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Chen KL, Chen CF, Wu PK, Wang PH, Chen TH, Chen CM, Chen WM. Balancing Tumor Control and Cartilage Preservation for Patients with Giant Cell Tumor of Bone Around the Knee: A Clinical Report from a Single Institute. J Bone Joint Surg Am 2025; 107:e50. [PMID: 40048502 DOI: 10.2106/jbjs.23.01478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
BACKGROUND When managing aggressive giant cell tumor of bone (GCTB) around the knee joint, surgeons are often caught in a dilemma when determining whether to perform marginal excision or intralesional curettage. The purpose of this study was to report the long-term results of different treatment strategies in our institute. METHODS We retrospectively reviewed 64 eligible cases (34 female and 30 male) with a GCTB (37 in the distal femur, 27 in the proximal tibia) treated from 2002 to 2013. Forty patients received intralesional curettage (group A). Twenty-four received marginal excision of the tumor, with 18 of them undergoing reconstruction with unicondylar osteoarticular allograft (UOA) (group B) and 6 receiving arthroplasty reconstruction (group C). The minimum follow-up was 8 years, and the oncological status, clinical outcomes, and cartilage condition were analyzed. RESULTS Tumor recurrence was most common in group A (10 of 40, 25.0%), followed by group B (1 of 18, 5.6%) and group C (0 of 6). Eleven patients in group A (27.5%) and 6 in group B (33.3%) developed osteoarthritis (Kellgren-Lawrence grade 3 or 4). Five patients in group A (12.5%) and 3 patients in group B (16.7%) received total knee arthroplasty. Risk factors for the development of osteoarthritis in group A included a centrally located tumor, tumor length of >6 cm, a tumor-cartilage distance of ≤3 mm, and >50% subchondral bone involvement. In group B, osteoarthritis mostly resulted from postoperative complications. The mean Musculoskeletal Tumor Society (MSTS) score was 87.9 in group A, 84.8 in group B, and 93.3 in group C. CONCLUSIONS Although intralesional curettage preserved cartilage and resulted in better function, it was associated with a higher tumor recurrence rate in our series. For advanced tumors close to the articular cartilage with significant subchondral bone involvement, marginal excision with UOA reconstruction might be a viable alternative. Arthroplasty should be reserved for patients who have bicondylar involvement with severe bone and cartilage loss making cartilage preservation impossible. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kuan-Lin Chen
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Po-Kuei Wu
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Pai-Han Wang
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Tain-Hsiung Chen
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chao-Ming Chen
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan
| | - Wei-Ming Chen
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei City, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei City, Taiwan
- Orthopedic Department, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Vijay BK, Gopal D, Pawan Kumar G, Rao M. Spinal giant cell tumour presenting as a posterior mediastinal mass. BMJ Case Rep 2025; 18:e262838. [PMID: 40379300 DOI: 10.1136/bcr-2024-262838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2025] Open
Abstract
Posterior mediastinal masses frequently originate from neurogenic tumours; however, other possible causes include vascular abnormalities, cysts and primary bone tumours. We present a case involving a man in his 20s who experienced back pain, sudden sensorimotor weakness in both lower limbs and loss of bladder control. Imaging studies, including CT and MRI, identified a posterior mediastinal extramedullary mass associated with vertebral destruction and intrathecal extension. A biopsy of the mass confirmed it to be a giant cell tumour of bone. The patient was treated with denosumab, steroids and spinal decompression and was scheduled for definitive surgery. In young individuals presenting with a posterior mediastinal mass, signs of inflammation and early neurological symptoms, it is essential to consider primary bone tumours as a possible diagnosis.
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Affiliation(s)
- Balaji K Vijay
- Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Durgeshwar Gopal
- Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Garg Pawan Kumar
- Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
- Department of Pathology & Lab Medicine, All India Institute of Medical sciences, Jodhpur, Rajasthan, India
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Igrec J, Jernej L, Smolle MA, Steiner J, Scheipl S, Lohberger B, Leithner A, Brcic I. Surgical and radiological outcomes of giant cell tumor of the bone: prognostic value of Campanacci grading and selective use of denosumab. J Orthop Traumatol 2025; 26:27. [PMID: 40317378 PMCID: PMC12049345 DOI: 10.1186/s10195-025-00841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 03/22/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases. METHODS We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes. RESULTS The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition. CONCLUSIONS Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Jasminka Igrec
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8010, Graz, Austria.
| | - Lisa Jernej
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jakob Steiner
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8010, Graz, Austria
| | - Susanne Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Iva Brcic
- D&R Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria.
