Giant Cell Reparative Granuloma

Definition

A benign reactive lesion of bone with fibroblastic stroma, haemorrhage and unevenly spaced giant cells. It occurs in the jaws and in the small bones of the hands and feet.

Epidemiology

  • Second and third decades
  • Phalanges and metacarpals most affected in the hand

Pathology

  • Giant cells clustered around haemorrhage, unevenly spread
  • Reactive osteoid within a fibrous stroma
  • Resembles the solid variant of aneurysmal bone cyst and brown tumour
  • USP6 rearrangement in some, linking it with aneurysmal bone cyst
  • Lacks the H3F3A mutation of giant cell tumour of bone

Clinical Features

  • Painful swelling of a finger or toe
  • Preceding trauma in some
  • Pathological fracture through thinned cortex

Investigations

  • Radiograph shows a lytic expansile lesion with cortical thinning and no matrix
  • Serum calcium and parathyroid hormone exclude brown tumour
  • Biopsy is needed for diagnosis
  • CT shows cortical breach before curettage
  • MRI defines soft tissue extension

Differential Diagnosis

Management

  • Curettage and bone graft. Standard treatment
  • Repeat curettage. Local recurrence
  • En bloc excision or ray amputation. Recurrent or destructive lesions

Prognosis

  • Local recurrence after curettage is frequent
  • No metastatic potential
  • Recurrences usually settle with repeat curettage

References

  1. Wold LE, Dobyns JH, Swee RG, Dahlin DC. Giant cell reaction (giant cell reparative granuloma) of the small bones of the hands and feet. Am J Surg Pathol. 1986, 10(7), 491-6. PubMed
  2. Eck HC, Weiner SD. Giant-cell reparative granuloma of the hands and feet. Orthopedics. 2004, 27(1), 67-70. PubMed

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.