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Pujol O, Castellanos S, Carrasco MG, Garzón A, Romagosa C, Vélez R. Massive Desmoplastic Fibroma of the Proximal Tibia: Case Report. Rev Bras Ortop 2024; 59:e114-e118. [PMID: 39027175 PMCID: PMC11254431 DOI: 10.1055/s-0043-1771492] [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: 10/08/2022] [Accepted: 12/02/2022] [Indexed: 07/20/2024] Open
Abstract
Desmoplastic fibroma of bone is a very uncommon, benign but locally aggressive fibrogenic tumor. This report describes the case of a 45-year-old patient with a massive desmoplastic fibroma of the proximal tibia. A two-staged surgical procedure was successfully performed: wide resection and endoprosthetic reconstruction. Surgeons should be aware of the complexity of its treatment in the locally advanced and aggressive cases. A comprehensive review of the literature is also provided.
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Affiliation(s)
- Oriol Pujol
- Unidade de Oncologia Ortopédica, Departamento de Cirurgia Ortopédica, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autónoma de Barcelona. Barcelona, Spain
| | - Sara Castellanos
- Unidade de Oncologia Ortopédica, Departamento de Cirurgia Ortopédica, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autónoma de Barcelona. Barcelona, Spain
| | - María G. Carrasco
- Unidade de Oncologia Ortopédica, Departamento de Cirurgia Ortopédica, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autónoma de Barcelona. Barcelona, Spain
| | - Alejandro Garzón
- Departamento Anatomopatológico, Hospital Universitari Vall d'Hebron, Barcelona. Universitat Autónoma de Barcelona. Barcelona, Spain
| | - Cleofe Romagosa
- Departamento Anatomopatológico, Hospital Universitari Vall d'Hebron, Barcelona. Universitat Autónoma de Barcelona. Barcelona, Spain
| | - Roberto Vélez
- Unidade de Oncologia Ortopédica, Departamento de Cirurgia Ortopédica, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autónoma de Barcelona. Barcelona, Spain
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De Vita A, Vanni S, Miserocchi G, Fausti V, Pieri F, Spadazzi C, Cocchi C, Liverani C, Calabrese C, Casadei R, Recine F, Gurrieri L, Bongiovanni A, Ibrahim T, Mercatali L. A Rationale for the Activity of Bone Target Therapy and Tyrosine Kinase Inhibitor Combination in Giant Cell Tumor of Bone and Desmoplastic Fibroma: Translational Evidences. Biomedicines 2022; 10:biomedicines10020372. [PMID: 35203581 PMCID: PMC8962296 DOI: 10.3390/biomedicines10020372] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 12/10/2022] Open
Abstract
Giant cell tumor of bone (GCTB) and desmoplastic fibroma (DF) are bone sarcomas with intermediate malignant behavior and unpredictable prognosis. These locally aggressive neoplasms exhibit a predilection for the long bone or mandible of young adults, causing a severe bone resorption. In particular, the tumor stromal cells of these lesions are responsible for the recruiting of multinucleated giant cells which ultimately lead to bone disruption. In this regard, the underlying pathological mechanism of osteoclastogenesis processes in GCTB and DF is still poorly understood. Although current therapeutic strategy involves surgery, radiotherapy and chemotherapy, the benefit of the latter is still debated. Thus, in order to shed light on these poorly investigated diseases, we focused on the molecular biology of GCTB and DF. The expression of bone-vicious-cycle- and neoangiogenesis-related genes was investigated. Moreover, combining patient-derived primary cultures with 2D and 3D culture platforms, we investigated the role of denosumab and levantinib in these diseases. The results showed the upregulation of RANK-L, RANK, OPN, CXCR4, RUNX2 and FLT1 and the downregulation of OPG and CXCL12 genes, underlining their involvement and promising role in these neoplasms. Furthermore, in vitro analyses provided evidence for suggesting the combination of denosumab and lenvatinib as a promising therapeutic strategy in GCTB and DF compared to monoregimen chemotherapy. Furthermore, in vivo zebrafish analyses corroborated the obtained data. Finally, the clinical observation of retrospectively enrolled patients confirmed the usefulness of the reported results. In conclusion, here we report for the first time a molecular and pharmacological investigation of GCTB and DF combining the use of translational and clinical data. Taken together, these results represent a starting point for further analyses aimed at improving GCTB and DF management.
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Affiliation(s)
- Alessandro De Vita
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Silvia Vanni
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
- Correspondence:
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, 47121 Forli, Italy;
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Claudia Cocchi
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Chiara Calabrese
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Roberto Casadei
- Orthopedic Unit, Morgagni-Pierantoni Hospital, 47121 Forli, Italy;
| | - Federica Recine
- Medical Oncology Unit, Azienda Ospedaliera San Giovanni Addolorata, 00184 Roma, Italy;
| | - Lorena Gurrieri
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.V.); (G.M.); (V.F.); (C.S.); (C.C.); (C.L.); (C.C.); (L.G.); (A.B.); (L.M.)
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Intramedullary Fixation With a Short Nail in a Young Patient Presenting With a Pathological Proximal Femur Fracture. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e21.00055-7. [PMID: 34077396 PMCID: PMC8174550 DOI: 10.5435/jaaosglobal-d-21-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
An 18-year-old man presented with a pathological fracture of the right proximal
femur. Desmoplastic fibroma was diagnosed through histological studies. Surgical
management involved extended intralesional curettage and fracture stabilization
by open reduction with intramedullary nailing, using a short Gamma nail. At
42-month follow-up, the patient presented no limitations or recurrence. Internal
fixation after prior intralesional curettage is a valid treatment strategy for
pathological fractures in young patients. A short nail was chosen to prevent
direct tumor cell seeding throughout the femur and future recurrence. Fracture
consolidation was achieved because of the healing potential of a young
patient.
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