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Tan X, Zhang Y, Wei D, Yang Y, Xiang F. Denosumab for giant cell tumors of bone from 2010 to 2022: a bibliometric analysis. Clin Exp Med 2023; 23:3053-3075. [PMID: 37103655 DOI: 10.1007/s10238-023-01079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Giant cell tumors of the bone (GCTB) are considered moderately malignant bone tumors. Denosumab, as a neoadjuvant therapy, provides new possibilities for treating GCTB. However, even after multiple studies and long-term clinical trials, there are limitations in the treatment process. Research data and Medical Subject Headings terms related to denosumab and GCTB were collected from January 2010 to October 2022 using the Web of Science and MeSH ( https://meshb.nlm.nih.gov ) browsers. These data were imported into CiteSpace and VOSviewer softwares for bibliometric analysis. Overall, 445 publications on denosumab and GCTB were identified. Over the last 12 years, the growth rate of the total number of publications has remained relatively stable. The USA published the highest number of articles (83) and had the highest centrality (0.42). Amgen Inc. and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) First Ortoped Rizzoli were identified as the most influential institutions. Many authors have made outstanding contributions to this field. Lancet Oncology had the highest journal impact factor (54.433). Local recurrence and drug dosage are current research hotspots, and future development trends will mainly focus on prognostic markers of GCTB and the development of new therapies. Further research is required to analyze denosumab's safety and efficacy and understand its local recurrence of GCTB, to identify the optimal dose. Future progress in this field will likely focus on exploring new diagnostic and recurrence markers to monitor disease progression and examine new therapeutic targets and treatment strategies.
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Affiliation(s)
- Xiaoqi Tan
- Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Zhang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Daiqing Wei
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Yunkang Yang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
| | - Feifan Xiang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China.
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China.
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Formica VM, Bruno V, Scotto Di Uccio A, Cocca E, Rossi B, Zoccali C. The giant cell tumor during pregnancy: A review of literature. Orthop Traumatol Surg Res 2022; 109:103396. [PMID: 36087835 DOI: 10.1016/j.otsr.2022.103396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2022] [Accepted: 07/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Giant cell tumors (GTC) of bone are benign, locally aggressive tumors generally occurring in young people with a female predominance during reproductive age. Considering their worsening during pregnancy it has been suggested that pregnancy can accelerate GCT progression or favor recurrence but correlation between tumor growth and pregnancy has not yet been clarified. Aim of this study was to clarify clinical characteristics, timing and type of treatment through a literature review on GTCs occurring during pregnancy. PATIENTS AND METHODS An electronic search was performed in December 2020 in PubMed, Scopus, Embase, Medline, Cochrane Register using the keywords "giant cell tumor" AND "pregnancy" looking for papers reporting cases of giant cell tumors of the bone onset or recurred during pregnancy. The electronic search identified 212 papers; sixteen studies were selected, for a total of 32 cases. RESULTS The diagnosis was made during pregnancy in 24 cases and after the partum in 8 cases. 27 cases were new diagnoses while 5 cases were recurrences. Pulmonary metastases were reported in 3 patients. The treatment was performed during the pregnancy in 7 out of 32 cases; in the remaining 27 cases treatment was performed after delivery. The hormone receptor status was reported in 14 patients. Data regarding follow-up was reported for 26 out of 32 patients; three patients had local recurrences that were treated with wide resection and amputation in 2 and 1 case, respectively; at the last follow-up all patients were apparently without any evidence of disease except for three patients who had stable lung metastases. DISCUSSION In case of GCT during pregnancy, a multidisciplinary approach is necessary to offer the patients the best treatment in terms of mother and child's health. A correct diagnosis is necessary and not confusing tumor symptoms with ones of pregnancy is mandatory in order not to delay the diagnosis and let the tumor progress. Actually, even though pregnancy would seem to promote GCT growth and aggressiveness, the relationship is not clear. More studies are necessary to clarify this interesting aspect. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Virginia M Formica
- Hand and Microsurgery Unit, Jewish Hospital, Via Fulda, 14, 00148 Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Scotto Di Uccio
- School of General Surgery, General Surgery and Organ Transplantation Unit, Umberto I Polyclinic of Rome, Sapienza University, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Emilio Cocca
- Orthopaedic and Traumatology Unit, Department of General Surgery, Plastic Surgery, Orthopedics, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro 3, 00185 Rome, Italy
| | - Barbara Rossi
- Oncological Orthopaedics Department. IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Carmine Zoccali
- Orthopaedic and Traumatology Unit, Department of General Surgery, Plastic Surgery, Orthopedics, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro 3, 00185 Rome, Italy; Oncological Orthopaedics Department. IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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Yuan B, Zhang L, Yang S, Ouyang H, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center. Global Spine J 2022; 12:1449-1461. [PMID: 33499650 PMCID: PMC9393967 DOI: 10.1177/2192568220982280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. RESULTS Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid-fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. CONCLUSIONS Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.
