Giant Cell-Rich Tumors of Bone

Denosumab as treatment of central giant cell granuloma of the jaws. a scoping review

Denosumab has been considered a treatment option for Central Giant Cell Granuloma (CGCG) a benign locally aggressive osteolytic lesion of the jaws. This study aimed to perform a scoping review of CGCG treated with Denosumab. The research question was: What is Denosumab's effectiveness in treating CGCG of the jaws? Studies that used Denosumab as a treatment for CGCGs in the jaws were selected following PRISMA-ScR guidelines, using Pubmed/Medline, Scopus, and Springer Link databases, among others. Demographics, clinical information, dosing, efficacy, adverse drug reactions (ADRs), and imaging tests used to assess the evolution of the lesions were extracted. Twenty-one studies were selected. Sixty patients with a mean age of 23.2 years were treated with Denosumab, 42% with 120 mg subcutaneously monthly, additional doses on days 1, 8, and 15 for month 1 in adults. In children, dosing was adjusted by weight to 60 or 70 mg. To avoid ADRs 500 mg of calcium and 400 IU of vitamin D orally were used. Initial effective response was reported after 1-3 months, with recurrence of 19.6% and ADRs in 74% of cases. Denosumab is effective for CGCG with monthly subcutaneous doses of 120 mg, 60 or 70 mg in patients < 45 or 50 kg for ≥ 12 months with calcium and vitamin D supplementation until remission changes are observed. Extensive or refractory lesions were the main indications. Common ADRs were hypo and hypercalcemia. Further studies are needed to define dose and supplementation protocols to avoid ADRs during and after therapy.

Histones and their practical application in bone tumors: Do I always need them?

Historically, the diagnosis of giant cell-rich neoplasms arising in bone has been challenging owing to overlapping clinical and radiographic findings resulting in the difficult separation of several neoplasms, particularly when biopsy material is limited. However, with the discovery of the driver histone mutations in giant cell tumor of bone (GCTB) and chondroblastoma, as well as USP6 rearrangements in aneurysmal bone cyst, pathologists now have objective ancillary tools to aid in the separation of several histologically similar giant cell-rich neoplasms. Furthermore, the recognition of histone mutations has allowed pathologists to revisit several entities, such as "malignant chondroblastoma," and furthered our understanding of phenomena such as "aneurysmal bone cyst-like change," formerly recognized as "secondary aneurysmal bone cyst." Herein, the evolution of testing for histone mutations in bone tumors is considered; the sensitivity and specificity of the histone antibodies is reviewed; and a practical guide for the use of these ancillary tests is offered.

Management of RANKL-mediated Disorders With Denosumab in Children and Adolescents: A Global Expert Guidance Document

CONTEXT

Denosumab is an effective treatment for many receptor activator of nuclear factor kappa-B ligand (RANKL)-mediated disorders but there are potential safety considerations and limited data to guide its use in children and adolescents.

OBJECTIVE

This document seeks to summarize the evidence and provide expert opinion on safe and appropriate use of denosumab in pediatric RANKL-mediated disorders.

PARTICIPANTS

Ten experts in pediatric bone and mineral medicine from 6 countries with experience in the use of denosumab participated in the creation of this document.

EVIDENCE

Data were sourced from the published literature, primarily consisting of case reports/series and review articles because of the lack of higher level evidence. Expert opinion of the authors was used substantially when no published data were available.

CONCLUSION

Denosumab is an effective treatment for RANKL-mediated disorders in children and adolescents but is often not curative and, in some cases, is best used in conjunction with surgical or other medical treatments. Careful multidisciplinary planning is required to define the goals of treatment and expert oversight needed to manage the risk of mineral abnormalities. Substantive, collaborative research efforts are needed to determine optimal treatment regimens and minimize risks.

Fine needle aspiration of bone lesions: A tertiary care centre experience

BACKGROUND

Bone fine needle aspiration (FNA) presents several diagnostic challenges including limited sample material, reduced ability to assess the architecture, and lack of a standardised reporting system. The aim of our study is to present our experience regarding bone FNA.

METHODS

We performed a 6-year retrospective search of our archives to identify all FNA cases of bone lesions. Available data regarding patients' demographics, cytopathology, and surgical pathology were recorded. The FNA cases were then grouped into five categories (atypical, neoplasm-benign, neoplasm of unknown malignant potential, suspicious for malignancy, and malignant) and the risk of malignancy (ROM) was calculated.

RESULTS

A total of 341 FNA cases performed in 337 patients (M = 173, F = 164; mean age = 57.2 years) were identified. The iliac crest was the most commonly biopsied site (n = 134). The adequacy of bone FNA was 77.4%. The sensitivity and specificity regarding the nature of the lesion were 96.5% and 100%, respectively. The overall diagnostic accuracy of bone FNA was 77%. The accuracy of bone FNA for non-metastatic bone lesions including non-neoplastic lesions was 74%, while the diagnostic accuracy of bone FNA for a metastatic disease was 83.5%. The diagnostic accuracy for primary neoplastic lesions was 70%. The frequency (n,%) of cytomorphological categories were as follows: atypical (30, 8.8%); neoplasm-benign (6, 1.8%); neoplasm of unknown malignant potential (18, 5.3%); suspicious for malignancy (4, 1.2%); and malignant (145, 42.5%). The ROM in these categories was respectively as follows: 51.7%, 0%, 46.7%, 100%, and 99.1%.

