8, 14.0%). Imaging features were identified in GCTB cases occurring in the long tubular bones. Compared with adult GCTB patients, pediatric GCTB patients had a larger superior–inferior (SI) diameter (P = 0.005) and smaller left-to-right diameter/SI diameter ratio (P = 0.001). Epiphyseal involvement was relatively less common in pediatric patients with GCTBs than in adult patients (P = 0.009). The median age of patients without epiphyseal involvement was lower than the median age of patients with epiphyseal involvement (11 vs 17 y).Conclusion: GCTB in the pediatric age group is rare. This study has found that, in pediatric patients with GCTBs, the epiphysis is relatively less involved, and the tumor is more likely to grow longitudinally. These findings are helpful in the diagnosis of GCTBs in the pediatric population.Keywords: giant cell tumors of bone, pediatric, diagnosis, CT, magnetic resonance imaging