Blood-borne spread of a benign giant cell tumor from the radius to the soft tissue of the hand

Development and validation of a prognostic index to predict pulmonary metastasis of giant cell tumor of bone

Purpose

Giant cell tumor of bone (GCTB) is an intermittent tumor with a low probability of pulmonary metastasis. Our aim was to investigate the risk factors and establish a nomogram predictive model for GCTB pulmonary metastasis.

Methods

We retrospectively evaluated GCTB patients at our center from 1991 to 2014. The cohort was randomized into training and validation sets. Univariate and multivariate analyses were used to evaluate the risk factors of pulmonary metastasis. A nomogram was established. Internal validation was achieved based on ROC curve and C-index values in the validation set. Decision curve analysis was performed to assess the clinical performance of the nomogram.

Results

417 patients were studied, including benign and malignant GCTBs. The average follow up was 79 months. Pulmonary metastases were observed in 27 cases. Four independent risk factors were identified: malignancy, tumor bearing time, times of recurrence and tumor size. A nomogram was developed to predict pulmonary metastasis with C-index values of 0.857 and 0.785 in the training and validation groups. In the decision curve analysis, patients could benefit from the nomogram, which differentiates patients at high risk for pulmonary metastasis and avoids unnecessary examination. According to the nomogram, patients with final risks of more than 0.06 should be scheduled for further chest scans.

Conclusion

Malignancy, tumor bearing time, times of recurrence and tumor size were independent risk factors for pulmonary metastasis in GCTB patients. The nomogram can accurately predict the risk of pulmonary metastasis and help doctors to make clinical decisions for further chest examinations.

Pulmonary metastasis of giant cell tumor of bones

Giant cell tumor of bone (GCTB) accounts for 5% of primary skeletal tumors. Although it is considered to be a benign lesion, there are still incidences of pulmonary metastasis. Pulmonary metastasis of GCTB may be affected by tumor grading and localization as well as the age, gender and overall health status of the patient. Patients with local recurrence are more likely to develop pulmonary metastasis of GCTB. High expression of some genes, cytokines and chemokines may also be closely related to the metastatic potential and prognosis of GCTB. The treatment of the primary GCTB is key to the final outcome of the disease, as intralesional curettage has a significantly higher local recurrence and pulmonary metastasis rate than wide resection. However, even patients with pulmonary metastasis seem to have a good prognosis after timely and appropriate surgical resection. It is hoped that with the development of novel surgical methods and drugs, pulmonary metastasis of GCTB can be prevented and treated more effectively.

Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review

Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.

Histologically verified lung metastases in benign giant cell tumours--14 cases from a single institution

From 1975 to 1997, 649 cases of benign giant cell tumours of the bone were treated at the Istituto Rizzoli. Fourteen patients (2.1%) experienced lung metastases after a mean of 35.2 months. The time interval between the diagnosis and the appearance of the lung metastases ranged from 3 months to 11.9 years. Metastasectomy was performed in all patients. Histologically, the metastases were identical to the primary bone lesions. Two patients with unresectable multiple metastases received additional chemotherapy. After a follow-up of 70 months (range: 8.2 to 185 months), all patients are alive. Ten patients showed no evidence of disease, one of these after a second resection of metastases, and four patients presented stable disease with multiple lung metastases. Local recurrence of the bone lesion occurred in seven patients before or simultaneously to the metastases. In contrast to previous reports, we could not detect a predominance of the distal radius, but all of the patients had a stage III tumour according to the Enneking criteria of benign lesions. We conclude that even metastatic benign giant cell tumours have an excellent prognosis after adequate resection. No prognostic factors despite high-grade lesions were detectable.

Cutaneous metastases of a giant cell tumor of bone: case report

A 47-year-old patient with the previous history of a giant cell tumor of the left femur presented with 3 cutaneous nodules located on the face. Histologic examination revealed skin metastases of a giant cell tumor of bone, with dermal and subcutaneous nodules characterized by multinucleate giant cells and mononuclear cells. The patient died 10 months later from widespread metastases to the lung and brain. A panel of enzymo- and immunohistochemical markers reactive and osteoclastic, fibroblastic and histiocytic determinants was tested on the cutaneous lesions. The results indicated osteoclastic lineage of the multinucleate giant cells whereas the mononuclear cells showed features of fibroblastic differentiation. Cutaneous metastasis from a giant cell tumor of bone is an extraordinary event and so far has only been reported once.

Giant-cell tumor of bone, stage II, displaying translocation t(12;19)(q13;q13)

A new case of giant-cell tumour (GCT) of bone with benign histological features, clinical stage II, has been reviewed with immunohistochemistry and electron microscopy. After short-term tissue culture the karyotype, using G-banding techniques, presented a consistent translocation t(12;19)(q13;q13). Nude mice xenografts of the tumour were unsuccessful after 6 months of follow-up. Presence of such chromosomal rearrangement may be related to locally aggressive, histologically benign giant-cell tumors of bone.

Malignant fibrous histiocytoma in a child's hand

A 3-year-old girl had a 4-month history of a tumor in her right hand. The tumor was located in the subcutaneous and soft tissues of the palm and the long, ring, and small fingers. Histologic studies showed a malignant fibrous histiocytoma that was confirmed by the ultrastructural study as having a fibroblastic and histiocytic origin. The long, ring, and small fingers were amputated. The postoperative course was normal, and 18 months later no recurrence or metastases were observed.