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Tan Y, Zhang S, Zhang J, Huang T, Li X, Zhou X, Zhang J. Denosumab treatment for progressive Enneking stage II cervical giant-cell tumor conservatively. Funct Integr Genomics 2023; 23:76. [PMID: 36867323 DOI: 10.1007/s10142-023-01004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
Cervical giant cell tumor of the bone (GCTB) is a rare, primary benign bone tumor in pediatric patients. Surgery remains the primary choice for treating resectable cervical GCTB. Additional adjuvant therapeutic options are available for patients with unresectable cervical GCTB, including the anti-RANKL monoclonal antibody, denosumab. We represented a case incidentally found in a 7-year-old female, who complained severe craniocervical pain, grade 2-3 dysphagia, dysphonia, hypesthesia, and extremity weakness. The patient showed an impressive clinical response to denosumab, both clinically and radiologically, without adverse events or recurrence. To date, this is the youngest patient ever reported to have a progressive Enneking stage II C3 GCTB treated with denosumab alone. Denosumab can be administered as a single and conservative therapy for pediatric patients with unresectable upper cervical GCTB, avoiding the risks and morbidity of surgical and radiative treatment.
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Affiliation(s)
- YiXuan Tan
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Shuhan Zhang
- Department of Anesthesia, Shanghai Changzheng Hospital, Shanghai, China
| | - Jinling Zhang
- Medical School of Nanjing University, Nanjing, China
| | - Tao Huang
- Huzhou University, Huzhou, Zhejiang, China
| | - Xiaoming Li
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China.
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China.
| | - Jiefeng Zhang
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China.
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Luo Y, Xiu P, Chen H, Zeng J, Song Y, Li T. Denosumab salvage therapy in an 11-year-old boy with locally recurrent unresectable giant cell tumor of the lumbar spine after surgery. Neurochirurgie 2023; 69:101427. [PMID: 36828057 DOI: 10.1016/j.neuchi.2023.101427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 02/24/2023]
Abstract
Giant cell tumors (GCTs) of the bone are locally aggressive primary bone tumors with a benign character. Spinal involvement is rare which accounts for approximately 5% of all primary bone tumors and it is quite rare in the lumbar spine. An 11-year-old boy patient presented with pain of low back and bilateral low extremities. Lumbar CT and MRI revealed a lytic lesion of the L4 vertebra corpus. The patient earned remarkable and timely recovery with 2 surgical interventions and the use of denosumab. Surgical resection for GCTs is still preferable as the initial treatment, denosumab should be utilized after tumor resection whether based on the purpose of prevention or treatment of tumor recurrence.
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Affiliation(s)
- Y Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China
| | - P Xiu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China
| | - H Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China
| | - J Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China
| | - Y Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China
| | - T Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China.
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3
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Muacevic A, Adler JR, Shum JS, Ng KK. Sacral Giant Cell Tumor Presenting as Low Back Pain in the Chiropractic Office: A Case Report. Cureus 2023; 15:e33262. [PMID: 36741639 PMCID: PMC9891398 DOI: 10.7759/cureus.33262] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
Sacral giant cell tumors are a rare cause of low back pain and may be challenging to identify via routine clinical examination and radiography. A 47-year-old woman presented to a chiropractor with a one-month history of worsening low back pain with radiation to the posterior thighs, worsened with ambulation, and used a cane to walk. She previously saw an orthopedic surgeon and was diagnosed with lumbar spondylosis, having tried anti-inflammatory medications, exercises, and acupuncture without success. The chiropractor ordered lumbar magnetic resonance imaging which revealed an aggressive sacral lesion and referred the patient to an oncologist. The oncologist performed positron emission tomography/computed tomography and biopsy, confirming a sacral giant cell tumor. A surgical team recommended tumor resection, lumbosacral fusion, radiotherapy, and zoledronic acid infusion. Sacral giant cell tumors are rare and may be challenging to identify via routine radiography. These tumors are an important differential to consider for patients with unexplained lumbosacral symptoms unresponsive to care.
