Forty-Two Cases of Pediatric Giant Cell Tumor of Bone: Insights From a 25-Year Multi-Institutional Cohort

Background: Pediatric giant cell tumor (GCT) of bone is rare and remains poorly characterized. Skeletally immature patients may demonstrate increased metaphyseal involvement and higher recurrence rates, but existing data are limited to small single-institution series. We evaluated the clinical and surgical characteristics of pediatric GCT and compared recurrence by physeal status. Methods: A retrospective review of patients younger than 19 years of age with histologically confirmed GCT of bone treated surgically at 3 tertiary centers from 1997 to 2022 was performed. Clinical, radiographic, and surgical data, including physeal status, were collected. Local recurrence-free survival (LRFS) was estimated using Kaplan-Meier analysis and compared by physeal status using the log-rank test. Recurrence rates were compared using the Fisher exact test, with significance set at P <0.05. Results: Forty-two patients with a median age of 16 years (62% female) were included. Most tumors (76%) involved long bones, most commonly the femur (29%), with a median size of 5 cm. The overall local recurrence rate was 45%, with a median time to recurrence of 7 months. Recurrence was observed in 55% (6/11) of patients with open physes compared to 38% (8/21) with closed physes ( P =0.50). Preoperative magnetic resonance imaging (MRI) was available in 27 patients, including 15 (56%) with tumors demonstrating bone marrow edema (BME). BME was associated with a higher recurrence (67% vs. 17%; P =0.019). Metastatic disease was rare (5%). LRFS rates at 12, 24, and 60 months were 71.4%, 61.7%, and 52.6%, respectively. Patients with closed physes demonstrated higher LRFS across all time points compared to those with open physes, though these differences did not reach statistical significance. Conclusions: Local recurrence rates were high in pediatric GCT and numerically higher in patients with open physes, although the difference did not reach statistical significance. BME on preoperative MRI was associated with higher recurrence and warrants further study. Individualized treatment and vigilant early surveillance may improve local control while preserving growth potential. Levels of Evidence: Level IV.