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Spindle Cell Sarcoma Degeneration of Giant Cell Tumor of the Knee, Imaged With F-18 FDG PET-CT and Tc-99m MDP Bone Scan

Makis, William, MD; Hickeson, Marc, MD

doi: 10.1097/RLU.0b013e3181c7c124
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Giant cell tumor is a benign but aggressive bone tumor that occurs in young adults ages 20 to 40, accounts for 20% of benign bone tumors, occurs mostly in the metaphyso-epiphyseal region of long bones, and is characterized by the presence of multinucleated giant cells. The risk of malignant degeneration is approximately 10%. We present a 46-year-old man with a history of recurrent giant cell tumor of the left tibial plateau, treated with total knee prosthesis in 2006. In 2008, he presented with knee pain, and a Tc-99m MDP bone scan showed increased uptake surrounding the knee prosthesis. A F-18 fluoro-deoxy-glucose positron emission tomography-computed tomography (FDG PET-CT) scan showed intense uptake in the soft tissue surrounding the distal left femur, as well as other skeletal and soft tissue sites of abnormal FDG uptake. The biopsy of the distal left femur revealed the presence of spindle cell sarcoma.

From the Department of Nuclear Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.

Received for publication April 20, 2009; revision accepted August 19, 2009.

This manuscript or any containing figures or tables have not been submitted to any publication previously.

None of the authors have any financial or other relationships that might lead to a conflict of interest.

The manuscript has been read and approved by all the authors, and the requirements for authorship have been met. Each author believes that the manuscript represents honest work.

Reprints: William Makis, MD, Department of Nuclear Medicine, Royal Victoria Hospital, 687 Pine Ave West, Floor M2, Montreal, Quebec, H3A 1A1, Canada. E-mail:

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