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Wang H, He Y, Wan L, Li C, Li Z, Li Z, Xu H, Tu C. Deep learning models in classifying primary bone tumors and bone infections based on radiographs. NPJ Precis Oncol 2025; 9:72. [PMID: 40074845 PMCID: PMC11904180 DOI: 10.1038/s41698-025-00855-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
Primary bone tumors (PBTs) present significant diagnostic challenges due to their heterogeneous nature and similarities with bone infections. This study aimed to develop an ensemble deep learning framework that integrates multicenter radiographs and extensive clinical features to accurately differentiate between PBTs and bone infections. We compared the performance of the ensemble model with four imaging models based solely on radiographs utilizing EfficientNet B3, EfficientNet B4, Vision Transformer, and Swin Transformers. The patients were split into external dataset (N = 423) and internal dataset [including training (N = 1044), test (N = 354), and validation set (N = 171)]. The ensemble model outperformed imaging models, achieving areas under the curve (AUCs) of 0.948 and 0.963 on internal and external sets, respectively, with accuracies of 0.881 and 0.895. Its performance surpassed junior and mid-level radiologists and was comparable to senior radiologists (accuracy: 83.6%). These findings underscore the potential of deep learning in enhancing diagnostic precision for PBTs and bone infections (Research Registration Unique Identifying Number (UIN): researchregistry10483 and with details are available at https://www.researchregistry.com/register-now#home/registrationdetails/6693845995ba110026aeb754/ ).
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Affiliation(s)
- Hua Wang
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu He
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lu Wan
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chenbei Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhaoqi Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhihong Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Shenzhen Research Institute of Central South University, Guangdong, China
| | - Haodong Xu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Chao Tu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
- Shenzhen Research Institute of Central South University, Guangdong, China.
- Changsha Medical University, Changsha, Hunan, China.
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Tung EL, Ecklund K, Shailam R, Rosenthal DI, Vicentini JRT. Distinguishing Epiphyseal Mass Lesions in Children, Adolescents, and Young Adults. Radiographics 2025; 45:e240194. [PMID: 39913321 DOI: 10.1148/rg.240194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2025]
Abstract
This slide presentation reviews the differential diagnosis of epiphyseal mass lesions in children, adolescents, and young adults, identifies imaging features of epiphyseal mass lesions that suggest specific diagnoses, and provides a framework for evaluating these lesions at MRI with the goal of narrowing the differential diagnosis.
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Affiliation(s)
- Eric L Tung
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (E.L.T., R.S., D.I.R., J.R.T.V.); Harvard Medical School, Boston, Mass (E.L.T., K.E., R.S., D.I.R., J.R.T.V.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (K.E.)
| | - Kirsten Ecklund
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (E.L.T., R.S., D.I.R., J.R.T.V.); Harvard Medical School, Boston, Mass (E.L.T., K.E., R.S., D.I.R., J.R.T.V.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (K.E.)
| | - Randheer Shailam
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (E.L.T., R.S., D.I.R., J.R.T.V.); Harvard Medical School, Boston, Mass (E.L.T., K.E., R.S., D.I.R., J.R.T.V.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (K.E.)
| | - Daniel I Rosenthal
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (E.L.T., R.S., D.I.R., J.R.T.V.); Harvard Medical School, Boston, Mass (E.L.T., K.E., R.S., D.I.R., J.R.T.V.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (K.E.)
| | - Joao Rafael T Vicentini
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (E.L.T., R.S., D.I.R., J.R.T.V.); Harvard Medical School, Boston, Mass (E.L.T., K.E., R.S., D.I.R., J.R.T.V.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (K.E.)
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Henderson RD, Shirodkar K, Hussein M, Jenko N, Jeys L, Botchu R. Measurable progression of giant cell tumour of bone associated with pregnancy - A tertiary sarcoma centre analysis. J Clin Orthop Trauma 2024; 59:102825. [PMID: 39650720 PMCID: PMC11617685 DOI: 10.1016/j.jcot.2024.102825] [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: 04/30/2024] [Revised: 10/26/2024] [Accepted: 11/14/2024] [Indexed: 12/11/2024] Open
Abstract
Introduction Giant cell tumour of bone (GCTB) is a benign but locally aggressive bone tumour with a higher predilection for females of reproductive age. GCTB management poses a unique set of challenges during pregnancy due to risks associated with imaging and treatment options. Pregnancy has been implicated in GCTB progression and tumour recurrence, however an exact mechanism has not been established. This study aims to confirm the relationship between the diagnosis and progression of GCTB during pregnancy. Methods A 17-year retrospective analysis of our tertiary sarcoma referral centre database was performed to identify the relevant patients. Pregnancy-associated tumours were defined by those already present or diagnosed during pregnancy, and up to 12 months postpartum. Lesion volume was determined by mathematical ellipsoidal modelling technique to simplify the estimation, with cross-sectional measurements obtained from the three standard orthogonal planes on initial and surveillance imaging. Due to logistical challenges, follow-up imaging was performed at either our tertiary sarcoma centre or under guidance at regional imaging centres convenient to the patient. Results The diagnosis of GCTB was made in 113 female patients during this 17-year period, of which 20 were associated with pregnancy with a mean age of 28.8 years (range 19-40 years). 12 patients had their primary or recurrent GCTB diagnosed, or known tumour progress during pregnancy, whilst the remaining 8 were diagnosed shortly thereafter to within 12 months postpartum. The most common tumour sites were located around the knee (30 %) and distal radius (25 %). A statistically significant pattern of growth was observed through the surveillance period (p 0.018), within a relatively short mean follow-up period of only 89.8 days (SD 54.5; 13-192 days). Conclusion This study demonstrates the significant association that pregnancy has with the growth and progression of both primary and recurrent GCTB. Pregnant patients should be subject to close surveillance well into the postpartum period due to possible accelerated disease progression and potential for disease recurrence.