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Tsuji Y, Fukuo Y, Kanemitsu T, Katayama Y, Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Baba I, Takami T, Wanibuchi M. Multimodal Management of Combined Posterior and Anterior Surgical Approach and Postoperative Pharmacological Therapy for Giant Cell Tumor of the Cervical Spine Encasing the Vertebral Artery: A Technical Case Report. Neurol Med Chir (Tokyo) 2022; 62:438-443. [PMID: 36031352 PMCID: PMC9534568 DOI: 10.2176/jns-nmc.2022-0158] [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: 11/20/2022] Open
Abstract
Giant cell tumor (GCT) of bone is essentially benign but locally aggressive, and the rate of local recurrence is high when the resection is not enough. En bloc resection is recommended as an ideal solution for GCT to decrease the risk of local recurrence, but it remains challenging for cervical GCT. In this technical case report, we present a case of extensively infiltrating GCT of the cervical spine completely encasing the vertebral artery (VA) on one side. The tumor was distributed to layers A-D, sectors 3-8 based on the Weinstein-Boriani-Biagini staging. Combined posterior and anterior surgical approach for the cervical spine was successfully performed and followed by postoperative adjuvant pharmacological therapy. This kind of multimodal management may be one of the solutions for advanced cervical GCT.
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Affiliation(s)
- Yuichiro Tsuji
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University.,Department of Neurosurgery, Kano General Hospital
| | - Yusuke Fukuo
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Takuya Kanemitsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Ichiro Baba
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
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5
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Hashimoto K, Nishimura S, Miyamoto H, Toriumi K, Ikeda T, Akagi M. Comprehensive treatment outcomes of giant cell tumor of the spine: A retrospective study. Medicine (Baltimore) 2022; 101:e29963. [PMID: 35960103 PMCID: PMC9371551 DOI: 10.1097/md.0000000000029963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
There is no consensus on a treatment strategy for spinal giant cell tumor of bone (GCTB) because of the difficulty in their treatment. Treatment options often include the use of the controversial denosumab, an antibody therapy aimed at tumor shrinkage, different curettage techniques, resection, or a combination of these therapies. The current study aimed to identify treatment methods associated with favorable outcomes in patients with spinal GCTB. We retrospectively reviewed 5 patients with spinal GCTB, including patients with tumors of the sacrum, treated at our hospital between September 2011 and November 2020. Two men and 3 women were included in the study. The median follow-up period was 74 months (range: 14-108 months). We surveyed the tumor site, treatment method, denosumab use, and outcomes. The median age was 17 years (range: 17-42 years). There were 2 cases of sacral GCTB and 1 case each of lumbar, cervical, and thoracic vertebral GCTB. The comorbidities observed included hepatitis, malignant lymphoma, atopic dermatitis, and asthma. The treatment method included zoledronic acid after embolization and denosumab, denosumab only, curettage and posterior fusion, and curettage resection after embolization and anterior and posterior fusion. Denosumab was used in all cases. Three patients were continuously disease-free, 1 patient with no evidence of disease, and 1 patient alive with disease. Aggressive treatment, especially surgical treatment, may lead to good results in spinal GCTB.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
- *Correspondence: Kazuhiko Hashimoto, Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka 589-8511, Japan (e-mail: )
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Hiroshi Miyamoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Kensuke Toriumi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Terumasa Ikeda
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
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Yao H, Duan P, Zhu X, Zhong Y, Li X, Wang H, Chou D. Treatment of Benign C2 Tumors with Transoral Curettage and Posterior Instrumentation with Minimum 2-Year Follow-Up: Technical Note. Neurol India 2022; 70:68-73. [DOI: 10.4103/0028-3886.336331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Cervical spine giant cell bone tumor. Med Clin (Barc) 2021; 157:593-594. [PMID: 33972102 DOI: 10.1016/j.medcli.2021.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/20/2022]
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8