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Affiliation(s)
- Bei Yuan
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Peking University Health Science Center, Haidian District, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Shaomin Yang
- Department of Pathology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Hanqiang Ouyang
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Liang Jiang
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Liang Jiang and Zhongjun Liu, Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. Emails: ;
| | - Feng Wei
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Liang Jiang and Zhongjun Liu, Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. Emails: ;
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Borkowska AM, Szumera-Ciećkiewicz A, Szostakowski B, Pieńkowski A, Rutkowski PL. Denosumab in Giant Cell Tumor of Bone: Multidisciplinary Medical Management Based on Pathophysiological Mechanisms and Real-World Evidence. Cancers (Basel) 2022; 14:cancers14092290. [PMID: 35565419 PMCID: PMC9100084 DOI: 10.3390/cancers14092290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The widely accepted local therapy in extremity giant cell tumor of bone (GCTB) is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. Most GCTB patients with localized disease can be successfully treated with surgical curettage; patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice. Abstract (1) Despite the benign nature of the giant cell tumor of bone (GCTB), it shows a local recurrence rate of up to 50% and a chance of malignant transformation. The widely accepted local therapy in extremity GCTB is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab, a human monoclonal antibody directed against the RANKL and associated inhibition of the RANKL pathway, is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. (2) The literature review of patients with GCTB treated with denosumab is performed via PubMed, using suitable keywords from January 2009 to January 2021. (3) Current indications for denosumab use are not definitively clear and unambiguous. Most GCTB patients with localized disease can be successfully treated with surgical curettage, and the role of denosumab in preoperative therapy in this patient population remains unclear. (4) However, patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice.
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Affiliation(s)
- Aneta Maria Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Bartłomiej Szostakowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Andrzej Pieńkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Piotr Lukasz Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
- Correspondence:
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Howard EL, Gregory J, Tsoi K, Evans S, Flanagan A, Cool P. Comorbidities and Pregnancy Do Not Affect Local Recurrence in Patients With Giant Cell Tumour of Bone. Cureus 2020; 12:e9164. [PMID: 32802601 PMCID: PMC7419151 DOI: 10.7759/cureus.9164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study evaluates the relationship between pregnancy, comorbid conditions and giant cell tumour of bone. Furthermore, it examines if pregnancy and comorbid conditions affect the outcome following treatment for this tumour. A multi-centre retrospective review was conducted of consecutive patients with a confirmed histological diagnosis of giant cell tumour of bone between June 2012 and May 2017. A total of 195 patients were identified from two centres. Of these, 168 patients were treated with curative intent and had more than six months follow-up. Data were collected on pregnancy status, comorbid conditions, site of disease, surgical management and local recurrence rates. Statistical analysis included the Fisher exact test and Kaplan-Meier survival analysis. There were 72 females of childbearing age, of which 15 (21%) were currently pregnant or had been pregnant within the last six months. The pregnancy rate is higher than the highest reported pregnancy rate over the last 10 years (8.4%; Fisher test, p = 0.033). Women were more likely to have a comorbid condition than men (Fisher test, p < 0.002) and had a higher rate of autoimmune disease than the normal population (p = 0.015). Men were older than women (Wilcoxon test, p = 0.046) and had less risk of local recurrence (logrank test, p = 0.014). Pregnancy or comorbid conditions did not increase the local recurrence rate. Predictors for local recurrence included location in the distal radius (logrank test, p < 0.001), intralesional treatment (logrank test, p = 0.008) and age less than 40 (logrank test, p = 0.043). In conclusion, giant cell tumour of bone is more common in pregnant females and patients with immune disease. Comorbidities and pregnancy do not affect the local recurrence rate. Male patients over 40 years of age have a lower risk of local recurrence, and patients with disease in the distal radius have a high risk of recurrence.
