Giant Cell Tumor of the Larynx Treated by Surgery and Adjuvant Denosumab: Case Report and Review of the Literature

Management of Giant Cell Tumor of the Hyoid bone- A rare Clinical Entity with Review of Literature

BACKGROUND

Giant cell tumors (GCTs) are typically found in the long bones but can also occur in the head and neck region. GCT of the larynx is a rare entity with only 42 reported cases in the international literature. Furthermore, to the best of our knowledge this is the largest laryngeal GCT reported in the literature to date. GCT of the larynx can present with dysphonia, dyspnea, and/or dysphagia and should be considered in the differential diagnosis of a neck mass.

PATIENT AND METHODS

A38-year-old man presented with complaints of mass in the neck with dysphonia and dysphagia. On clinical examination,there was huge spherical swelling extending from submental region till sternal notch with overlying normal skin. Computed tomography (CT) neck revealed a 20 × 15.7 cm mass centered on the hyoid bone, which was further diagnosed by histopathology as giant cell tumour on biopsy. The patient was counselled on treatment options and it was decided to proceed with a surgical approach. The patient consented to and successfully underwent en-bloc excision of mass with hyoid bone. Histopathology report revealed GCT of Hyoid bone.Currently the patient has no evidence of disease at 25 months follow-up, has an optimal voice, and is on regular follow -up with us.

DISCUSSION AND CONCLUSION

GCTs of the larynx have a good prognosis and can be treated successfully through complete resection of the tumor, negating the need for adjunctive therapy such as radiation, chemotherapy or denosumab therapy.

Giant cell tumor of thyroid cartilage: A diagnostic dilemma on aspiration cytology

Giant cell tumor of the larynx is an uncommon entity with only 44 cases reported in the literature. These tumors occur most commonly in the epiphysis of the long bones of female patients in third decade. Here in we report a case of 23 years old male patient who presented with an anterior neck swelling since past 4 months. Ultrasound and computed tomography of neck revealed a heterogenously enhancing lesion involving posteroinferior half of right thyroid cartilage with extension into the extra laryngeal strap muscle and intralaryngeal right true vocal cord and false vocal cord. The findings were suggestive of a neoplastic cartilagenous lesion. A fine needle aspiration of the right anterior neck mass was performed which showed many mononuclear cells along with multinucleated osteoclast type giant cells. No thyroid follicular cells or inflammatory cells were seen. A diagnosis of giant cell tumor of the thyroid cartilage was rendered on cytology. A biopsy was subsequently performed for the patient which confirmed the same. Hence, although giant cell tumor of the larynx is a rare entity, with very few cases reported in the literature, these tumors should be included in the differential diagnosis of giant cell lesions of the neck and aspiration cytology can offer an accurate and quick diagnosis in such cases.

Recurrence of Giant Cell Tumor of The Larynx

Giant cell tumor of the larynx is a rare tumor. It was first reported by Wessely et al in 1940. Thirty-nine cases have been reported until now and together with the current case 2 recurrences were encountered. In this case report, our aim was to discuss conservative management because of the suspicion of recurrence. A 70-year-old male patient was admitted to our clinic with the complaint of hoarseness. A tumor measuring 1 × 1 cm located in the anterior half right vocal fold and extending to the anterior comissure was found on laryngeal endoscopy. Direct laryngoscopy and biopsy of the mass revealed giant cell tumor on histopathological examination. Tumor resection with cordectomy through laryngofissure and subsequently medialization thyroplasty were performed. Horaseness of the patient improved. On 2-year follow-up, a tumoral lesion suggesting recurrence was found on the vocal cord. Direct laryngoscopy and biopsy confirmed recurrence. Total laryngectomy was performed. This is the second case of recurrent giant cell tumor of the larynx. The therapy of choice should be selected considering the possibility of recurrence.

Giant Cell Tumor of Cervical Spine Presenting as Acute Asphyxia: Successful Surgical Resection After Down-Staging With Denosumab

STUDY DESIGN

Case report and literature review.

OBJECTIVE

To describe treatment of a unique case of acute airway obstruction by a large C7 giant cell tumor (GCT) with preoperative denosumab followed by surgical resection, and review the literature on this rare entity.

SUMMARY OF BACKGROUND DATA

Standard treatment for GCTs includes surgical resection or curettage and packing. Large lesions in the spine may require preoperative therapy with denosumab, a human monoclonal antibody to RANKL, to facilitate surgery. It is highly unusual for GCT arising in cervical spine to present with acute asphyxia (requiring tracheostomy).

METHODS

We report a patient with large C7 GCT that caused tracheal compression with almost complete airway obstruction requiring emergency intubation.