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Yayan J. Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis. Cancer Control 2021; 27:1073274820934822. [PMID: 32869648 PMCID: PMC7710399 DOI: 10.1177/1073274820934822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Denosumab is a human monoclonal antibody that has been used successfully in the treatment of giant cell tumors of bone. These tumors are rare and, in principle, benign, but they are highly aggressive, locally advanced, osteolytic bone tumors that can metastasize to the lungs. Denosumab is an effective treatment when these tumors cannot be surgically removed or when surgical resection is likely to lead to severe morbidity (eg, loss of limbs or joints). The aim of this systematic review and meta-analysis was to investigate patients with giant cell tumors of bone who experienced tumor progression during treatment with denosumab and to compare them with patients who experienced reduction of their giant cell tumors of bone during treatment with denosumab. METHODS Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for trials submitted by January 7, 2020, that reported the efficacy and safety of denosumab in patients with giant cell tumors of bone. RESULTS Sixty studies were reviewed, involving a total of 1074 patients who had giant cell tumors of bone and were treated with denosumab. Of the 60 studies, 58% of the patients were from case series studies, 39% from open-label phase II studies, and 3% from case reports. The response rate for denosumab as a treatment for giant cell tumors of bone was 97.5%, with statistical significance (P < .0001). Pain in the limbs was statistically the most common adverse event for denosumab treatment in case series studies (P < .0001). No treatment-related deaths occurred in the reviewed studies. CONCLUSION Cumulative evidence supports the addition of surgery to optimal medical therapy with denosumab to reduce tumor size, clinical symptoms, and mortality among patients with giant cell tumors of bone.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, 163483Witten/Herdecke University, Witten, Germany
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9
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Multiprofessional Management of Giant Cell Tumors in the Cervical Spine: A Systematic Review. World Neurosurg 2021; 151:53-60. [PMID: 33857672 DOI: 10.1016/j.wneu.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Giant cell tumors of the bone (GCTB) are rare bone tumors, especially in the cervical spine. Generally considered benign, local aggressiveness and metastatic growth have been described. Surgical concepts for GCTB are challenged by complex neurovascular anatomy. Specific clinical management guidelines are nonexistent. This systematic review aims to compile existing evidence on the treatment of GCTB of the cervical spine. METHODS Four electronic databases were searched: Medline, Embase, Web of Science, and Cochrane Library. All clinical studies reporting the treatment of GCTB in the human cervical spine in English language were found eligible for review. RESULTS Seven studies were included in the synthesis including a total number of 54 patients. Of those patients, 46 (85%) were treated for naive nonrecurrent GCTB. Only 1 study is considered a cohort study; all other studies were case reports. Generally, intralesional procedures were performed in 13 (24%) cases. Subtotal resections were reported for 11 (20%) patients. Twenty-eight (52%) patients were surgically treated with piecemeal resection, en-bloc resection, or spondylectomy. Thirty-six (67%) patients underwent adjuvant radiotherapy. A combination of radiotherapy and chemotherapy was reported in 2 (4%) cases. Bisphosphonates were prescribed for 9 (17%) patients. Inconsistent reporting of outcome data did not allow for comparative analyses. CONCLUSIONS Best available evidence suggests that the most aggressive surgical approach should be the main goal of any GCTB surgery. No specific adjuvant or neoadjuvant treatment can be recommended as superior due to a lack of comparative data. Therapeutic approaches need to be planned thoroughly on an individual basis.
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An Intraoperative Surprise! A Rare Case Report of Primary Craniovertebral Junction Hydatid Disease Mimicking a Bony Tumor. World Neurosurg 2020; 146:171-176. [PMID: 33220475 DOI: 10.1016/j.wneu.2020.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Craniovertebral junction (CVJ) hydatid disease, although rare, forms an important differential diagnosis of CVJ bony pathologies, especially in endemic areas due to the sheer volume of cases presented there. The authors report a rare case of CVJ hydatid disease mimicking a bony expansile tumor on imaging. CASE DESCRIPTION A 21-year-old woman presented with a left-sided neck tilt and pain for 3 months, intermittent low-grade fever, and features of high cervical myelopathy (Nurick grade II). Magnetic resonance imaging and computed tomography imaging showed a solid enhancing mass with numerous small cystic areas with bony erosion of the basiocciput, C1 and C2 vertebrae, suggestive of an expansile bony lesion (osteoblastoma/giant cell tumor/aneurysmal bone cyst). She underwent a posterior approach for decompression and spinal fixation, and multiple clear grape-like cysts were encountered that were confirmed to be hydatid cysts on histopathology. All visible cysts were excised and instrumented fusion of the CVJ performed. Albendazole was continued for 6 weeks and at 3 months' follow-up, the patient remains asymptomatic with no recurrence on imaging. CONCLUSIONS The authors conclude that in tropical regions, hydatid disease of the cervical spine should be considered in the differential diagnosis of patients presenting with high cervical compressive myelopathy, especially when associated with fever. Spinal hydatosis may mimic a bony lesion on imaging and should be kept in mind, as in addition to routine decompression, use of scolicidal agents and intact removal of cysts have a significant effect on reducing the recurrence rate and improving the outcome.
