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Srinivas M, Nichkaode P, Sharma B, Haval S. Giant Cell Tumor of the Anterior Arc of the Rib: A Case Report. Cureus 2024; 16:e58679. [PMID: 38774168 PMCID: PMC11107139 DOI: 10.7759/cureus.58679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
Tumors that develop on the chest wall are usually rare. This case report highlights a rare occurrence of a giant cell tumor originating from the anterior arch of the fourth rib. The patient, a 21-year-old male, presented with a bulging mass that had been gradually increasing in size over an eight-month period, reaching dimensions of 12 x 8 cm. Despite the noticeable swelling, the patient reported no associated pain or discomfort and denied any history of weight loss or trauma. The absence of chest pain or cardiovascular symptoms distinguished this case from other chest wall pathologies. This report underscores the importance of considering rare entities such as giant cell tumors in the differential diagnosis of chest wall masses, especially in cases where clinical presentation and patient history do not align with more common conditions.
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Affiliation(s)
- Manu Srinivas
- General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Prabhat Nichkaode
- Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Bijay Sharma
- General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shriya Haval
- General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Poosiripinyo T, Sukpanichyingyong S, Salang K, Mahikul W, Chobpenthai T. Non‑surgical outcomes and risk factors for pulmonary metastasis from giant cell tumor of bone. Oncol Lett 2023; 26:508. [PMID: 37920440 PMCID: PMC10618933 DOI: 10.3892/ol.2023.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
The present study detailed four factors associated with an increased risk of pulmonary metastasis, age, pathological fracture, local recurrence and mode of treatment. Local recurrence and pathological fracture were independent risk factors for developing metastasis. From January 2016 to December 2021, data from 50 patients diagnosed with giant cell tumor of bone (GCTB) treated in Khon Kaen Hospital, Thailand, were retrospectively analyzed. The risk factors, including age at diagnosis, location of GCTB, clinical presentation, Campanacci stage and no. of local recurrences, for GCTB-induced pulmonary metastasis were evaluated using univariate and multivariable logistic regression analyses. Of the 50 patients analyzed, 9 patients (18%), with a mean age of 46.3 years (range, 18-68 years), developed pulmonary metastasis. No patients died from pulmonary metastasis in the present study. Statistically significant associations were observed between the development of metastasis and both clinical fracture [odds ratio (OR), 6.107; 95% confidence interval (CI), 1.08-34.70] and local recurrence (OR, 6.48; 95% CI, 1.03-40.87). Patients presenting with both a clinical fracture and local tumor recurrence require more rigorous clinical observation due to the significantly elevated risk of disease progression.
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Affiliation(s)
- Thanate Poosiripinyo
- Department of Orthopedics, Khon Kaen Hospital, Mueang Khon Kaen, Khon Kaen 40000, Thailand
| | | | - Krits Salang
- Department of Orthopedics, Khon Kaen Hospital, Mueang Khon Kaen, Khon Kaen 40000, Thailand
| | - Wiriya Mahikul
- Department of Orthopedics, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Thanapon Chobpenthai
- Department of Orthopedics, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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Hasan BZ, Mesregah MK. A technical note on autologous iliac crest bone grafting for restoration of the distal tibial articular surface. J Exp Orthop 2023; 10:50. [PMID: 37120769 PMCID: PMC10149547 DOI: 10.1186/s40634-023-00612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
PURPOSE This technical note describes a reconstructive technique of the distal tibial articular surface using autologous iliac crest bone graft. METHODS Following curettage and high-speed burring of giant cell tumor of bone (GCTB) of the distal tibial articular surface, the resulting cavity was filled, and the articular surface was reconstructed using autologous tricortical iliac crest bone graft. The graft was fixed to the tibia with a plate. RESULTS The smooth congruent articulating surface of the distal tibia was restored. Full ankle range of motion was achieved. No recurrence was detected in the follow-up imaging. CONCLUSIONS The currently reported technique using autologous tricortical iliac crest bone graft is a viable option for reconstructing the articular surface of the distal tibia.
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Affiliation(s)
- Bahaa Zakarya Hasan
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt.
