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Liang HF, Xu H, Zhan MN, Xiao J, Li J, Fei QM. Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery: A case report. World J Clin Cases 2024; 12:2894-2903. [PMID: 38899300 PMCID: PMC11185343 DOI: 10.12998/wjcc.v12.i16.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/15/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor (GCT) who require emergency decompressive surgery, there is still a lack of relevant reports on surgical options. This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy (TES). Despite tumor recurrence, three-level TES was repeated after denosumab therapy. CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor. After emergency TES, the patient's spinal cord function recovered, and permanent paralysis was avoided. The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT. Unfortunately, the tumor recurred 9 months after the first surgery. After 12 months of denosumab therapy, the tumor size was reduced, and tumor calcification. To prevent recurrent tumor progression and provide a possible cure, a three-level TES was performed again. The patient returned to an active lifestyle 1 month after the second surgery, and no recurrence of GCT was found at the last follow-up. CONCLUSION This patient with acute paraplegia underwent TES twice, including once in an emergency, and achieved good therapeutic results. TES in emergency surgery is feasible and safe when conditions permit; however, it may increase the risk of tumor recurrence.
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Affiliation(s)
- Hai-Feng Liang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Orthopaedic Surgery, Shanghai Geriatric Medical Center, Shanghai 201104, China
| | - Hao Xu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Meng-Na Zhan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian Xiao
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Juan Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Orthopaedic Surgery, Shanghai Geriatric Medical Center, Shanghai 201104, China
| | - Qin-Ming Fei
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Orthopaedic Surgery, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai 200940, China
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Todi N, Hiltzik DM, Moore DD. Giant cell tumor of bone and secondary osteoarthritis. Heliyon 2024; 10:e30890. [PMID: 38807896 PMCID: PMC11130671 DOI: 10.1016/j.heliyon.2024.e30890] [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: 10/27/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumor of bone is a commonly encountered aggressive epiphyseal bone tumor, most often treated surgically. The natural history and presentation are classically described but the histopathology is poorly understood. Intralesional curettage is the mainstay of treatment, but there is significant variation in the use of adjuvant and cavity filling modalities. No gold standard has been agreed upon for treatment, and a variety of techniques are currently in use. Given its location, secondary osteoarthritis is a known long-term complication. This review examines the natural history of giant cell tumors, treatment options and complications, and subsequent development of osteoarthritis. Arthroplasty is usually indicated for secondary osteoarthritis although data is limited on its efficacy. Further directions will likely center on improved pharmacological treatments as well as improved arthroplasty techniques.
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Affiliation(s)
- Niket Todi
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - David M. Hiltzik
- Northwestern University, Department of Orthopaedic Surgery, 303 E Superior St, Chicago, IL, 60611, USA
| | - Drew D. Moore
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Department of Orthopaedic Surgery, 586 Pioneer Dr, Rochester, MI, 48309, USA
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Cui L, Sun Y, Jin T, Fan D, Liu W. Giant cell tumor of bone at distal radius suffered more soft tissue recurrence and ultrasonography is effective to detect the soft tissue recurrence. Discov Oncol 2024; 15:103. [PMID: 38573423 PMCID: PMC10994907 DOI: 10.1007/s12672-024-00918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Soft tissue recurrence of giant cell tumor of bone (GCTB) is rare. This study aims to provide its prevalence, recurrent locations, risk factors, effective detection methods and a modified classification for this recurrence. METHODS Patients with soft tissue recurrence after primary surgery for GCTB were screened from January 2003 to December 2022. General data, recurrence frequency, types according to an original classification (type-I: peripheral ossification; type-II: central ossification; type-III: without ossification), a modified classification with more detailed subtypes (type I-1: ≤ 1/2 peripheral ossification; type I-2: ≥ 1/2 peripheral ossification; type II-1: ≤ 1/2 central ossification; type II-2: ≥ 1/2 central ossification; type III: without ossification), locations, detection methods such as ultrasonography, X-ray, CT or MRI, Musculoskeletal Tumor Society (MSTS) scores were recorded. Multivariate regression analysis was conducted to identify risk factors for recurrence frequency. RESULTS A total of 558 recurrent cases were identified from 2009 patients with GCTB. Among them, 32 were soft tissue recurrence. The total recurrence rate was 27.78% (558/2009). Soft tissue recurrence rate was 5.73% among 558 recurrent cases, and 1.59% among 2009 GCTB patients, respectively. After excluding one patient lost to follow-up, 10 males and 21 females with the mean age of 28.52 ± 9.93 (16-57) years were included. The definitive diagnosis of all recurrences was confirmed by postoperative pathology. The interval from primary surgery to the first recurrence was 23.23 ± 26.12 (2-27) months. Eight recurrences occurred from primary GCTB located at distal radius, followed by distal femur (6 cases). Recurrence occurred twice in 12 patients and 3 times in 7 patients. Twenty-seven recurrences were firstly detected by ultrasonography, followed by CT or X-ray (10 cases in each). Types at the first recurrence were 5 cases in type-I, 8 in type-II and 18 in type-III. According to the modified classification, 3 patients in type I-1, 2 in type I-2, 1 in type II-1, 7 in type II-2, and 18 in type III. The mean MSTS score was 26.62 ± 4.21 (14-30). Neither Campanacci grade nor recurrence type, modified classification and other characters, were identified as risk factors. CONCLUSIONS Soft tissue recurrence of GCTB may recur for more than once and distal radius was the most common location of primary GCTB that would suffer a soft tissue recurrence. Ultrasonography was a useful method to detect the recurrence. Since no risk factors were discovered, a careful follow-up with ultrasonography was recommended.
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Affiliation(s)
- Lukuan Cui
- Department of Bone and Soft Tissue Oncology, Cangzhou Hospital of Integrated TCM-WM·Hebei, No. 5, Xianghai Road, Cangzhou, 061000, Hebei, People's Republic of China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), No. 5, Xianghai Road, Cangzhou, 061000, Hebei, People's Republic of China
| | - Yang Sun
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital Affiliated to Capital Medical University, No. 31, Xinjiekou East Steet, Xicheng District, Beijing, 100035, People's Republic of China
| | - Tao Jin
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital Affiliated to Capital Medical University, No. 31, Xinjiekou East Steet, Xicheng District, Beijing, 100035, People's Republic of China
| | - Daoyang Fan
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital Affiliated to Capital Medical University, No. 31, Xinjiekou East Steet, Xicheng District, Beijing, 100035, People's Republic of China
| | - Weifeng Liu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital Affiliated to Capital Medical University, No. 31, Xinjiekou East Steet, Xicheng District, Beijing, 100035, People's Republic of China.
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Elshenawy M, Arabi TZ, Ateya HA, Elhassan T, Ali SS, Othman RK, Alkhatib R, Elshentenawy A, Badran A. The Effectiveness of Denosumab in Middle Eastern Patients With Giant Cell Tumor of the Bone: A Single-Center, Retrospective Study. Cureus 2024; 16:e58292. [PMID: 38752067 PMCID: PMC11094665 DOI: 10.7759/cureus.58292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Giant cell tumor of the bone (GCTB) is an aggressive benign tumor, which constitutes 5% of all primary bone tumors. Denosumab, a receptor activator of nuclear factor κB ligand monoclonal antibody, inhibits osteoclast-induced bone destruction and has demonstrated promising results in patients with GCTB. However, the long-term efficacy of the drug has not been extensively studied, especially in the Middle East. METHODOLOGY In this study, we retrospectively analyzed the five-year progression-free survival (PFS) in patients with GCTB at a single Saudi center. PFS was defined as the time from diagnosis until disease progression, relapse, or death. Events were censored after five years from diagnosis. RESULTS Sixty-two patients with GCTB were included in the study. The median age at diagnosis was 31.16 years, and 38 (61.3%) patients were female. Twenty-nine patients (46.8%) received denosumab during the study period. The median duration of denosumab treatment was 5.06 months, and the median number of cycles was 6. The median PFS was not reached, and the five-year PFS rate was 60.3%. Age, gender, body mass index, performance status at presentation, and tumor location had no impact on five-year PFS. Denosumab treatment prolonged PFS; however, this was not statistically significant compared to non-denosumab patients (P = 0.603). CONCLUSIONS Denosumab does not seem to provide superior long-term outcomes compared to surgery alone. Although our findings are generally consistent with other studies in the literature, larger long-term studies are needed to confirm our findings.