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Singh PK, Agrawal M, Mishra S, Agrawal D, Sawarkar D, Jagdevan A, Verma S, Doddamani R, Meena R, Garg K, Chandra PS, Kale SS. Management of C2 Body Giant Cell Tumor by Innovatively Fashioned Iliac Crest Graft and Modified Cervical Mesh Cage Used as Plate. World Neurosurg 2020; 140:241-246. [PMID: 32473331 DOI: 10.1016/j.wneu.2020.05.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locally aggressive vertebral body tumors of the axis must be treated with wide local excision for best outcome. Reconstruction of the load-bearing vertebra needs to be done after tumor resection in such a manner so as to give stable, long-term fusion in this young population. METHODS We describe the management strategy of a 25-year-old acutely quadriplegic patient, with respiratory distress, with a C2 giant cell tumor. The use of a novel iliac crest graft modification used for C2 reconstruction along with a modified mesh cage used as an anterior plate has been reported. RESULTS The patient had a good outcome at 18 months' follow-up, with neurologic improvement and a solid fusion. CONCLUSIONS Iliac crest autograft is inexpensive and easy to harvest and can be considered as a C2 prosthesis, especially in a resource-constrained setting. Modified iliac crest graft can be used for load transmission from C1 lateral mass to C3 body, and the mesh cage can be modified according to need as a plate with good results in an emergency.
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Affiliation(s)
- Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Dattaraja Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amandeep Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Poodipedi S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Mohaidat ZM, Al-Jamal HZ, Bany-Khalaf AM, Radaideh AM, Audat ZA. Giant cell tumor of bone: Unusual features of a rare tumor. Rare Tumors 2019; 11:2036361319878894. [PMID: 31598208 PMCID: PMC6764048 DOI: 10.1177/2036361319878894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
Giant cell tumor of bone is a benign tumor with an aggressive behavior. Its typical subarticular location and high recurrence risk can be associated with significant morbidity. Although benign, it can rarely metastasize especially to the lungs. Also, it can be multicentric in less than 1% of patients. Late malignant transformation, although rare, can occur with a very poor prognosis. This series reports on these unusual and challenging features and management considerations of giant cell tumor of bone. This retrospective study included review of the medical records of patients with a confirmed histopathological diagnosis of giant cell tumor of bone. A total of 25 patients (16 females and 9 males) with a mean age of 34.5 years were included; 22 had primary tumors, while 3 were referred with recurrent tumors. Pain was the most common presenting symptom. Most patients had grade III tumors. Tumors around the knee were the most common. Multicentric tumors were detected in three patients. Twenty-three patients (20 primary giant cell tumor of bone and 3 with recurrence) received treatment. Most patients (15/23) were treated with intralesional curettage with or without adjuvants. Seven patients had wide excision. Recurrence was seen in 45% (9/20) of primary giant cell tumor of bone especially with difficult anatomical locations. Most recurrences occurred more than 4 years after treatment. Pulmonary nodules were detected in four patients; two of them showed resolution during follow-up. One patient developed secondary sarcoma transformation with a fatal outcome. Giant cell tumor of bone was more common in females. Long bones were more affected, especially around the knee. Intralesional curettage was the most frequently used treatment. Recurrence was associated with inadequate tumor resection (especially in difficult anatomical location), younger age, male gender, and advanced local tumor grade. Denosumab can be used in the treatment of pulmonary metastasis, multicentric and recurrent giant cell tumor of bone. Due to late recurrence and malignant transformation, a prolonged follow-up is warranted.
