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Figure 2 (a) Radiograph of the pelvis AP view; (b) 3D reconstruction and (c) axial section of CT showing expansile lytic lesion involving the right sacral ala with cortical break and surrounding soft-tissue component extending into right SI joint space MS-275 mouse and pelvis ... The review radiographs of her left forearm showed wrist subluxation (Figures 1(e) and 1(f)), though the patient had no complaints in her wrist. Skeletal survey and screening radiographs showed suspicious lesions in her lung fields which turned out to be pulmonary metastases on Contrast Enhanced CT (CECT) of chest (Figure 3). CECT of brain and abdomen were normal. Technetium99 whole body bone scan showed hotspots in the sacrum and both lungs; there was no evidence of recurrence at distal radius. Figure 3 Multiple irregular opacities in apical segments of right upper lobe and left lingular superior segment, anterobasal and posterobasal segments suggestive of metastasis. After optimizing the patient, sacral lesion was treated by thorough intralesional curettage and bone grafting (Figure 4(a)). The procedure relieved patient of severe episodic pain. The patient developed superficial surgical site infection which later went on to heal with regular dressings and antibiotics. Patient is clinically asymptomatic at one-year follow-up. Pulmonary metastases could not be evaluated further or treated GDC-0449 manufacturer as the patient was unwilling for any intervention. 3. Discussion Less than 1% of cases of GCT are multicentric in origin [1, 4�C10]. Most of the cases of MCGCT are reported as single case Quinapyramine or as small series [2, 5�C15]. Hoch et al. published the largest known series of 30 cases of MCGCT in 2006 [2]. Dhillon and Prasad [4] in 2007 published a comprehensive review on ��Multicentric giant-cell tumor of bone�� where a total of 101 cases reported so far worldwide were described. Hoch et al. classified tumours as being ��synchronous�� when multiple tumours had been discovered at the initial presentation or when a second tumour had been diagnosed within six months after the first. If the second tumour developed more than six months after the first lesion, the lesions were considered to be ��metachronous�� [1, 2, 16]. In our patient, sacral lesion was found incidentally on the skeletal survey at the initial presentation and is hence classified as synchronous. Most of the case series reported occurrence of MCGCT at a younger age when compared to solitary GCT [8, 14, 16]. The mean age of multicentric GCT was found to be 22.5 years [4]. Distal radius and sacrum are among the common sites for solitary GCT in the appendicular and axial skeletons, respectively. The age of our patient and the sites of tumor are typical of solitary giant cell tumour, which typically presents in third to fifth decades of life [2].