Malignant Transformation of Giant Cell Tumor of Bone and the Association with Denosumab Treatment: A Radiology and Pathology Perspective

Figure 2

Case 3, a 55-year-old female with a pathological fracture of the femur with underlying GCTB. (a) X-ray at the time of diagnosis showed a pathological fracture through a well-defined osteolytic lesion with a sclerotic margin in the distal femur meta- and epiphysis, initially treated by external fixation. (b) Coronal and (c) sagittal CT images at the time of diagnosis showed the pathological fracture extending through the anterior and posterior cortices (arrows) and no internal matrix. (d) Morphology at the time of curettage shows many mononuclear stromal cells intermixed with large osteoclast-like giant cells without atypical morphological features. (e) At the time of curettage; areas with reactive woven bone with typical osteoblast lining are seen, which may be due to the clinical fracture. (f) At the time of curettage; heterogeneous positive H3G34W staining in stromal cells.