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Affiliation(s)
- Emma L Howard
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Jonathan Gregory
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Kim Tsoi
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Scott Evans
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Adrienne Flanagan
- Pathology, The Royal Orthopaedic Hospital NHS Foundation Trust, Stanmore, GBR
| | - Paul Cool
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR.,Medical Sciences, Keele University, Keele, GBR
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Siesel C, Muhammad B, Weiner S. Giant Cell Tumor After Distal Radius Open Reduction and Internal Fixation in a Pregnant Woman: A Case Report. JBJS Case Connect 2020; 10:e2000165. [PMID: 32910571 DOI: 10.2106/jbjs.cc.20.00165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 32-year-old pregnant woman presented with new wrist pain after a fall. She had undergone surgical repair to the same wrist 6 years previously for a distal radius fracture. At that time, there was no evidence of a bone lesion. Current radiographs revealed a radiolucent lesion in the metaepiphyseal region. Intraoperative frozen section confirmed a giant cell tumor (GCT). Definitive management consisted of intralesional curettage, burring, and cementation of the distal radius with reapplication of distal radius plate. CONCLUSION Currently, there is no known link between GCT and fracture or pregnancy.
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Affiliation(s)
- Craig Siesel
- 1Department of Orthopaedic Surgery, Summa Health, Akron, Ohio 2Northeast Ohio Medical University, Rootstown, Ohio
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Bitterman J, Donovan J, Lam M. Diagnosis and rehabilitation of a pregnant woman with spinal cord disorder due to spinal cord tumor. Spinal Cord Ser Cases 2019; 5:8. [PMID: 30701085 PMCID: PMC6345917 DOI: 10.1038/s41394-019-0153-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Spinal cord tumors are a rare cause of spinal cord disorder (SCD). Early diagnosis can be challenging, especially in patient populations with other potential etiologies for back pain, such as pregnant women. Case presentation A 28-year-old female presented at 8 weeks gestation with thoracic back pain initially diagnosed as gestational low back pain. Her symptoms progressed to lower extremity weakness. After diagnosis and resection of a spinal cord ependymoma, we collaborated with the inpatient interdisciplinary team to devise a rehabilitation program focused on minimizing pregnancy-related complications and optimizing care of a newborn in the setting of a new paraplegia. Discussion Providers should not assume all pregnant women with low back pain have gestational back pain, as it can be due to more insidious causes. The rehabilitation course for women who develop an SCD during gestation should be carefully tailored toward their pre- and post-natal care and with the education of how the disorder can affect pregnancy and parenting.
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Affiliation(s)
- Jason Bitterman
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Jayne Donovan
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ USA
- Kessler Institute for Rehabilitation, West Orange, NJ USA
| | - Mylan Lam
- Kessler Institute for Rehabilitation, West Orange, NJ USA
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Figueiro-Filho EA, Al-Sum H, Parrish J, Wunder JS, Maxwell C. Maternal and Fetal Outcomes in Pregnancies affected by Bone and Soft Tissue Tumors. AJP Rep 2018; 8:e343-e348. [PMID: 30574428 PMCID: PMC6261736 DOI: 10.1055/s-0038-1676289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022] Open
Abstract
Objective This study was aimed to describe perinatal outcome of a cohort of pregnant patients with bone and soft tissue tumors and to compare the current series with our group's previously reported experience. Methods Pregnant women diagnosed before and during pregnancy were identified, retrospectively, for the years 2004 to 2014. Relevant maternal and neonatal data were collected. Results Forty-eight patients were identified. Ten cases were diagnosed during pregnancy. Pelvis, abdomen, and extremities were the most common tumor locations. Osteosarcoma, liposarcoma, and Ewing's sarcoma were the most common histological types and comprise more than 50% of the cases. Metastases occurred in nine cases. Most of the cases (60%) were treated surgically during pregnancy and delivery occurred at term. Chemotherapy was delayed until after delivery. There were no perinatal or infant deaths. Patients presented with advanced maternal disease in 18% in previous report (1983-2003) versus 40% in present report (2004-2014). Metastases were present in 40% and maternal death rate was approximately 20% in both cohorts. Conclusion Pregnant women with bone and soft tissue tumors are candidates for standard surgical management during pregnancy. Other treatments, such as chemotherapy and radiotherapy must be evaluated for each woman on a case-by-case basis. Iatrogenic prematurity was common in our findings.