CONCLUSION

FNA is a sensitive and specific technique for the diagnosis of bone lesions. In most instances, an accurate diagnosis can be achieved if adequate material, ancillary studies, and radiological correlation are available.

Giant Cells of Various Lesions Are Characterised by Different Expression Patterns of HLA-Molecules and Molecules Involved in the Cell Cycle, Bone Metabolism, and Lineage Affiliation: An Immunohistochemical Study with a Review of the Literature

Giant cells (GCs) are thought to originate from the fusion of monocytic lineage cells and arise amid multiple backgrounds. To compare GCs of different origins, we immunohistochemically characterised the GCs of reactive and neoplastic lesions (n = 47). We studied the expression of 15 molecules including HLA class II molecules those relevant to the cell cycle, bone metabolism and lineage affiliation. HLA-DR was detectable in the GCs of sarcoidosis, sarcoid-like lesions, tuberculosis, and foreign body granuloma. Cyclin D1 was expressed by the GCs of neoplastic lesions as well as the GCs of bony callus, fibroid epulis, and brown tumours. While cyclin E was detected in the GCs of all lesions, p16 and p21 showed a heterogeneous expression pattern. RANK was expressed by the GCs of all lesions except sarcoid-like lesions and xanthogranuloma. All GCs were RANK-L-negative, and the GCs of all lesions were osteoprotegerin-positive. Osteonectin was limited to the GCs of chondroblastoma. Osteopontin and TRAP were detected in the GCs of all lesions except xanthogranuloma. RUNX2 was heterogeneously expressed in the reactive and neoplastic cohort. The GCs of all lesions except foreign body granuloma expressed CD68, and all GCs were CD163- and langerin-negative. This profiling points to a functional diversity of GCs despite their similar morphology.

Potential alternative drug treatment for bone giant cell tumor

Background: Bone giant cell tumor (BGCT) is one of the world's major disease types of locally aggressive bone tumors. In recent years, denosumab treatment has been introduced before curettage surgery. However, the current therapeutic was practical only sometimes, given the local recurrence effects after discontinuation of denosumab. Due to the complex nature of BGCT, this study aims to use bioinformatics to identify potential genes and drugs associated with BGCT. Methods: The genes that integrate BGCT and fracture healing were determined by text mining. The gene was obtained from the pubmed2ensembl website. We filtered out common genes for the function, and signal pathway enrichment analyses were implemented. The protein-protein interaction (PPI) networks and the hub genes were screened by MCODE built-in Cytoscape software. Lastly, the confirmed genes were queried in the Drug Gene Interaction Database to determine potential genes and drugs. Results: Our study finally identified 123 common specific genes in bone giant cell tumors and fracture healing text mining concepts. The GO enrichment analysis finally analyzed 115 characteristic genes in BP, CC, and MF. We selected 10 KEGG pathways and identified 68 characteristic genes. We performed protein-protein interaction analysis (PPI) on 68 selected genes and finally identified seven central genes. In this study, these seven genes were substituted into drug-gene interactions, and there were 15 antineoplastic drugs, 1 anti-involving drug, and 1 anti-influenza drug. Conclusion: The 7 genes (including ANGPT2, COL1A1, COL1A2, CTSK, FGFR1, NTRK2, and PDGFB) and 17 drugs, which have not been used in BGCT, but 6 of them approved by the FDA for other diseases, could be potential genes and drugs, respectively, to improve BGCT treatment. In addition, the correlation study and analysis of potential drugs through genes provide great opportunities to promote the repositioning of drugs and the study of pharmacology in the pharmaceutical industry.

A Rare Giant Cell Tumour in the Distal Radius of a Seven-Year-Old Girl: A Case Report

A giant cell tumour (GCT) is a benign and locally aggressive tumour that is usually observable in a skeletally mature patient involving the end of long bones. The reported incidence of this tumour in a skeletally immature patient is extremely rare. However, we report one such case in the distal radius of a seven-year-old female patient. Having presented with painful swelling of the right distal forearm, she underwent clinical and radiological examination, and a diagnosis of distal radius GCT was made. The tumour was treated with curettage, fibular graft, and synthetic bone graft. This case report shows the importance of including GCT in children as a differential diagnosis. This tumour may have a good prognosis if diagnosed and treated early.

Cytodiagnosis of giant cell tumour presenting at unusual age and site with review of literature

Giant cell tumour (GCT), also known as osteoclastoma, is an osteolytic tumour. It involves the epiphyseal and metaphyseal regions of long bones in adults. On rare occasions, these may occur in paediatric patients, and may involve uncommon locations such as the sternum, pelvis and, particularly infrequently, rib bones. We present a rare case of GCT in the rib of a child, diagnosed on fine needle aspiration.