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Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J 2022; 104-B:1352-1361. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0401.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Aims We performed a systematic literature review to define features of patients, treatment, and biological behaviour of multicentric giant cell tumour (GCT) of bone. Methods The search terms used in combination were “multicentric”, “giant cell tumour”, and “bone”. Exclusion criteria were: reports lacking data, with only an abstract; papers not reporting data on multicentric GCT; and papers on multicentric GCT associated with other diseases. Additionally, we report three patients treated under our care. Results A total of 52 papers reporting on 104 patients were included in the analysis, with our addition of three patients. Multicentric GCT affected predominantly young people at a mean age of 22 years (10 to 62), manifesting commonly as metachronous tumours. The mean interval between the first and subsequent lesions was seven years (six months to 27 years). Synchronous lesions were observed in one-third of the patients. Surgery was curettage in 63% of cases (163 lesions); resections or amputation were less frequent. Systemic treatments were used in 10% (n = 14) of patients. Local recurrence and distant metastases were common. Conclusion Multicentric GCT is rare, biologically aggressive, and its course is unpredictable. Patients with GCT should be followed indefinitely, and referred promptly if new symptoms, particularly pain, emerge. Denosumab can have an important role in the treatment. Cite this article: Bone Joint J 2022;104-B(12):1352–1361.
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Affiliation(s)
- Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Jones NF, Graham DJ. Radical Resection of a Recurrent Giant Cell Tumor of the Distal Ulna and Immediate Reconstruction With a Distal Radio-Ulnar Joint Implant Arthroplasty. Hand (N Y) 2020; 15:727-731. [PMID: 31965863 PMCID: PMC7543204 DOI: 10.1177/1558944719895779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Giant cell tumors (GCTs) of the distal ulna are rare. Despite being benign, they can be locally aggressive and may recur following conventional treatment by curettage and bone grafting. Salvage reconstructive options after failed conventional treatment include Darrach resection, Suave-Kapandji procedure, hemi-arthroplasty, or total joint arthroplasty. Methods: We discuss reconstruction options for the distal radio-ulnar joint following tumor resection, and present the outcomes of a constrained distal radio-ulnar prosthesis in a 29-year-old male following resection of a distal ulna GCT. Results: Reconstruction of the distal radio-ulnar joint by a constrained prothesis yielded excellent functional outcomes following resection of a GCT of the distal ulna. Conclusions: This case demonstrates that successful oncologic and functional outcomes can be achieved by radical resection of a recurrent GCT of the distal ulna and reconstruction with a constrained total joint arthroplasty.
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Affiliation(s)
- Neil F. Jones
- University of California, Los Angeles, USA,Neil F. Jones, Department of Orthopaedic Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - David J. Graham
- Gold Coast University Hospital, Southport, Queensland, Australia
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Aycan OE, Sökücü S, Özer D, Çetinkaya E, Arıkan Y, Kabukçuoğlu YS. Primary bone tumors and tumor like lesions of the ulna. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:30-34. [PMID: 29773449 PMCID: PMC6424703 DOI: 10.1016/j.aott.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 03/27/2017] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to discuss the diagnosis and surgical management and their results according to stage of primary bone tumors at ulna and to share our experience on this exceptional location for bone tumors. METHODS We have retrospectively reviewed our clinics database and identified 23 cases (14 males and 9 females, mean age was 28.9 (range 4-77)) with primary bone tumors and tumor like lesion involvement of ulna. The patients were evaluated according to complaints, type and grade of tumor, treatment, recurrence and functional status. RESULTS The most common first referral complaint was constrictive pain in 52.1% of the cases, benign tumors and tumor like lesions of the bone constituted 73.9% whereas malignant bone tumors were 26.1%, 39.1% of the lesions were located in distal end of ulna and the mean follow up was 33.8 months (range 8-172 months). Local recurrence has unexpectedly occurred in 3 benign lesions (13.1%). CONCLUSION Benign bone lesions tend to involve distal and proximal ends, malign bone lesions involve diaphysis mostly. Both benign and malignant diaphyseal lesions of the ulna have better postoperative results regarding the lesions at both ends of ulna. One should also take care of recurrences even after a decade from the primary surgery. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Osman Emre Aycan
- Department of Orthopaedic Surgery, Siverek State Hospital, Turkey.