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Affiliation(s)
- Ziyad M Mohaidat
- Orthopedic Surgery Division, Department of Special Surgery, Jordan University of Science & Technology, Irbid, Jordan
| | - Hisham Z Al-Jamal
- Orthopedic Surgery Division, Department of Special Surgery, Jordan University of Science & Technology, Irbid, Jordan
| | - Audai M Bany-Khalaf
- Orthopedic Surgery Division, Department of Special Surgery, Jordan University of Science & Technology, Irbid, Jordan
| | - Ahmad M Radaideh
- Orthopedic Surgery Division, Department of Special Surgery, Jordan University of Science & Technology, Irbid, Jordan
| | - Ziad A Audat
- Orthopedic Surgery Division, Department of Special Surgery, Jordan University of Science & Technology, Irbid, Jordan
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13
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Chen CJ, Brien EW. Early postoperative compilations of bone filling in curettage defects. J Orthop Surg Res 2019; 14:261. [PMID: 31419993 PMCID: PMC6698034 DOI: 10.1186/s13018-019-1297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for mechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl methacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of the study is to show that good functional result can be achieved with curettage and bone filler, regardless of type. Methods A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment and placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and paresthesia. Complication rates at our single institution were compared against literature values for three study cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Z-score for two populations were used to compare our subset against literature values and between different bone filling types. Results Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which the bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate of 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any complications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had sample sizes too small for statistical comparison. Statistical comparison yielded no significant difference between complications in any of the filling groups (P = 0.411). Conclusions Some has even argued that bone defects following curettage do not require bone filling for good outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be conferred by filling large bone defects. There was no significant difference in postoperative complication rates between allograft, bone graft substitute, and PMMA when compared at our institution and with literature values. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent reconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as a suitable alternative to other bone filling modalities.
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Affiliation(s)
- Clark J Chen
- Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
| | - Earl W Brien
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
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Sertbaş İ, Karatay M, Hacisalihoğlu UP. Cervical spine giant cell bone tumor: a case report. World J Surg Oncol 2019; 17:82. [PMID: 31078142 PMCID: PMC6511659 DOI: 10.1186/s12957-019-1625-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Giant cell tumors (GCTs) of the bone are locally aggressive primary bone tumors with a benign character. Spinal involvement is rare and they are quite rare in the cervical spine. Case presentation A 31-year-old male patient presented with neck pain. Cervical CT revealed a lytic lesion extending posteriorly and causing the collapse of the C4 vertebra corpus. The patient underwent excision of the tumor extending from the anterior to the posterior with a single-stage anterior intervention followed by the placement of an anterior cage and plate-screw system for fusion. The pathology was reported as GCT. Conclusions The posteriorly located lesion was widely curetted through an anterior approach in a single session.
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Affiliation(s)
- İdris Sertbaş
- Department of Neurosurgery, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi,Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey.
| | - Mete Karatay
- Department of Neurosurgery, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi,Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey
| | - Uguray Payam Hacisalihoğlu
- Department of Pathology, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi, Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey
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Xu K, Wan W, Li B, Li J, Huang Q, Liu Y, Jiang D, Xu Y, Xiao J. Prognostic Significance of Preoperative Plasma D-Dimer Level and Clinical Factors in Patients with Spinal Giant Cell Tumor: Retrospective Analysis of 153 Patients in a Single Center. World Neurosurg 2019; 122:e872-e880. [DOI: 10.1016/j.wneu.2018.10.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
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Lin P, Lin N, Teng W, Wang SD, Pan WB, Huang X, Yan XB, Liu M, Li HY, Li BH, Sun LL, Wang Z, Zhou XZ, Ye ZM. Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases. Orthop Surg 2018; 10:107-114. [PMID: 29878714 PMCID: PMC6001436 DOI: 10.1111/os.12375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT. Methods A retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21–40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow‐up was 81.3 months (range, 35.7–172.1 months). Results All patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse‐free time after the first surgery was 32.3 months (range, 10.5–62.6 months). The overall mean relapse‐free time was 40.2 months (range, 10.5–157 months). No distant metastasis was found in our series. At the final follow‐up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery. Conclusion Intralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.
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Affiliation(s)
- Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Wangsiyuan Teng
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Sheng-Dong Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Wei-Bo Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiao-Bo Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Meng Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Heng-Yuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Bing-Hao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Ling-Ling Sun
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xing-Zhi Zhou
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhao-Ming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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Elder BD, Ishida W, Goodwin CR, Bydon A, Gokaslan ZL, Sciubba DM, Wolinsky JP, Witham TF. Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis. Neurosurg Focus 2017; 42:E16. [PMID: 28041327 DOI: 10.3171/2016.8.focus16112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3-9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5-6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.
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Affiliation(s)
- Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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