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Affiliation(s)
| | - Hythem Al-Sum
- Division of Maternal-Fetal Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Jacqueline Parrish
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Maxwell
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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En Bloc Resection Versus Intralesional Surgery in the Treatment of Giant Cell Tumor of the Spine. Spine (Phila Pa 1976) 2017; 42:1383-1390. [PMID: 28146024 DOI: 10.1097/brs.0000000000002094] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, ambispective observational study. OBJECTIVE The aim of this study was to quantify local recurrence (LR) and mortality rates after surgical treatment of spinal giant cell tumor and to determine whether en bloc resection with wide/marginal margins is associated with improved prognosis compared to an intralesional procedure. SUMMARY OF BACKGROUND DATA Giant cell tumor (GCT) of the spine is a rare primary bone tumor known for its local aggressiveness. Optimal surgical treatment remains to be determined. METHODS The AOSpine Knowledge Forum Tumor developed a comprehensive multicenter database including demographics, presentation, diagnosis, treatment, mortality, and recurrence rate data for GCT of the spine. Patients were analyzed based on surgical margins, including Enneking appropriateness. RESULTS Between 1991 and 2011, 82 patients underwent surgery for spinal GCT. According to the Enneking classification, 59 (74%) tumors were classified as S3-aggressive and 21 (26%) as S2-active. The surgical margins were wide/marginal in 27 (36%) patients and intralesional in 48 (64%) patients. Thirty-nine of 77 (51%) underwent Enneking appropriate (EA) treatment and 38 (49%) underwent Enneking inappropriate (EI) treatment. Eighteen (22%) patients experienced LR. LR occurred in 11 (29%) EI-treated patients and six (15%) EA-treated patients (P = 0.151). There was a significant difference between wide/marginal margins and intralesional margins for LR (P = 0.029). Seven (9%) patients died. LR is strongly associated with death (Relative Risk 8.9, P < 0.001). Six (16%) EI-treated patients and one (3%) EA-treated patients died (P = 0.056). With regards to surgical margins, all patients who died underwent intralesional resection (P = 0.096). CONCLUSION En bloc resection with wide/marginal margins should be performed when technically feasible because it is associated with decreased LR. Intralesional resection is associated with increased LR, and mortality correlates with LR. LEVEL OF EVIDENCE 3.
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Zheng K, Xu M, Wang B, Yu XC, Hu YC. Giant Cell Tumor of the Mobile Spine Occurring in Pregnancy: A Case Report and Literature Review. Orthop Surg 2017; 9:252-256. [PMID: 28547859 DOI: 10.1111/os.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/16/2017] [Indexed: 11/26/2022] Open
Abstract
Giant cell tumor (GCT) is a benign, locally aggressive tumor that rarely occurs in the spine. They usually occur in patients between 20 and 40 years of age; some patients with GCT present in hospital with pregnancy. The management of these patients can be challenging. The current study reports a case of GCT located in the sixth thoracic vertebra of a 31-year-old female at 34 weeks of gestation. An osteolytic lesion, 3.5 cm × 3.5 cm in diameter, was identified on CT. An MRI test of the lesion revealed a soft tissue mass involving the T 6-7 vertebrae, extending to the right pedicle of the T 6 vertebra and causing significant spinal cord compression. The patient delivered a healthy boy by cesarean at 35 weeks of gestation. One week later, she underwent a T 6 -T 7 laminectomy, posterior spinal decompression, and instrument fusion. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. At the 2-year follow-up, there is no evidence of local reoccurrence and the patient has no constitutional symptoms. The present study also reviews eight similar previously reported cases of GCT in the mobile spine, with a discussion of the demographic characteristics, treatment, and prognosis of pregnant patients. This report adds to the existing literature, making the reader aware that clinical symptoms of GCT in the mobile spine can be misinterpreted as a symptom of pregnancy. For spinal GCT in pregnant women, continued pregnancy and definitive surgery after the baby is born are recommended without any serious nerve damage.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Bing Wang
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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Chen R, Xiao A, Xing L, You C, Liu J. A rare thoracic intraspinal schwannoma in twin pregnancy with aggravated clinical presence: A case report following CARE. Medicine (Baltimore) 2017; 96:e6327. [PMID: 28296753 PMCID: PMC5369908 DOI: 10.1097/md.0000000000006327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION This is the first case report about a thoracic intraspinal schwannoma in twin pregnancy with aggressive clinical presentation. CLINICAL PRESENCE AND DIAGNOSES A 21-year-old woman presented with a 2-month history of back pain and slight lower extremity numbness and weakness, and her symptoms were misdiagnosed as normal reactions to pregnancy until she progressed to complete paralysis and incontinence within 2 weeks. She was then confirmed to have thoracic intraspinal schwannoma through MRI. INTERVENTIONS AND OUTCOMES Surgery was performed using a unilateral hemilaminectomy approach with a comfortable lateral position during operation. The patient exhibited significant improvements in sensation and muscle strength after surgery. She delivered 2 healthy baby girls by eutocia in her 38th week of pregnancy. LESSONS The diagnosis of this disease and the 4 possible mechanisms of its aggravated clinical presence are discussed. Intraspinal schwannomas during pregnancy are rare but may cause critical consequences for both the mother and the fetus. Timely diagnosis and multidisciplinary treatment by obstetricians, anesthesiologists, surgeons, oncologists, and neonatologists are essential for the clinical management of this disease.