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Affiliation(s)
- Mahmoud Elshenawy
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- Department of Clinical Oncology and Nuclear Medicine, Menoufiya University, Shebin El Kom, EGY
| | - Tarek Z Arabi
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Heba A Ateya
- Department of Medical Oncology, Cairo University, Cairo, EGY
| | - Tusneem Elhassan
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saad S Ali
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Rana K Othman
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Ayman Elshentenawy
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Ahmed Badran
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, EGY
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Aydin S, Gulmez AO, Cinar HG. Clinic-Sphenoid Bone Giant Cell Bone Tumor. EAR, NOSE & THROAT JOURNAL 2023:1455613231212708. [PMID: 37994622 DOI: 10.1177/01455613231212708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Affiliation(s)
- Sonay Aydin
- Erzincan Binali Yıldırım Üniversitesi, Erzincan, Turkey
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Leland CR, Pratilas CA, Gross JM, Levin AS. Diffuse Pulmonary Metastases at Presentation of Giant Cell Tumor of Bone: A Case Report and Synthesis of Literature. JBJS Case Connect 2023; 13:01709767-202303000-00004. [PMID: 36821126 DOI: 10.2106/jbjs.cc.22.00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 02/24/2023]
Abstract
CASE We present a 23-year-old man with acute-on-chronic shoulder pain with an aggressive-appearing, destructive lesion of the left proximal humerus and diffuse lung metastases. Biopsy revealed conventional giant cell tumor of bone (GCTB) without sarcomatous differentiation, treated with resection and proximal humerus reconstruction. Without systemic treatment, his pulmonary metastases demonstrated modest spontaneous regression, with no impairment of pulmonary function. CONCLUSIONS Although GCTB is known to metastasize to lungs, these deposits most commonly follow local recurrence. We describe a young adult with diffuse pulmonary nodules at initial presentation, although still following an indolent clinical course without the need for additional systemic therapy.
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Affiliation(s)
- Christopher R Leland
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine A Pratilas
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - John M Gross
- Division of Surgical Pathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Xu R, Choong PFM. Metastatic giant cell tumour of bone: a narrative review of management options and approaches. ANZ J Surg 2022; 92:691-696. [PMID: 35143093 PMCID: PMC9303226 DOI: 10.1111/ans.17520] [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] [Received: 08/11/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
Giant cell tumour of bone (GCTB) is a locally aggressive bone neoplasm with a rare tendency to metastasise, most commonly to the lungs. The management of metastatic GCTB (metGCTB) is controversial due to its unpredictable behaviour. Asymptomatic patients should be monitored radiologically and undergo treatment only when disease progression occurs. Surgery is recommended for resectable metGCTB. Denosumab, a monoclonal antibody which inhibits receptor activator of nuclear factor‐κB ligand, is recommended for unresectable metGCTB with evidence from phase II trials demonstrating its safety and efficacy. Relapse after denosumab withdrawal may occur and prolonged treatment may be associated with serious adverse events, thus further research is warranted to inform a maintenance regimen with reduced dosing and frequency. Combined denosumab and bisphosphonate therapy has the potential to achieve sustained disease control or remission in unresectable metGCTB without requiring long‐term treatment and should be evaluated in prospective trials. Various novel agents have demonstrated in vitro and anecdotal efficacy and warrant further evaluation.
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Affiliation(s)
- Ruiwen Xu
- St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Hayashida K, Kawabata Y, Kato I, Kamiishi T, Matsuo K, Takeyama M, Inaba Y. Clinical and pathological analysis of giant cell tumor of bone with denosumab treatment and local recurrence. J Orthop Sci 2022; 27:215-221. [PMID: 33358447 DOI: 10.1016/j.jos.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is a primary bone tumor which comprises giant cells and two types of stromal cells. Recent studies have suggested therapeutic risks of denosumab. No previous studies have reported changes in serum TRACP-5b and SUVmax of 18F-FDG-PET/CT in recurred GCTB after denosumab treatment. Therefore, we assessed the relationship between clinical and pathological features of GCTB which recurred after denosumab treatment. METHODS We retrospectively reviewed the medical records of 26 patients with GCTB who underwent curettage between 2010 and 2018. Fourteen patients treated with denosumab were defined as the denosumab group. We evaluated TRACP-5b and SUVmax values in the denosumab group. H&E staining and immunohistochemistry for H3.3 G34W were performed for pathological assessment. Twelve patients treated without denosumab were defined as the non-denosumab group and compared with denosumab group. RESULTS The local recurrence rate in the denosumab group was 57.4%. The mean TRACP-5b and SUVmax values were significantly decreased after denosumab therapy (P < 0.001, 1077 ± 161 to 74 ± 9 mU/dL and 8.88 ± 0.40 to 3.79 ± 0.56, respectively). Both parameters significantly increased with local recurrence. H&E staining after denosumab treatment revealed the disappearance of giant cells and histological changes in stromal cells. Specimens of local recurrence subjected to H&E staining and immunohistochemistry for H3.3 G34W demonstrated almost identical features to those in the first biopsy. CONCLUSION Although denosumab can prevent GCTB from osteolysis, local recurrence cannot be reduced by denosumab treatment. The clinical and pathological results were almost the same as those before denosumab treatment, suggesting that the changes of GCTB by denosumab are reversible.
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Affiliation(s)
- Kenta Hayashida
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
| | - Yusuke Kawabata
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan.