| | - Sami Sökücü
- Department of Orthopaedic Surgery, Baltalimani Bone Diseases Training and Research Hospital, Turkey
| | - Devrim Özer
- Department of Orthopaedic Surgery, Baltalimani Bone Diseases Training and Research Hospital, Turkey
| | - Engin Çetinkaya
- Department of Orthopaedic Surgery, Baltalimani Bone Diseases Training and Research Hospital, Turkey
| | - Yavuz Arıkan
- Department of Orthopaedic Surgery, Baltalimani Bone Diseases Training and Research Hospital, Turkey
| | - Yavuz Selim Kabukçuoğlu
- Department of Orthopaedic Surgery, Baltalimani Bone Diseases Training and Research Hospital, Turkey
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Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases. Case Rep Oncol Med 2015; 2015:354158. [PMID: 26106496 PMCID: PMC4461722 DOI: 10.1155/2015/354158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 11/28/2022] Open
Abstract
Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.
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Multifocal metachronous giant cell tumor: case report and review of the literature. Case Rep Med 2014; 2014:678035. [PMID: 24511316 PMCID: PMC3912820 DOI: 10.1155/2014/678035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/13/2013] [Accepted: 12/05/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Giant cell tumors (GCTs) of bone are known for their local aggressiveness and high recurrence rate. There are rare cases of multicentric GCT and most are synchronous. We herein review metachronous multicentric GCT reported in the literature. Material and Methods. A MEDLINE, Cochrane, and Google Scholar search was done to collect all cases of multicentric metachronous GCT specifying the clinical, radiological, and histological characteristics of each location and its treatment. Results. A total of 37 multifocal giant cell tumors were found in the literature. 68% of cases of multicentric giant cell tumors occur in less than 4 years following treatment of the first lesion. Thirty-seven cases of multifocal metachronous GCT were identified in the literature until 2012. Patients with multicentric GCT tend to be younger averaging 23. There is a slight female predominance in metachronous GCT. The most common site of the primary GCT is around the knee followed by wrist and hand and feet. Recurrence rate of multicentric GCT is 28.5%. Conclusion. Multicentric giant cell tumor is rare. The correct diagnosis relies on correlation of clinical and radiographic findings with confirmation of the diagnosis by histopathologic examination.
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Novais EN, Shin AY, Bishop AT, Shives TC. Multicentric giant cell tumor of the upper extremities: 16 years of ongoing disease. J Hand Surg Am 2011; 36:1610-3. [PMID: 21872406 DOI: 10.1016/j.jhsa.2011.06.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 02/02/2023]
Abstract
Multicentric giant cell tumor is rare and accounts for less than 1% of all giant cell tumors of bone. We describe a case in which all the lesions occurred in the upper extremities. The 13-year-old boy's first tumor was in the left index metacarpal. Over 16 years, giant cell tumors occurred in 8 sites: right distal radius, left lunate, left middle metacarpal, left distal radius, right ring finger proximal phalanx, right radial head, left distal humerus, and left proximal humerus. Intralesional curettage of the lesions located in the hand and carpals was associated with a high incidence of local recurrence, whereas lesions in the proximal radius and in the humerus have not recurred.
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Affiliation(s)
- Eduardo N Novais
- Children's Hospital Colorado, University of Colorado, Department of Orthopedic Surgery, USA
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Tumeurs à cellules géantes de l’os. Particularités anatomocliniques: à propos de 14 cas. ONCOLOGIE 2010. [DOI: 10.1007/s10269-008-0973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rousseau MA, Ilharreborde B, Larousserie F, Babinet A, Tomeno B, Anract P. [Multicentric giant-cell tumor]. ACTA ACUST UNITED AC 2008; 93:848-53. [PMID: 18166958 DOI: 10.1016/s0035-1040(07)78469-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nearly all (99) giant-cell tumors are solitary. The multicentric presentation is exceptional and not well elucidated. We report the case of a patient presenting five foci identified over an eleven-year period (right tibia, left 4th metacarpal, sacrum, right femur, left femur). The proliferation index was identified for each focus. A review of the literature shows that the development of a new center after treatment for giant-cell tumor is a well-known event, with a wide variability in localizations, number and time to development. The most recent data suggest that each center would be independent progressing according to an individual course. Since histological transformation is not observed and multicenter forms are very exceptional, we suggest that it would not be necessary to propose specific screening for patients with a giant-cell tumor but that it would be good to inform the patient of the possibility of multicentric presentations.