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Affiliation(s)
- Ruiqi Chen
- Department of Neurosurgery, West China Hospital
| | - Anqi Xiao
- Department of Neurosurgery, West China Hospital
| | - Lu Xing
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital
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Zhou X, Liu XZ, Fan GT, Wu SJ, Zhao JN, Shi X. Expression of Matrix Metalloproteinase-9 and CD34 in Giant Cell Tumor of Bone. Orthop Surg 2017; 8:220-5. [PMID: 27384731 DOI: 10.1111/os.12250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/19/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Giant cell tumor of bone (GCTB) invades extensively and metastasizes, however, the pathological grade and imaging findings are not accurate predictors of its prognosis. Thus, the aim of this study was to explore the relationships between expression of cluster of differentiation (CD)34 and matrix metalloproteinase-9 (MMP-9) and the biological behavior of GCTB with the hope of identifying predictors of prognosis. METHODS Sixty-eight patients with GCTBs attending our institution from September 2008 to August 2013 were enrolled in this prospective study and grouped according to tumor location. Relevant patient characteristics were assessed. Additionally, the expression of CD34 and MMP-9 in these patients was assayed by an immunohistochemistry staining procedure and the relationships between CD34/MMP-9 and microvessel density (MVD) analyzed by Spearman correlation analysis. RESULTS It was found that CD34 factor localizes in the cytoplasm of the endothelial cells of small blood vessels in the tumor stroma and is strongly expressed in GCTBs. In addition, radiological grading showed that there was significantly more CD34 antibody-labeled MVD in invasive than in non-invasive tumors (P < 0.05) and significantly more CD34 antibody-labeled MVD in patients who developed recurrences than in those who did not (P < 0.05). Expression of MMP-9 was localized in the cytoplasm of tumor cells and the rate of MMP-9 positivity in GCTBs was significantly higher in active and invasive tumors than in non-invasive tumors (P < 0.01). Moreover, there were significantly more MVDs in MMP-9-positive than in MMP-9 negative tumors (P < 0.01). CD34 and MMP-9 are positively correlated with MVD values in GCTBs and closely correlated with their grade of malignancy. CONCLUSION Expression of CD34 and MMP-9 accurately predicts clinical behavior detection and prognosis of GCTBs.
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Affiliation(s)
- Xing Zhou
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xiao-Zhou Liu
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Gen-Tao Fan
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Su-Jia Wu
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jian-Ning Zhao
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xin Shi
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
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Fujibuchi T, Matsumoto S, Shimoji T, Ae K, Tanizawa T, Gokita T, Hayakawa K, Motoi N. Two-stage surgery on pregnant woman with a giant cell tumor of bone who refused blood transfusion: A case report. J Orthop Sci 2017; 22:169-172. [PMID: 26740439 DOI: 10.1016/j.jos.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Taketsugu Fujibuchi
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan.