RESULTS

The tumor responded to subcutaneously administered denosumab with marked decrease in size and relief of symptoms. Increased tumor mineralization in response to therapy facilitated subsequent successful surgical tumor resection. The patient remains symptom-free 2 years after surgery without tumor recurrence.

CONCLUSION

Denosumab can shrink the size of large GCTs, providing symptom relief before surgery and facilitate tumor resection.

LEVEL OF EVIDENCE

5.

A large giant cell tumor of the larynx: case report and review of the literature

BACKGROUND

Giant cell tumors (GCTs) are typically found in the metaphyseal-epiphyseal area of long bones but can also occur in the head and neck region. GCT of the larynx is a rare entity with only 42 reported cases in the international literature. Furthermore, to the best of our knowledge this is the largest laryngeal GCT reported in the literature to date. GCT of the larynx can present with dysphonia, dyspnea, and/or dysphagia and should be considered in the differential diagnosis of a neck mass.

CASE PRESENTATION

This case report describes a giant cell tumor of the left thyroid cartilage in a 30-year-old man who initially presented with dysphonia and dysphagia. Computed tomography (CT) revealed a 5 × 5.7 cm mass centered on the left thyroid cartilage, which was further diagnosed by histopathology as giant cell tumour by open biopsy. The patient was counselled on treatment options and it was decided to proceed with a surgical approach. The patient consented to and successfully underwent a total laryngectomy (TL). Currently the patient has no evidence of disease at 13 months follow-up, has an optimal prosthetic voice, and is able to tolerate all textures of foods.

CONCLUSION

GCTs of the larynx have a good prognosis and can be treated successfully through complete resection of the tumor, negating the need for adjunctive therapy such as radiation, chemo or denosumab therapy.

Interest of Denosumab for the Treatment of Giant-cells Tumors and Aneurysmal Bone Cysts of the Spine. About Nine Cases

STUDY DESIGN

A prospective cohort study.

OBJECTIVE

The aim of this study was to evaluate the interest of denosumab in the treatment of spinal giant-cells tumors (GCTs) and aneurysmal bone cysts (ABCs).

SUMMARY OF BACKGROUND DATA

To treat GCTs and ABCs, surgical resection remains the best treatment to limit local recurrence (LR) but constitutes an aggressive treatment with potential morbidity. Denosumab, a human antibody anti-RankL, inhibiting the differentiation of osteoclasts, could be an alternative treatment to avoid aggressive surgery.

METHODS

Patients suffering from GCTs and ABCs of the spine were included. Patients received a monthly subcutaneous injection of denosumab (120 mg) during a minimum of 6 months either as a neoadjuvant or as an adjuvant therapy. In association with denosumab, an osteosynthesis was added in case of vertebral fracture and a laminectomy in case of spinal cord compression. Clinical and computed tomography (CT)-scan outcomes were analyzed.

RESULTS

Eight GCTs and one ABC were included. The mean age was 35 years (range: 22-55 yr). Five patients had neurologic deficit. All patients were operated: six osteosynthesis, one "en bloc" resection, four curettages, and two of them associated with an osteosynthesis. Average duration of denosumab therapy was 12.9 months (range: 3.2-24 months). Among them, four patients began denosumab 6 months at least before the surgery. With a mean follow-up of 19.3 months (range: 3.2-52.4 months), back pain and neurologic deficit improved for all patients. Systematic CT-scan at 6 months showed decrease of tumor size and bone consolidation. Regarding patients treated by neoadjuvant denosumab treatment, intraoperative histologic analysis showed an absence of giant cells and a maximum of 10% of alive tumor cells.

CONCLUSION

Denosumab allows bone formation and tumor regression with a maximum efficacy after 6 months of treatment without widely substituting surgery. Long-term results are mandatory to confirm the interest of denosumab and to evaluate LR when stopping denosumab.

LEVEL OF EVIDENCE

3.

MRI of giant cell tumour of larynx: marked T 2 hypointensity due to abundant haemosiderin deposition

Giant cell tumours (GCTs) are benign tumours commonly found in the long bones. Rarely, they may occur in the larynx, often resulting in hoarseness and anterior neck swelling. Since Wessely reported the first case of laryngeal GCT in 1940, 35 cases have been identified. Herein, we present a case of a 53-year-old male with GCT of the larynx that showed T₁ and T₂ hypointense signal on MRI, presumably owing to abundant haemosiderin deposition. We also discuss the imaging findings of CT and ¹⁸F-fludeoxyglucose positron emission tomography scans, as well as the pathological correlation.