| | - Ikuma Kato
- Yokohama City University, Department of Molecular Pathology, Yokohama, Japan
| | - Takayuki Kamiishi
- Fujisawa City Hospital, Department of Orthopaedic Surgery, Fujisawa, Japan
| | - Kosuke Matsuo
- Fujisawa City Hospital, Department of Orthopaedic Surgery, Fujisawa, Japan
| | - Masanobu Takeyama
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
| | - Yutaka Inaba
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
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State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics. Cancers (Basel) 2021; 13:cancers13246298. [PMID: 34944917 PMCID: PMC8699510 DOI: 10.3390/cancers13246298] [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] [Received: 10/31/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The 2020 World Health Organization classification of soft tissue and bone tumors classified the giant cell tumor of bone (GCTB) as an intermediate malignant tumor, with locally aggressive behavior and high recurrence rate. Imaging plays a pivotal role in the assessment of GCTB, and this review tries to summarize the main concepts about GCTB histopathogenesis and new biomarkers, describing those GCTB imaging findings which could possibly be explained by tumor molecular alterations. We have illustrated pre-operative imaging features related to prognosis and radiological findings for response evaluation after surgical treatment and denosumab administration. We have also reported the results described in literature regarding the role of radiomics in aiding GCTB diagnosis, predicting possible post-treatment recurrence and providing a quantitative assessment of the response to denosumab treatment. Abstract Giant cell tumor of bone (GCTB) is classified as an intermediate malignant tumor due to its locally aggressive behavior, burdened by high local recurrence rate. GCTB accounts for about 4–5% of all primary bone tumors and typically arises in the metaphysis and epiphyses of the long tubular bones. Mutation of gene H3F3A is at the basis of GCTB etiopathogenesis, and its immunohistochemical expression is a valuable method for practical diagnosis, even if new biomarkers have been identified for early diagnosis and for potential tumor recurrence prediction. In the era of computer-aided diagnosis, imaging plays a key role in the assessment of GCTB for surgical planning, patients’ prognosis prediction and post treatment evaluation. Cystic changes, penetrating irregular margins and adjacent soft tissue invasion on preoperative Magnetic Resonance Imaging (MRI) have been associated with a higher rate of local recurrence. Distance from the tumor edge to the articular surface and thickness of unaffected cortical bone around the tumor should be evaluated on Computed Tomography (CT) as related to local recurrence. Main features associated with local recurrence after curettage are bone resorption around the graft or cement, soft tissue mass formation and expansile destruction of bone. A denosumab positive response is represented by a peripherical well-defined osteosclerosis around the lesion and intralesional ossification. Radiomics has proved to offer a valuable contribution in aiding GCTB pre-operative diagnosis through clinical-radiomics models based on CT scans and multiparametric MR imaging, possibly guiding the choice of a patient-tailored treatment. Moreover, radiomics models based on texture analysis demonstrated to be a promising alternative solution for the assessment of GCTB response to denosumab both on conventional radiography and CT since the quantitative variation of some radiomics features after therapy has been correlated with tumor response, suggesting they might facilitate disease monitoring during post-denosumab surveillance.
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Morii R, Tsukamoto S, Righi A, Honoki K, Tanaka Y, Kido A, Fujii H, Mavrogenis AF, Tanaka Y, Errani C. Effect of Adjuvant Chemotherapy on Localized Malignant Giant Cell Tumor of Bone: A Systematic Review. Cancers (Basel) 2021; 13:cancers13215410. [PMID: 34771573 PMCID: PMC8582404 DOI: 10.3390/cancers13215410] [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] [Received: 08/12/2021] [Revised: 10/02/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The effect of adjuvant chemotherapy on localized malignant giant cell tumors of the bone (GCTB) is unclear. We compared the mortality associated with wide resection compared to wide resection plus adjuvant chemotherapy for localized primary and secondary localized malignant GCTB. Among 745 relevant studies, 9 were included, with 39 and 73 primary and secondary malignant patients. In primary localized malignant GCTB, the mortality rates were 40% (6/15 patients) and 33% (8/24 patients) in the surgery plus adjuvant chemotherapy and surgery-only groups, respectively. The overall pooled odds ratio was 1.07 (p = 0.92). In secondary localized malignant GCTB, the mortality rates were 30.6% (11/36 patients) and 62.2% (23/37 patients) in the surgery plus adjuvant chemotherapy and surgery-only groups, respectively. The overall pooled odds ratio was 0.31 (p = 0.04). The effect of adjuvant chemotherapy remains unclear for primary localized malignant GCTB, but adjuvant chemotherapy improved the survival of patients with secondary localized malignant GCTB. Abstract A malignant giant cell tumor of the bone (GCTB) is a rare primary malignant tumor classified as primary or secondary. Wide resection of the primary tumor is recommended for localized malignant GCTB, but the effect of adjuvant chemotherapy is unclear. A systematic review was performed to compare the mortality associated with wide resection with that of wide resection plus adjuvant chemotherapy for primary and secondary localized malignant GCTB. Among the 745 studies identified, 9 were included. A total of 112 cases of localized malignant GCTB were included, with 39 and 73 cases being primary and secondary malignant GCTB. In primary localized malignant GCTB, the mortality rates were 40% (6/15 patients) and 33% (8/24 patients) in the surgery plus adjuvant chemotherapy and surgery-only groups, respectively. Overall pooled odds ratio was 1.07 (95% confidence interval, 0.26–4.37; p = 0.92). In secondary localized malignant GCTB, the mortality rates were 30.6% (11/36 patients) and 62.2% (23/37 patients) in the surgery plus adjuvant chemotherapy and surgery-only groups, respectively. The overall pooled odds ratio was 0.31 (95% confidence interval, 0.10–0.95; p = 0.04). The effect of adjuvant chemotherapy remains unclear for primary localized malignant GCTB, but adjuvant chemotherapy improved the survival of patients with secondary localized malignant GCTB.
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Affiliation(s)
- Rokuro Morii
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan; (R.M.); (K.H.); (H.F.); (Y.T.)
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan; (R.M.); (K.H.); (H.F.); (Y.T.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan; (R.M.); (K.H.); (H.F.); (Y.T.)
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, 3-1, Minamoto-Cho, Wakayama-City 640-8222, Wakayama, Japan;
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan;
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan; (R.M.); (K.H.); (H.F.); (Y.T.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City 634-8521, Nara, Japan; (R.M.); (K.H.); (H.F.); (Y.T.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
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Sharma S, Dhillon MS, Singh G, Das A. Fibular Strut Arthrodesis for Salvage of Campanacci Grade III Giant Cell Tumor of the Hallucal Proximal Phalanx: A Case Report. J Foot Ankle Surg 2021; 60:861-865. [PMID: 33757685 DOI: 10.1053/j.jfas.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
Involvement of toe phalanges by giant cell tumor (GCT) is extremely rare; tumors in these locations tend to be aggressive. Whereas aggressive GCTs of the distal phalanx may be managed successfully by en-bloc resection without reconstruction or amputation, management of these lesions, when they involve the proximal phalanx, can be challenging. We present a Campannaci grade III GCT of the hallucal proximal phalanx in a 14-year old girl that had breached into the dorsal soft tissues and the metatarso-phalangeal joint. Wide local resection of the proximal phalanx along with reconstruction arthrodesis with an autologous, non-vascularized fibular strut graft was performed. There was no recurrence at 3 years of follow-up. The patient had an excellent functional outcome. To the best of our knowledge, this is the first case reporting the outcomes of fibular strut arthrodesis for salvage of GCT of the hallucal proximal phalanx.
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Affiliation(s)
- Siddhartha Sharma
- Associate Professor, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep S Dhillon
- Professor and Head, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaganpreet Singh
- Assistant Professor, Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
| | - Ashim Das
- Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh VA, Puri A. The current standing on the use of denosumab in giant cell tumour of the bone. J Orthop Surg (Hong Kong) 2021; 28:2309499020979750. [PMID: 33331233 DOI: 10.1177/2309499020979750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Giant cell tumour of the bone (GCTB) has been classically treated surgically. With the advent of denosumab, there is potential to use it as a targeted therapy to downstage the tumour and control its progression. Like all new therapies, the dosage, duration, and long-term effects of treatment can only be determined over the time through numerous trials and errors. The current recommendation of use of the monoclonal antibody is 3-4 months of neoadjuvant denosumab in patients with advanced GCTB for cases who were not candidates for primary curettage initially, and prolonged use for surgically unsalvageable GCTB. The use of Denosumab in the adjuvant setting to prevent recurrence is not established.