| | - Seiichi Matsumoto
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Takashi Shimoji
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Keisuke Ae
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Taisuke Tanizawa
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Tabu Gokita
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Keiko Hayakawa
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Noriko Motoi
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
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Brodowicz T, Hemetsberger M, Windhager R. Denosumab for the treatment of giant cell tumor of the bone. Future Oncol 2016; 11:1881-94. [PMID: 26161925 DOI: 10.2217/fon.15.94] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Giant cell tumor of bone is typically composed of neoplastic stromal cells and non-neoplastic osteoclastic giant cells. RANK-expressing osteoclastic giant cells are recruited by RANK ligand excreted by the stromal cells, and used by these neoplastic cells to create expansion space. Denosumab specifically binds to and inhibits RANK ligand, thereby eradicating osteoclastic giant cells from the tumor and thus reducing osteolytic activity. Clinical studies reported disease stabilization and clinical benefit in terms of reduced pain and analgesics use, avoided surgeries or surgeries with less morbid procedures. Adverse events observed in patients with giant cell tumor of bone were consistent with the known safety profile of denosumab with a very low incidence of hypocalcemia and osteonecrosis. Overall, denosumab was shown to suppress osteolytic activity and slow disease progression and is thus a treatment option for patients with giant cell tumor of bone.
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Affiliation(s)
- Thomas Brodowicz
- Department of Internal Medicine 1/Oncology, Comprehensive Cancer Center Vienna, MusculoSkeletal Tumor Unit, Medical University Vienna, Vienna, Austria
| | | | - Reinhard Windhager
- Department of Orthopedics, Comprehensive Cancer Center Vienna, MusculoSkeletal Tumor Unit, Medical University Vienna, Vienna, Austria
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Abstract
BACKGROUND CONTEXT Spinal giant cell tumors (SGCT) remain challenging tumors to treat. Although advancements in surgical techniques and adjuvant therapies have provided new options for treatment, evidence-based algorithms are lacking. PURPOSE This study aims to review the peer-reviewed literature that addresses current treatment options and management of SGCT, to produce an evidence-based treatment algorithm. STUDY DESIGN/SETTING A systematic review was performed. METHODS Articles published between January 1, 1970 and March 31, 2015 were selected from PubMed and EMBASE searches using keywords "giant cell tumor" AND "spine" AND "treatment." Relevant articles were selected by the authors and reviewed. RESULTS A total of 515 studies were identified, of which 81 studies were included. Complete surgical resections of SCGT resulted in the lowest recurrence rates. However, morbidity of en bloc resections is high and in some cases, surgery is not possible. Intralesional resection can be coupled with adjuvant therapies, but evidence-based algorithms for use of adjuvants remain elusive. Several recent advancements in adjuvant therapy may hold promise for decreasing SGCT recurrence, specifically stereotactic radiotherapy, selective arterial embolization, and medical therapy using denosumab and interferon. CONCLUSIONS Complete surgical resection of SGCT should be the goal when possible, particularly if neurologic impairment is present. Denosumab holds promise as an adjuvant and perhaps stand-alone therapy for SGCT. Spinal giant cell tumors should be approached as a case-by-case problem, as each presents unique challenges. Collaboration of spine surgeons, radiation oncologists, and medical oncologists is the best practice for treating these difficult tumors.
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Matcuk GR, Patel DB, Schein AJ, White EA, Menendez LR. Giant cell tumor: rapid recurrence after cessation of long-term denosumab therapy. Skeletal Radiol 2015; 44:1027-31. [PMID: 25712768 DOI: 10.1007/s00256-015-2117-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/29/2015] [Accepted: 02/09/2015] [Indexed: 02/02/2023]
Abstract
We report a case of rapid recurrence of a giant cell tumor (GCT) of the distal radius in a 24-year-old woman following the cessation of long-term denosumab therapy. GCT of bone is a histologically benign tumor with multinucleated giant cells on a background of mononuclear giant cells usually presenting as a well-defined epi-metaphyseal lytic lesion without sclerotic margins. Denosumab, a monoclonal antibody to the receptor activator of nuclear factor kappa-B ligand (RANKL), has proven to be an effective neoadjuvant treatment for GCT. The tumor in this case had demonstrated a good response with sustained control for over 2 years while on denosumab therapy. However, within 2 months of cessation of therapy, the tumor demonstrated rapid recurrence and progression with growth, osteolysis, and increased soft tissue component. Despite reinitiating denosumab therapy, there was progressive tumor growth and destruction, ultimately necessitating below-the-elbow amputation. This case illustrates the need for maintenance of denosumab therapy for GCT of bone or definitive surgical treatment prior to its cessation.
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Affiliation(s)
- George R Matcuk
- Department of Radiology, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA,
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Delfyett WT, Fetzer DT. Imaging of Neurologic Conditions During Pregnancy and the Perinatal Period. Neurol Clin 2012; 30:791-822. [DOI: 10.1016/j.ncl.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318256e7f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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