Giant Cell Tumor of Bone with Multiple Non-Ossifying Fibromas in Pediatric Patient: A Case Report

Sarah Choe MD, Won Jong Chwa MD, Noa Eaton DO, Brendon Chou MD, David Hanna, Mariam Fahim DO

Southwest Healthcare Medical Education Consortium, Temecula, California, United States Emory University School of Medicine, Atlanta, Georgia, United States Western University of Health Sciences, Pomona, California, United States Cedars-Sinai Medical Center, Los Angeles, California, United States University of California San Diego, San Diego, California, United States

^*Correspondance to: Sarah Choe 

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Abstract:

Giant cell tumor of bone (GCTB) is a rare, locally aggressive osteolytic neoplasm predominantly affecting young adults, with pediatric cases comprising approximately 9% of reported series. Concurrent presentation of GCTB with non-ossifying fibromas (NOFs) in a pediatric patient has not been previously described. We report a 16-year-old female who presented with six weeks of progressive right knee pain and was found to have a distal femoral metaphyseal lesion extending to the epiphysis alongside two diaphyseal NOFs on MRI. Open biopsy confirmed GCTB, with immunohistochemistry demonstrating H3G34W (H3.3 G34W) positivity, excluding relevant histologic mimics. The patient underwent curettage, argon beam adjuvant treatment, corticocancellous bone grafting, and prophylactic internal fixation, with no evidence of recurrence at twelve-month follow-up. This case underscores the diagnostic challenge posed by concurrent benign-appearing lesions and the risk of anchoring bias in adolescent bone pathology. It further highlights the importance of independent lesion evaluation, low threshold for biopsy, and molecular confirmation in pediatric bone tumors. The potential shared biological mechanisms between GCTB and NOFs warrant further investigation through multicenter molecular profiling studies.

Keywords:

Giant cell tumor of bone; Non-ossifying fibroma; Pediatric bone tumor; Metaphyseal lesions; Orthopedic oncology

Cite the Article:

Choe S, Chwa WJ, Eaton N, Chou B, Hanna D, Fahim M. Giant Cell Tumor of Bone with Multiple Non-Ossifying Fibromas in Pediatric Patient: A Case Report. Ann Clin Case Rep. 2026; 11: 2837..