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Affiliation(s)
- Vivek Ajit Singh
- National Orthopaedic Centre of Excellence in Research & Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ajay Puri
- Tata Memorial Centre, Mumbai, Maharashtra, India
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Lucasti C, Patel D, Hawayek B, Maraschiello M, Kowalski J. Giant cell tumor of the thoracic spine causing acute paraplegia-a case report. JOURNAL OF SPINE SURGERY 2021; 7:208-213. [PMID: 34296034 DOI: 10.21037/jss-20-652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/29/2021] [Indexed: 12/30/2022]
Abstract
Giant cell tumors (GCT) are rare and account for approximately 5% of all primary bone tumors. GCTs in the spine make up less than 10% of all GCTs, and less than 5% of all primary spinal tumors. Less than 10% of spinal GCTs occur above the sacrum and cases involving the thoracic spine are seldom reported in the literature. In our case the patient presented with acute paraplegia of bilateral lower extremities after being seen in the emergency department a day earlier. An MRI and CT scan demonstrated near complete destruction of T8 vertebral body with a possible pathologic lesion and fracture associated with dorsal and ventral spinal cord compression and significant signal change within the spinal cord. She underwent T7-T9 laminectomy with excisional biopsy and was subsequently diagnosed with a primary GCT of the thoracic spine. She was definitively treated with resection and T4-12 fusion and 120 mg of denosumab. At four years post follow-up there has been no recurrence of the tumor to date. This is a more acute presentation than has previously been reported. Patients with GCT of the spine typically present with pain and may have further progression to neurologic deficit. This patient's rapid onset of paraplegia is more acute than has been previously reported in the literature. The authors believe that prompt surgical excision and treatment with denosumab can completely resolve GCT of the thoracic spine.
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Affiliation(s)
| | - Dil Patel
- University at Buffalo Orthopaedics and Sports Medicine, Buffalo, NY, USA
| | - Bradley Hawayek
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Mark Maraschiello
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Joseph Kowalski
- University at Buffalo Orthopaedics and Sports Medicine, Buffalo, NY, USA
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Yang E, Li T, Katz A. A giant cell tumor of the bone in the rib cage left to proliferate unfettered for seven years to an extensive size. Respir Med Case Rep 2021; 33:101419. [PMID: 34401267 PMCID: PMC8348908 DOI: 10.1016/j.rmcr.2021.101419] [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] [Received: 12/08/2020] [Revised: 02/21/2021] [Accepted: 04/27/2021] [Indexed: 10/29/2022] Open
Abstract
Giant cell tumors of the bone are generally benign tumors of the bone, though they can be locally invasive in nature. They are also known as "osteoclastomas," and patients are typically between 20 and 40 years of age, who present with pain and swelling of the joints. Though the tumor is benign, malignant degeneration, metastasis, and other complications of tumor growth are possible. Here we present a case where a delay in treatment led to a significant tumor burden. This tumor's unique location in the anterior arc of the rib, as well as its growth to a size that has rarely been reported, ultimately caused major compressive effects that significantly impacted our patient's quality of life.
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Affiliation(s)
- Ellen Yang
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, 60064, IL, USA
| | - Tianyang Li
- Department of Thoracic Surgery, Jinzhou Central Hospital, Liaoning, 121000, China
| | - Ariel Katz
- Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, 60064, IL, USA
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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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Zhu X, Huang R, Hu P, Yan P, Zhai S, Zhang J, Zhuang J, Yin H, Meng T, Yang D, Huang Z. Prognostic Factors for Survival in Patients with Malignant Giant Cell Tumor of Bone: A Risk Nomogram Analysis Based on the Population. Med Sci Monit 2021; 27:e929154. [PMID: 33594036 PMCID: PMC7899048 DOI: 10.12659/msm.929154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Malignant giant cell tumor of bone (MGCTB) is a rare histological type of malignant tumor that has a high tendency for local relapse and distant metastasis and ultimately leads to a poor prognosis. The purpose of this study was to describe the epidemiological features, identify the prognostic factors, and construct nomograms for patients with MGCTB. Material/Methods Patients with MGCTB that was histologically diagnosed between 1973 and 2014 were selected from the Surveillance, Epidemiology, and End Results (SEER) database as a training set. Survival analysis, Lasso regression, and random forests were used to identify the prognostic variables and establish the nomograms for patients with MGCTB, while an external cohort of 37 patients from our own institution and an external cohort of 163 patients from the SEER database in 2016 were used to validate the generalization performance of the nomograms. Results In total, univariate and multivariable analysis indicated that age, International Classification of Diseases for Oncology, historical stage, primary site, surgery information, radiotherapy, and chemotherapy were independent prognostic variables for overall survival or cause-specific survival. Nomograms based on the multivariable models were built to predict survival, and we achieved a higher C-index in subsequent multidimensional validation. Conclusions Age, historical stage, and chemotherapy were independent prognostic variables for overall survival and cause-specific survival of MGCTB patients, and radiotherapy and primary site were independent prognostic variables for overall survival. Nomograms based on significant clinicopathological features and clinical experience can be effective in predicting the probability of survival for MGCTB patients.
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Affiliation(s)
- Xiaolong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Runzhi Huang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).,Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Peng Hu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Penghui Yan
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Suna Zhai
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Jie Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Junwei Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Huabin Yin
- Department of Orthopedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Tong Meng
- Department of Orthopedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Daoke Yang
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Zongqiang Huang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Abstract
PURPOSE OF REVIEW Giant cell tumour of bone (GCTB) is an intermediate, locally aggressive primary bone tumour. In addition to local therapy, new drugs became available for this disease. Denosumab, a receptor activator of nuclear factor κ-B-ligand inhibitor, was introduced as systemic targeted therapy for advanced or inoperable and metastatic GCTB. Also, the bisphosphonate zoledronic acid has activity in GCTB by directly targeting the neoplastic stromal cells. RECENT FINDINGS In a small RCT, bisphosphonates were successful in controlling tumour growth and a higher apoptotic index of tumour cells was seen after zoledronic acid versus controls. Although bisphosphonate-loaded bone cement has not been studied to a large extent, it does not seem harmful and may constitute a logical local adjuvant. From the largest clinical trial to date, the risk-to-benefit ratio for denosumab in patients with advanced GCTB remains favourable, also in facilitating less morbid surgery. Concerns have arisen that recurrence rates would be higher than after conventional treatment, ranging from 20 to 100% in a systematic review, although this may be because of bias. H3F3A (G34W) driver mutations are helpful in the differentiation between GCTB and other giant cell-containing malignancies. H3.3-G34W proved sufficient to drive tumourigenesis. The cumulative incidence of malignancy in GCTB is estimated at 4%, of which primary malignancy 1.6% and secondary malignancy 2.4%, the latter mainly after radiation. To date, a potential causal relationship between denosumab and pulmonary metastases has not been confirmed; if they do not behave indolently, it would be advised to reassess diagnosis and consider malignancy. SUMMARY Denosumab remains a highly effective treatment option for patients with advanced GCTB. A short duration of 2-4 months neoadjuvant denosumab is advised to facilitate less morbid surgery and prevent incomplete curettage by macroscopic tumour alterations. Reduced dose intensity is being studied to reduce long term side-effects. Further research on bisphosphonates and other targets including H3.3-G34W remains warranted.
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Chen W, Yan Z, Tirumala V. Malignant giant cell tumor of bone or soft tissue treated by surgery with or without radiotherapy. J Orthop Res 2020; 38:2139-2148. [PMID: 32293747 DOI: 10.1002/jor.24698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
Malignant giant cell tumor of bone or soft tissue (MGCTBS) is one of the malignant tumors associated with poor prognosis. However, it remains controversial whether the combined treatment of both surgery and radiotherapy (surgery + RT) leads to better survival outcomes than surgical treatment alone (surgery alone) does for patients diagnosed with MGCTBS. We compared the two treatment strategies using the data provided by Surveillance, Epidemiology, and End Results (SEER) program. About 357 patients with MGCTBS who received either surgery + RT or surgery alone between 1975 and 2016 in the USA were identified and then matched based on their propensity scores estimated using the patients' baseline characteristics. We also performed a subgroup analysis for patients with high-grade and regional/distant tumor extension. Unadjusted Kaplan-Meier curves suggested that the surgery alone group had a better 10-year survival profile than the surgery + RT group. After propensity score matching, there was no statistical difference between the two treatment groups with respect to the 10-year cancer-specific survival and overall survival distributions. A subsequent subgroup analysis demonstrated that the surgery alone group has a similar 10-year survival comparing with the surgery + RT group for patients with high-grade and regional/distant tumor extension. The results of our study suggest that RT should not be recommended as a regular therapeutic method for MGCTBS, even for patients with high-grade histology and distant metastasis Clinical Significance: This study may provide better decision making for surgeons dealing with malignant giant cell tumor of bone or soft tissue. Type of study: Observation study. Level of evidence: Level III.