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Affiliation(s)
- M-A Rousseau
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris.
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Multicentric metachronous giant cell tumour of vertebrae and tibia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2008. [DOI: 10.1007/s00590-008-0302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Dhillon MS, Prabhudev Prasad AP, Virk MS, Aggarwal S. Multicentric giant cell tumor involving the same foot: A case report and review of literature. Indian J Orthop 2007; 41:154-7. [PMID: 21139770 PMCID: PMC2989141 DOI: 10.4103/0019-5413.32049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Multicentric giant cell tumour (GCT) is extremely rare; no case has been previously reported where two lesions occurred in the same foot at different sites. We report a case involving the calcaneus and subsequently the 3(rd) toe of the same foot and review the reported literature. In established cases of multicentricity, the histopathology has to be properly reviewed and the patient has to be followed up for a longer time with serial whole body assessment to pick up any subsquent lesions. The treatment of the local disease does not differ from a standard GCT.
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Affiliation(s)
- Mandeep S Dhillon
- Department of Orthopedics, PGIMER, Chandigarh, India,Correspondence: Dr. M. S. Dhillon, 1090/2, Sector 39 - B, Chandigarh, India. E-mail:
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11
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Rousseau MA, Handra-Luca A, Lazennec JY, Catonné Y, Saillant G. Metachronous multicentric giant-cell tumor of the bone in the lower limb. Case report and Ki-67 immunohistochemistry study. Virchows Arch 2004; 445:79-82. [PMID: 15278449 DOI: 10.1007/s00428-004-1011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 03/03/2004] [Indexed: 10/26/2022]
Abstract
Multicentric giant-cell tumors of the bone (GCTs) are rare. Little is known about the mechanisms by which these tumors spread and how 1% of GCT turn out to be multicentric. We report the case of a 19-year-old woman with metachronous multiple and recurrent GCTs that were unusual in their pattern of progression along the right lower limb over a 23-year period. Histology showed no evidence of malignant transformation. The treatment was repeated curettage and packing with cement. This did not permit a wide surgical margin, but avoided amputation and preserved full limb function. We tested the proliferation index marker Ki-67 in the tumor specimens. Ki-67 expression was limited to the mononuclear cell component of the tumors. The proliferation index was similar in each new tumor and higher in recurrences for each location. In this case, proliferation was initially low in the new tumor location, despite the time difference and independent from the initial clone evolution. Proliferation index increased in recurrent GCTs after marginal margin resection.
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Affiliation(s)
- Marc-Antoine Rousseau
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital La Pitié Salpêtrière, Université de Paris VI, 47 bd de l'Hôpital, 75013, Paris, France
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12
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Park IH, Jeon IH. Multicentric giant cell tumor of bone: ten lesions at presentation. Skeletal Radiol 2003; 32:526-9. [PMID: 12879297 DOI: 10.1007/s00256-003-0658-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Revised: 04/08/2003] [Accepted: 04/16/2003] [Indexed: 02/02/2023]
Abstract
The case of a 19-year-old man with multicentric and subsequent metachronous giant cell tumor of bone is presented. Ten lesions were identified at presentation and eventually two more lesions developed. The multiplicity of 12 lesions over a 40-month period is most unusual.
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Affiliation(s)
- Il-Hyung Park
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50 Samduk, Chung-Gu, 700-721 Taegu, Korea (South)
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Abstract
Metachronous multicentric giant cell tumors of bone are rare. The case of a 47-year-old woman who had a giant cell tumor of the ilium develop 24 years after resection of a giant cell tumor of the proximal tibia is reported. The initial and current surgical approaches for this patient are described. A literature review is presented to show that this patient had the longest disease-free interval documented for a patient with metachronous multicentric giant cell tumors.
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Taylor KF, Yingsakmongkol W, Conard KA, Stanton RP. Multicentric giant cell tumor of bone: a case report and review of the literature. Clin Orthop Relat Res 2003:267-73. [PMID: 12771839 DOI: 10.1097/01.blo.0000063784.32430.b0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Multicentric giant cell tumor of bone is the rare variant of a lesion that is relatively common in a skeletally mature population. An otherwise healthy 13-year-old boy presenting with this entity was followed up for 6 years. During this period, the patient was diagnosed with and treated for six individual lesions. One recurrence required resection, Ilizarov bone lengthening, and subsequent ankle arthrodesis. He remains fully active and free of distant metastasis.
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