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Ebeid WA, Badr IT, Mesregah MK, Hasan BZ. Incidence and progression of osteoarthritis following curettage and cementation of giant cell tumor of bone around the knee: long-term follow-up. J Orthop Traumatol 2023; 24:11. [PMID: 37024720 PMCID: PMC10079796 DOI: 10.1186/s10195-023-00693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/12/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is a benign locally aggressive tumor frequently treated with intralesional curettage and cementation. The aim of this study was to investigate the long-term incidence of arthritic changes following curettage and cementation of GCTB around the knee. MATERIALS AND METHODS This study was a retrospective review of patients with GCTB around the knee treated with curettage and cementation with a minimum follow-up of 10 years. The functional results were assessed using the Musculoskeletal Tumor Society (MSTS) score. The arthritic changes were classified using the Kellgren-Lawrence (KL) classification system of osteoarthritis. RESULTS This study included 119 patients, 54 males and 65 females, with a mean age of 29.4 ± 9.2 years. There were 35 (29.4%) patients with pathological fractures. There were 84 (70.6%) patients with de novo lesions and 35 (29.4%) with recurrent lesions. The mean follow-up period was 13.2 ± 3.16 years. The mean MSTS score was 28.5 ± 1.9. Overall, 25 (21%) patients developed variable degrees of arthritis of KL grade 1 (n = 7), KL grade 2 (n = 11), KL grade 3 (n = 4), and KL grade 4 (n = 3). Ten patients showed progression of arthritis during the follow-up period. Age at presentation, gender, presence of pathological fracture, whether the tumor was de novo or recurrent, and tumor location were not associated with arthritis incidence. CONCLUSIONS Curettage and cementation can be used safely to treat GCTB around the knee. Arthritis of the knee is a possible complication, but mild grades are expected in most cases. There was no association between arthritis incidence and age, gender, pathological fractures, tumor location, or recurrent tumors. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Walid Atef Ebeid
- Department of Orthopaedic Surgery, Cairo University, Cairo, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopaedic Surgery, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | | | - Bahaa Zakarya Hasan
- Department of Orthopaedic Surgery, Menoufia University, Shebin El-Kom, Menoufia, Egypt
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Leland CR, Pratilas CA, Gross JM, Levin AS. Diffuse Pulmonary Metastases at Presentation of Giant Cell Tumor of Bone: A Case Report and Synthesis of Literature. JBJS Case Connect 2023; 13:01709767-202303000-00004. [PMID: 36821126 DOI: 10.2106/jbjs.cc.22.00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 02/24/2023]
Abstract
CASE We present a 23-year-old man with acute-on-chronic shoulder pain with an aggressive-appearing, destructive lesion of the left proximal humerus and diffuse lung metastases. Biopsy revealed conventional giant cell tumor of bone (GCTB) without sarcomatous differentiation, treated with resection and proximal humerus reconstruction. Without systemic treatment, his pulmonary metastases demonstrated modest spontaneous regression, with no impairment of pulmonary function. CONCLUSIONS Although GCTB is known to metastasize to lungs, these deposits most commonly follow local recurrence. We describe a young adult with diffuse pulmonary nodules at initial presentation, although still following an indolent clinical course without the need for additional systemic therapy.
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Affiliation(s)
- Christopher R Leland
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine A Pratilas
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - John M Gross
- Division of Surgical Pathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
PURPOSE OF REVIEW Giant cell tumors of bone (GCTB) are intermediate, locally aggressive primary bone tumors. For conventional GCTB, surgery remains treatment of choice. For advanced GCTB, a more important role came into play for systemic therapy including denosumab and bisphosphonates over the last decade. RECENT FINDINGS In diagnostics, focus has been on H3F3A (G34) driver mutations present in GCTB. The most frequent mutation (G34W) can be detected using immunohistochemistry and is highly specific in differentiating GCTB from other giant cell containing tumors. PD-L1 expression can be used as biological marker to predict higher recurrence risks in GCTB patients.The use of bisphosphonate-loaded bone cement is under investigation in a randomized controlled trial. A new technique consisting of percutaneous microwave ablation and bisphosphonate-loaded polymethylmethacrylate cementoplasty was proposed for unresectable (pelvic) GCTB.Increased experience with use of denosumab raised concern on elevated recurrence rates. However, conclusions of meta-analyses should be interpreted with risk of indication bias in mind. Several small studies are published with short-course denosumab (varying from 3 to 6 doses). One small trial directly compared denosumab and zoledronic acid, with no statistical differences in radiological and clinical outcome, and nonsignificantly higher recurrence rate after denosumab. As bisphosphonates directly target neoplastic stromal cells in GCTB, larger directly comparative trials are still warranted. SUMMARY Neoadjuvant denosumab is highly effective for advanced GCTB, and a short-course is advised to facilitate surgery, whereas increased recurrence rates remain of concern. Randomized controlled trials are conducted on bisphosphonate-loaded bone cement and on optimal dose and duration of neoadjuvant denosumab. PD-L1 could be a potential new therapy target in GCTB.
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Martin JR, Auran RL, Duran MD, de Comas AM, Jacofsky DJ. Management of Primary Aggressive Tumors of the Knee. J Knee Surg 2022; 35:585-596. [PMID: 35181876 DOI: 10.1055/s-0042-1743221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary bone sarcomas and aggressive benign bone tumors are relatively rare. It is essential to recognize features that are concerning for these aggressive tumors based on a patient's history, physical exam, and radiographs. Physicians and other health care providers should have a high suspicion for these tumors and promptly refer these patients to orthopaedic oncologists. A multidisciplinary, team-based approach is required to obtain an accurate diagnosis and provide comprehensive care. This review discussed the appropriate work-up, biopsy principles, relevant peri-operative medical management, and surgical treatment options for patients with aggressive primary bone tumors around the knee. Primary bone sarcomas (osteosarcoma and chondrosarcoma) and aggressive benign bone tumors (giant cell tumor, chondroblastoma, and chondromyxoid fibroma) that have a predilection to the distal femur and proximal tibia are the focus of this review.
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Affiliation(s)
- John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
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