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Affiliation(s)
- Wenhao Chen
- Department of Orthopaedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhiyu Yan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Venkat Tirumala
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Yamaga K, Kuwamoto S, Mukunoki D, Osaki M, Nagashima H. Successful Treatment with Denosumab of a Giant Cell Tumor of Bone in the Iliac Bone of an 84-Year-Old Man. Yonago Acta Med 2020; 63:228-233. [PMID: 32884443 DOI: 10.33160/yam.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022]
Abstract
We report a case of GCTB in an 84-year-old Japanese man who had a tumor in his left iliac bone and was treated safely with denosumab. The patient noticed a painful mass, with gradual enlargement, in his left low back next to the iliac region. Magnetic resonance imaging revealed that the tumor measured 94 × 66 × 90 mm and was located in the left iliac bone. Histologically, the tumor was composed of proliferative oval-shaped mononuclear cells, admixed with large number of osteoclast-like giant cells. Immunohistochemically, a strong positivity for histone 3.3 G34W mutant protein was observed in the nuclei of the mononuclear cells, confirming the diagnosis of GCTB. Because it was considered as unresectable tumor, the patient was treated with denosumab without any side effects.
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Affiliation(s)
- Kensaku Yamaga
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, Yonago 683-8504, Japan
| | - Daichi Mukunoki
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Mari Osaki
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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20
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Significance of EGFR/HER2 Expression and PIK3CA Mutations in Giant Cell Tumour of Bone Development. BIOMED RESEARCH INTERNATIONAL 2020. [DOI: 10.1155/2020/2931784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Giant Cell Tumour of Bone (GCTB) is a rare bone tumour. Locally aggressive and recurrent, it might evolve into pulmonary metastases. Our present work is aimed at investigating the involvement of the epidermal growth factor receptor (ErbB) family and its downstream effectors in the development and recurrence of GCTB. For this purpose, we used a cohort of 32 GCTB patients and we evaluated the clinicohistological features and the expression of RANKL, EGFR, and HER2. The mutation status of KRAS, PI3KCA, and PTEN gene as potential oncogene involved in GCTB was also evaluated. We found a significant correlation between advanced histological stages, overexpression of EGFR/HER2, and tumour recurrence. Moreover, two mutations were found in the PIK3CA gene: a missense mutation, 1634A>C, detected for the first time in GCTB patients, without influencing the stability of the protein, and a frameshift mutation, c.1658_1659delGTinsC, causing the loss of the protein kinase domain. Altogether, these results suggest that overexpression of HER2/EGFR, Campanacci, and histological stages could be used as a novel prognostic marker for GCTB recurrence.
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21
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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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Tang H, Moro A, Feng W, Lai Y, Xiao Z, Liu Y, Wang K. Giant cell tumors combined with secondary aneurysmal bone cysts are more likely to develop postoperative recurrence: A retrospective study of 256 cases. J Surg Oncol 2019; 120:359-365. [PMID: 31219620 DOI: 10.1002/jso.25588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/02/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE The epidemiology and clinicopathology of aneurysmal bone cysts (ABCs) secondary to giant cell tumors of bone (GCTBs) have been well documented in the previous literature. However, reports on whether secondary ABCs could affect the postoperative recurrence of GCTBs are rare. This study analyzed the effects of secondary ABCs and other relevant clinical factors on the postoperative recurrence of GCTBs of the extremities. METHODS We retrospectively analyzed 256 cases of GCTBs of the extremities that were treated surgically at our institution. Among them, there were 60 patients diagnosed with GCTBs combined with secondary ABCs and 196 patients diagnosed with simple GCTBs. Intralesional curettage and tumor resection were performed in 136 and 120 cases, respectively. Univariate analysis, Kaplan-Meier survival analysis, and multivariate regression analysis were used to assess the factors for postoperative recurrence. The follow-up period was at least 24 months. RESULTS The total postoperative recurrence rate was 32%. The recurrence rate in the secondary ABCs group was significantly higher than that in the simple GCTBs group (53.3% vs 25.5%, P < 0.05). Curettage was associated with a higher recurrence rate than tumor resection (42.5% vs 20%, P < 0.05). Kaplan-Meier survival analysis showed that patients with GCTBs combined with secondary ABCs and who were treated by intralesional curettage had a decreased disease-free survival rate. The hazard ratio was 2.18 (95% confidence interval [CI], 1.15-4.13) for the group of GCTB combined with ABCs ( P = 0.01) and 1.97 (95% CI, 1.22-7.50) for the curettage group ( P = 0.01), respectively. Multivariate regression analysis revealed that the presence of secondary ABCs and curettage were independent factors for recurrence of GCTBs. CONCLUSION According to the results of this study, the presence of secondary ABCs is a potential risk factor for postoperative relapse of GCTBs.
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Affiliation(s)
- HaiJun Tang
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Abu Moro
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - WenYu Feng
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - YinJuan Lai
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - ZengMing Xiao
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Liu
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kun Wang
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Palmerini E, Picci P, Reichardt P, Downey G. Malignancy in Giant Cell Tumor of Bone: A Review of the Literature. Technol Cancer Res Treat 2019; 18:1533033819840000. [PMID: 30935298 PMCID: PMC6446439 DOI: 10.1177/1533033819840000] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Primary and recurrent giant cell tumor of bone is typically benign; however, rarely
giant cell tumor of bone can undergo malignant transformation. Malignancy in giant cell
tumor of bone may be primary (adjacent to benign giant cell tumor of bone at first
diagnosis) or secondary (at the site of previously treated giant cell tumor of bone).
Malignant giant cell tumor of bone has a poor prognosis; it is important to distinguish
malignant from benign lesions to facilitate appropriate management. The true incidence
of malignant giant cell tumor of bone is not known, probably owing to inaccurate
diagnosis and inconsistent nomenclature. We have analyzed current data to provide a
robust estimate of the incidence of malignancy in giant cell tumor of bone. Methods: A literature search was performed to source published reports of primary and secondary
cases of malignant giant cell tumor of bone. Studies that reported a denominator were
used to estimate the incidence of malignancy. Results: We identified 4 large series of patients with malignant giant cell tumor of bone that
provided data on 2315 patients with giant cell tumor of bone. Across these studies, the
cumulative incidence of malignancy was 4.0%; the cumulative incidence of primary
malignancy was 1.6% compared with 2.4% for secondary malignancy. Our analyses confirmed
that most malignant giant cell tumor of bone is secondary and occurs following
radiation. In addition, data from 8 small series showed that 4.8% of patients with giant
cell tumor of bone who received radiation therapy developed secondary malignancy. Conclusions: Malignant giant cell tumor of bone is rare, and its identification is hindered by a
lack of clear diagnostic criteria. For optimal care of patients with giant cell tumor of
bone, we recommend: comprehensive histologic sampling to ensure accurate diagnoses;
watchful follow-up, particularly for patients treated with radiation; and timely
treatment of local recurrence.
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Affiliation(s)
- Emanuela Palmerini
- 1 Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli / Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University, Bologna, Italy
| | - Piero Picci
- 2 Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Peter Reichardt
- 3 Department of Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Gerald Downey
- 4 Biostatistics, Amgen Ltd, Cambridge, United Kingdom
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Zhang X, Zhu X, Li J, Liu N, Li Q, Su X. Fine needle aspiration of giant cell tumor involving thyroid gland: A case report of an unprecedented entity. Diagn Cytopathol 2018; 46:879-882. [PMID: 30146712 DOI: 10.1002/dc.24053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaorong Zhang
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
- Department of Pathology; Affiliated Hospital of Jiujiang University; Jiujiang China
| | - Xianglan Zhu
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Jinnan Li
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Nian Liu
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Qiyuan Li
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
| | - Xueying Su
- Department of Pathology; West China Hospital of Sichuan University; Chengdu China
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Itkin B, Straminsky S, De Ronato G, Lewi D, Marantz A, Bardach A. Prognosis of metastatic giant cell tumor of bone in the pre-denosumab era. A systematic review and a meta-analysis. Jpn J Clin Oncol 2018; 48:640-652. [PMID: 29741702 DOI: 10.1093/jjco/hyy067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/20/2018] [Indexed: 12/16/2022] Open
Abstract
Background Data on long-term prognosis of metastatic GCT (mGCT) is scant. The frequency of spontaneous regressions (SRs) is unknown. We aimed to estimate the prognosis of mGCT. Methods We searched electronic scientific literature databases and generic Internet from January 1980 to August 2017. After identifying eligible studies we performed descriptive analyses and meta-analyses to estimate overall survival (OS), disease specific survival (DSS) and frequency of SRs in the years before the widespread use of denosumab. We performed pre-specified subgroup analyses of studies published before and after 2000 and of those with more and less than 10 years of follow-up. Results After retrieving and combining data from 26 relevant retrospective case-series totaling 242 patients with a median follow-up of 6.9 years, the estimated pooled OS was 86.9% (95% CI 78.0-94.2). Pooled DSS was 88.0% (95% CI 79.7-94.7). SRs were observed in 4.5% of patients. In the subgroup of studies published after 2000 mGCT was the only cause of death of affected subjects. In case-series with a follow-up longer than 10 years pooled DSS was 69.7% (95% CI 25.5-99.8). Conclusions To our knowledge this is the first study to derive estimated pooled OS and DSS of mGCT based on a large dataset. SRs were not exceptional phenomena. In a long run the disease could impact in a significant way on the life expectancy of affected subjects.
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Affiliation(s)
- Boris Itkin
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | | | | | - Daniel Lewi
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | - Adolfo Marantz
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy, Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Argentina
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Liede A, Hernandez RK, Tang ET, Li C, Bennett B, Wong SS, Jandial D. Epidemiology of benign giant cell tumor of bone in the Chinese population. J Bone Oncol 2018; 12:96-100. [PMID: 30148063 PMCID: PMC6107898 DOI: 10.1016/j.jbo.2018.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
Background Quantifying the incidence of giant cell tumor (GCT) of bone is challenging because it is a rare, histologically benign bone tumor for which population-level statistics are unavailable in most countries. We estimated the 2017 incidence of GCT in China using a direct (registry-based) approach with available population-based data. Materials and Methods The most recent age- and sex-specific incidence rates of GCT recorded in the Bone Tumor Registry in Japan (2015) were applied to 2017 age- and sex-matched populations projected by the United Nations for China in order to estimate 2017 incidence. An adjustment factor calculated using registry data suggesting that GCT may represent a greater proportion of bone tumors in China than in Japan (Guo, 1999) was applied to provide secondary estimates. Results Annual GCT incidence was estimated to be 1.49 per million population or 2094 new cases in China for 2017. A comparison of this estimated incidence with Japan (1.25 per million) and the United States (1.38 per million) indicates that the incidence is somewhat higher in China using identical methods. Secondary estimates suggest that GCT incidence in China may be as high as 2.57 per million or 3625 new cases in 2017. The corresponding 3-year limited-duration prevalence of GCT in China using a registry-based approach and general age-specific mortality is 6276 (secondary estimate: 10,876). Conclusions Leveraging unique population-based registry data, we estimated that GCT is a rare disease in the Chinese population with an incidence ranging between 1.49 and 2.57 cases per million persons per year. Possible differences in diagnostic classification of GCT, urban-rural demographics, and the younger demographic distribution of the Chinese population may underlie observations that GCT, a condition that primarily affects young individuals (20-40 years of age), accounts for a higher proportion of skeletal tumors in China than in other regions.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen, 1120 Veterans Boulevard, ASF3, Thousand Oaks and South San Francisco, CA, USA
| | - Rohini K Hernandez
- Center for Observational Research, Amgen, 1120 Veterans Boulevard, ASF3, Thousand Oaks and South San Francisco, CA, USA
| | - En-Tzu Tang
- Oncology, R&D, Amgen China, RM. 1501∼1506, 15F of Platinum Tower, No. 233 Taicang Road, HuangPu District, Shanghai 200020 PR China
| | - Chuang Li
- Oncology, R&D, Amgen China, RM. 1501∼1506, 15F of Platinum Tower, No. 233 Taicang Road, HuangPu District, Shanghai 200020 PR China
| | - Brian Bennett
- Plan A Inc., 759 Villa Street, Suite A, Mountain View, CA 94041, USA
| | - Steven S Wong
- Plan A Inc., 759 Villa Street, Suite A, Mountain View, CA 94041, USA
| | - Danielle Jandial
- Global Development (Oncology), Amgen Inc., One Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA 91320-1799, USA
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Sugiyama H, Omonishi K, Yonehara S, Ozasa K, Kajihara H, Tsuya T, Takeshima Y. Characteristics of Benign and Malignant Bone Tumors Registered in the Hiroshima Tumor Tissue Registry, 1973-2012. JB JS Open Access 2018; 3:e0064. [PMID: 30280138 PMCID: PMC6145567 DOI: 10.2106/jbjs.oa.17.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reported information on the characteristics of benign bone tumors is disjointed, and the long-term trends in the occurrence of malignant bone tumors by histological type have not been reported in Japan. Our aim was to describe the characteristics of both benign and malignant bone tumors as described in cases registered in the Hiroshima Tumor Tissue Registry from 1973 to 2012. METHODS Cases were identified with the International Classification of Diseases for Oncology (ICD-O-3) topography code C40-C41 (bones, joints, and articular cartilage), and histological types were classified according to the World Health Organization 2013 system. We described the distribution of the cases by behavior, sex, skeletal site of tumor occurrence, histological type, period at diagnosis (in 10-year groups), and age at diagnosis (in 10-year groups). RESULTS We observed 2,542 benign bone tumors, 272 intermediate bone tumors, and 506 malignant bone tumors. We confirmed that 81.6% of benign bone tumors were chondrogenic, consisting primarily of osteochondromas and enchondromas. Giant cell tumor of bone was the most dominant type of intermediate tumor, whereas osteogenic tumors and chondrogenic tumors were the most dominant types of malignant tumors. Among malignant bone tumors, 41.7% of tumors occurred in the long bones of the lower limb, and there were different peaks of age at the time of diagnosis for osteogenic tumors and chondrogenic tumors. A similar distribution of histological types was seen throughout the 40-year observation period. CONCLUSIONS Osteochondroma and enchondroma differed in terms of the age of the patient at the time of diagnosis and the skeletal sites where the tumors most frequently occurred. Giant cell tumor had a large impact on occurrence as a common type of intermediate bone tumor. CLINICAL RELEVANCE The results of the present study, based on pathological tissue registry data, provide knowledge about the epidemiological and pathological features of bone tumors in Japan.
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Affiliation(s)
- Hiromi Sugiyama
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Hiroshima, Japan
| | - Kunihiro Omonishi
- Department of Pathology, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Shuji Yonehara
- Department of Pathology and Research Laboratory, Welfare Association Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Hiroshima, Japan
| | - Hiroki Kajihara
- Hiroshima Prefecture Medical Association, Hiroshima, Hiroshima, Japan
| | - Takafumi Tsuya
- Hiroshima Prefecture Medical Association, Hiroshima, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Institute of Biomedical and Health Sciences, Graduate School of Hiroshima University, Hiroshima, Hiroshima, Japan
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Broehm CJ, Inwards CY, Al-Ibraheemi A, Wenger DE, Jenkins SM, Jin L, Oliveira AM, Zreik RT, Carter JM, Boland JM, Fritchie KJ. Giant Cell Tumor of Bone in Patients 55 Years and Older: A Study of 34 Patients. Am J Clin Pathol 2018; 149:222-233. [PMID: 29425276 DOI: 10.1093/ajcp/aqx155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Most giant cell tumors of bone (GCTs) occur in patients aged 20 to 40 years. We analyzed features of GCT in patients 55 years or older. METHODS GCTs were examined for fibrosis, matrix, cystic change, histiocytes, mitoses, and necrosis. Clinical/radiologic data were collected. RESULTS Thirty-four (5%) of 710 GCTs occurred in patients older than 55 years (14/20 male/female; 56-83 years) in long bones (n = 24), vertebrae (n = 6), pelvis (n = 3), and metacarpal (n = 1). Imaging was classic in 26 of 27 cases; one case appeared malignant. Morphologic patterns included fibrosis (n = 29), bone formation (n = 19), cystic change (n = 8), necrosis (n = 8), foamy histiocytes (n = 7), and secondary aneurysmal bone cyst formation (n = 1). Mitoses ranged from 0 to 18 per 10 high-power fields. Six recurred; one patient developed metastasis. Four of five cases harbored H3F3A mutations. CONCLUSIONS GCTs in patients 55 years or older share pathologic characteristics with those arising in younger adults. Fibrosis and reactive bone are common, potentially leading to diagnostic confusion in this population. No histologic features correlate with adverse outcome.
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Affiliation(s)
- Cory J Broehm
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Alyaa Al-Ibraheemi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Long Jin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andre M Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Riyam T Zreik
- Department of Pathology, Baylor Scott & White Health, Temple, TX
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Xu L, Jin J, Hu A, Xiong J, Wang D, Sun Q, Wang S. Soft tissue recurrence of giant cell tumor of the bone: Prevalence and radiographic features. J Bone Oncol 2017; 9:10-14. [PMID: 29018768 PMCID: PMC5626916 DOI: 10.1016/j.jbo.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022] Open
Abstract
Aim Recurrence of giant cell tumor of bone (GCTB) in the soft tissue is rarely seen in the clinical practice. This study aims to determine the prevalence of soft tissue recurrence of GCTB, and to characterize its radiographic features. Methods A total of 291 patients treated by intralesional curettage for histologically diagnosed GCTB were reviewed. 6 patients were identified to have the recurrence of GCTB in the soft tissue, all of whom had undergone marginal resection of the lesion. Based on the x-ray, CT and MRI imaging, the radiographic features of soft tissue recurrence were classified into 3 types. Type I was defined as soft tissue recurrence with peripheral ossification, type II was defined as soft tissue recurrence with central ossification, and type III was defined as pure soft tissue recurrence without ossification. Demographic data including period of recurrence and follow-up duration after the second surgery were recorded for these 6 patients. Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate functional outcomes. Results The overall recurrence rate was 2.1% (6/291). The mean interval between initial surgery and recurrence was 11.3 ± 4.1 months (range, 5–17). The recurrence lesions were located in the thigh of 2 patients, in the forearm of 2 patients and in the leg of the other 2 patients. According to the classification system mentioned above, 2 patients were classified with type I, 1 as type II and 3 as type III. After the marginal excision surgery, all patients were consistently followed up for a mean period of 13.4 ± 5.3 months (range, 6–19), with no recurrence observed at the final visit. All the patients were satisfied with the surgical outcome. According to the MSTS scale, the mean postoperative functional score was 28.0 ± 1.2 (range, 26–29). Conclusions The classification of soft tissue recurrence of GCTB may be helpful for the surgeon to select the appropriate imaging procedure to detect the recurrence. In addition, the marginal resection can produce a favorable outcome for the patients.
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Affiliation(s)
- Leilei Xu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
| | - Jing Jin
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Annan Hu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
| | - Jin Xiong
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
| | - Dongmei Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Qi Sun
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Shoufeng Wang
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
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31
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Inoue G, Imura T, Miyagi M, Saito W, Tazawa R, Nakazawa T, Takaso M. Total en bloc spondylectomy of the eleventh thoracic vertebra following denosumab therapy for the treatment of a giant cell tumor. Oncol Lett 2017; 14:4005-4010. [PMID: 28943907 PMCID: PMC5592882 DOI: 10.3892/ol.2017.6655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/21/2017] [Indexed: 12/18/2022] Open
Abstract
Although denosumab has been reported to induce effective clinical results with respect to tumor shrinkage in a short-term follow-up clinical study, total spondylectomy is recognized as the treatment of choice for eradicating giant cell tumors (GCTs) of the spine. The present study reports the case involving a GCT in the 11th thoracic vertebra complicated by idiopathic scoliosis and treated using total en bloc spondylectomy (TES) with preoperative denosumab therapy. A 35-year-old woman received preoperative denosumab therapy for 8 months, followed by surgery using a computed tomography (CT)-based navigation system that optimized accuracy by recognizing the area of the detached parietal pleura, the irregular border of the collapsed vertebra, and the adjacent vertebra. Complete en bloc resection of the vertebra could be performed, suggesting denosumab can be an effective adjuvant therapy which can reduce the complexity of TES and CT-navigation system facilitated the safe use of this surgical method in a patient with idiopathic scoliosis.
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Affiliation(s)
- Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Takayuki Imura
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Wataru Saito
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Ryo Tazawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
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van der Heijden L, Dijkstra PDS, Blay JY, Gelderblom H. Giant cell tumour of bone in the denosumab era. Eur J Cancer 2017; 77:75-83. [PMID: 28365529 DOI: 10.1016/j.ejca.2017.02.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/12/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
Abstract
Giant cell tumour of bone (GCTB) is an intermediate locally aggressive primary bone tumour, occurring mostly at the meta-epiphysis of long bones. Overexpression of receptor activator of nuclear factor kappa-B ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated osteoclast-like giant cells, causing lacunar bone resorption. Preferential treatment is curettage with local adjuvants such as phenol, alcohol or liquid nitrogen. The remaining cavity may be filled with bone graft or polymethylmethacrylate (PMMA) bone cement; benefits of the latter are a lower risk of recurrence, possibility of direct weight bearing and early radiographic detection of recurrences. Reported recurrence rates are comparable for the different local adjuvants (27-31%). Factors increasing the local recurrence risk include soft tissue extension and anatomically difficult localisations such as the sacrum. When joint salvage is impossible, en-bloc resection and endoprosthetic joint replacement may be performed. Local tumour control on the one hand and maintenance of a functional native joint and quality of life on the other hand are the main pillars of surgical treatment for this disease. Current knowledge and development in the fields of imaging, functional biology and systemic therapy are forcing us into a paradigm shift from a purely surgical approach towards a multidisciplinary approach. Systemic therapy with denosumab (RANKL inhibitor) or zoledronic acid (bisphosphonates) blocks, respectively inhibits, bone resorption by osteoclast-like giant cells. After use of zoledronic acid, stabilisation of local and metastatic disease has been reported, although the level of evidence is low. Denosumab is more extensively studied in two prospective trials, and appears effective for the optimisation of surgical treatment. Denosumab should be considered in the standard multidisciplinary treatment of advanced GCTB (e.g. cortical destruction, soft tissue extension, joint involvement or sacral localisation) to facilitate surgery at a later stage, and thereby aiming at immediate local control. Even though several questions concerning optimal treatment dose, duration and interval and drug safety remain unanswered, denosumab is among the most effective drug therapies in oncology.
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Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P D Sander Dijkstra
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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El Houmami N, Minodier P, Bouvier C, Seligmann H, Jouve JL, Raoult D, Fournier PE. Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach. Eur J Clin Microbiol Infect Dis 2017; 36:771-777. [PMID: 28054229 DOI: 10.1007/s10096-016-2886-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
Abstract
Primary epiphyseal subacute osteomyelitis (PESAO) caused by Mycobacterium species in young children is poorly recognized. We aimed to define the spectrum of this uncommon condition and to propose a novel diagnostic approach. We performed a systematic review of the literature on the PubMed website by selecting all reports of isolated infantile PESAO caused by Mycobacterium species since 1975. We identified 350 citations, of which 174 were assessed for eligibility based on title and abstract. The full text of 81 eligible citations was screened, and relevant data of 15 children under 4 years of age with mycobacterial PESAO were extracted. These data were pooled with those from our Institution. Data from 16 children were reviewed. The median age was 16 ± 7 months and the male:female ratio 1.7. The knee was the most common infection site (94%). The diagnosis of mycobacterial disease was delayed in all cases (range, 2 weeks to 6 months), and initially presumed by histology in 15 children (94%). Microbiologically proven diagnosis was confirmed by bone cultures in 8 of the 15 children (53%), and by specific PCR in 2 of the 3 culture-negative bone specimens (67%). Three children experienced long-term orthopedic complications despite surgical drainage and prolonged antimycobacterial regimens. All recently reported cases came from high-burden tuberculosis areas. Mycobacterium species contribute to the burden of infantile PESAO in endemic tuberculosis areas and may cause growth disturbances. We argue in favor of the early recognition of mycobacterial disease by specific molecular assays in children with infantile PESAO living in high-burden areas.
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Affiliation(s)
- N El Houmami
- Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France. .,Department of Pediatric Orthopedics, University La Timone Children's Hospital, Aix-Marseille University, Marseille, France.
| | - P Minodier
- Department of Pediatric Emergency Medicine, University North Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France
| | - C Bouvier
- Department of Pathology, University La Timone Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France
| | - H Seligmann
- Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - J-L Jouve
- Department of Pediatric Orthopedics, University La Timone Children's Hospital, Aix-Marseille University, Marseille, France
| | - D Raoult
- Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - P-E Fournier
- Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France
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Hu Y, Zhao L, Zhang H, Yu X, Wang Z, Ye Z, Wu S, Guo S, Zhang G, Wang J, Ning X. Sex Differences in the Recurrence Rate and Risk Factors for Primary Giant Cell Tumors Around the Knee in China. Sci Rep 2016; 6:28173. [PMID: 27321308 PMCID: PMC4913301 DOI: 10.1038/srep28173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
Although giant cell tumor of bone (GCTB) is more common in women in Western countries, it tends to be more common in men in Asian countries. We aimed to determine the sex differences in clinical characteristics, local recurrence rate, and relevant risk factors for local recurrence in primary GCTB around the knee. Between March 2000 and June 2014, patients with primary GCTB around the knee were recruited from 7 institutions in China, and 410 patients were included. The age at diagnosis was younger in women than in men (34.0 vs 37.2 years). The local recurrence rates were 23.4% overall, 25.8% in men, and 20.7% in women. Lower local recurrence rates were observed with en-bloc marginal resection in both men (6.9%) and women (3.1%). With tumors located in the distal femur, the local recurrence rate was higher for men than for women (29.1% vs 14.3%, P = 0.025). Local recurrence was significantly associated with the tumor location and surgical operation in men and only surgical operation in women. These findings suggest that more aggressive operations should be considered in men with GCTB in the proximal fibula.
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Affiliation(s)
- Yongcheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China
| | - Liming Zhao
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China.,The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300071, China
| | - Huilin Zhang
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China.,The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300071, China
| | - Xiuchun Yu
- Department of Orthopedics, The General Hospital of Jinan Military Commanding Region, 25 Shifan Road, Jinan, Shandong 250031, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Forth Military Medical University, No. 15 West Changle Road, Xincheng District, Xi'an, Shaanxi, 710032, China
| | - Zhaoming Ye
- Centre for Orthopaedic Research, Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310008, China
| | - Sujia Wu
- Department of Orthopaedics, Jin Ling Hospital, 305 Zhong Shan East Road, Nanjing 210002, Jiangsu Province, China
| | - Shibing Guo
- Orthopedics Department, Second Affiliated Hospital of Inner Mongolia Medical University, 1 Yingfang Road, Huimin District, Hohhot, 010050, P.R. China
| | - Guochuan Zhang
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute &Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute &Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
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Surgery methods and soft tissue extension are the potential risk factors of local recurrence in giant cell tumor of bone. World J Surg Oncol 2016; 14:114. [PMID: 27094617 PMCID: PMC4837597 DOI: 10.1186/s12957-016-0871-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 04/12/2016] [Indexed: 12/30/2022] Open
Abstract
Background Various treatments of giant cell tumor of bone (GCTB) included in curettages and resections and with adjuvant are exerted, but the best treatment is controversial. The aim of the study was the identification of individual risk factors after various treatments in GCTB. Methods A total of 179 patients treated for GCTB between 1998 and 2010 were concluded in the retrospective study. All patients were treated with intralesional curettage, extensive curettage, or wide resection. Mean follow-up was 60.2 ± 18.7 months (36~112 months). Age, gender, tumor location, Campanacci grade, soft tissue extension, pathological features, and surgical methods were performed to univariate Kaplan-Meier survival analysis and multivariate Cox regression analysis. Results The local recurrence rates of intralesional curettage (41.9 %) and extensive curettage (19.0 %) were significantly higher than that of wide resection (7.7 %). The higher risk of local recurrence was found for soft tissue extension (hazard = 7.921, 95 % CI 1.107~56.671), compared with no statistical significances between gender, location, Campanacci grade, pathologic fracture, and local recurrences, which were shown by Kaplan-Meier analysis. However, recurrence-free survival (RFS) of patients younger than 30 was significantly lower than that of patients older than 30. The RFS of pathologic fracture patients with soft tissue extension was significantly lower than that of pathologic fracture patients without soft tissue extension. Multivariate Cox regression analysis indicated that the independent variable that contributed to recurrence-free survival was soft tissue extension and surgical methods. The RFS of extensive curettage had no statistically significant difference with wide resection and was significantly higher than that of intralesional curettage. Use of high-speed burring and bone cement significantly decreased the local recurrence rate. Conclusions Age (below 30 years), gender, tumor location, Campanacci grade, and pathologic fracture have no statistically significant influence on local recurrences. Soft tissue extension and intralesional curettage of surgical methods increased the RFS. The results of the present study suggested that compared with curettage and wide section, treatment of GCTB by extensive curettage could provide the favorable local control and functional recovery. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0871-z) contains supplementary material, which is available to authorized users.
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