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Affiliation(s)
- RD Henderson
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - M Hussein
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - L Jeys
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Shah A, Mesenger J, Schwartz B, Saigal G, Samtani S. Giant Cell Tumor of the Central Skull Base. Cureus 2024; 16:e69602. [PMID: 39421119 PMCID: PMC11485220 DOI: 10.7759/cureus.69602] [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: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Giant cell tumor (GCT) of bone is an uncommon indolent tumor, typically occurring in the meta-epiphysis of long bones in young adults. GCT arising in the clivus is exceedingly rare, and even more uncommon in the pediatric population. We present a case of a 13-year-old patient diagnosed with a large GCT in the clivus. Initial clinical and radiographic findings were suspicious for a GCT, although other more common skull base tumors were also considered in the differential diagnosis. Certain key radiographic features suggested the diagnosis of a GCT, including the low T2 signal within the mass on MRI and the T2 hypointense rim corresponding with a cortical shell present on CT. An endoscopic biopsy confirmed the diagnosis. This report highlights the unique diagnostic challenges and broad differential in this case while underscoring the role of imaging in detection and precise anatomic delineation that helps guide therapeutic decisions and improve patient prognosis.
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Affiliation(s)
- Anuj Shah
- Department of Radiology, University of Miami Miller School of Medicine, Miami, USA
| | - Jacob Mesenger
- Department of Radiology, University of Miami Miller School of Medicine, Miami, USA
| | - Benjamin Schwartz
- Department of Radiology, University of Miami Health System/Jackson Memorial Hospital, Miami, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Health System/Jackson Memorial Hospital, Miami, USA
| | - Sameer Samtani
- Department of Radiology, University of Miami Health System/Jackson Memorial Hospital, Miami, USA
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Gupta N, Rubina, Rahman A, Aftab M, Khan R. Giant Cell Tumor of the Temporal Bone with Direct Invasion into the Middle Ear and Skull Base: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2890-2894. [PMID: 38883509 PMCID: PMC11169301 DOI: 10.1007/s12070-024-04550-w] [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: 08/26/2023] [Accepted: 02/04/2024] [Indexed: 06/18/2024] Open
Abstract
Giant cell tumor (GCT) of bone is a rare, benign, osteolytic neoplasm that most commonly occurs in early adulthood and often involves the long bones of the body. Although GCT largely affects the epiphyses of long bones, several reports of GCT involvement of the cranial and facial bones exist in the literature. In addition to reviewing other reported cases of GCT of the lateral skull base in the literature, the authors report here on the clinical presentation, radiographic findings, and management of a patient found to have a GCT of the squamous part of temporal bone invading the middle ear and infratemporal fossae, which was treated by en bloc resection of the lateral skull base.
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Affiliation(s)
- Nainsi Gupta
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Rubina
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Abdur Rahman
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Mohammad Aftab
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Roobina Khan
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
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Expósito D, Martel J, Alvarez de Sierra B, Bueno A, Vilanova C, Vilanova JC. Neoplastic and Non-neoplastic Bone Lesions of the Knee. Semin Musculoskelet Radiol 2024; 28:225-247. [PMID: 38768589 DOI: 10.1055/s-0044-1781471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Numerous anatomical variants are described around the knee, many of which look like bony lesions, so it is important to know them to avoid unnecessary complementary tests and inadequate management. Likewise, several alterations in relation to normal development can also simulate bone lesions.However, numerous pathologic processes frequently affect the knee, including traumatic, inflammatory, infectious, and tumor pathology. Many of these entities show typical radiologic features that facilitate their diagnosis. In other cases, a correct differential diagnosis is necessary for proper clinical management.Despite the availability of increasingly advanced imaging techniques, plain radiography is still the technique of choice in the initial study of many of these pathologies. This article reviews the radiologic characteristics of tumor and nontumor lesions that may appear around the knee to make a correct diagnosis and avoid unnecessary complementary radiologic examinations and inadequate clinical management.
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Affiliation(s)
- Diana Expósito
- Department of Radiology, Hospital Sanitas La Moraleja, Madrid, Spain
| | - José Martel
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Angel Bueno
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Cristina Vilanova
- Department of Orthopaedic Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
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Gharpinde MR, Pisulkar G, Taywade S, Awasthi AA, Suneja A. Excision of a Giant Cell Tumor With Bone Grafting and Bone Cementing of the Proximal Humerus: A Case Report. Cureus 2024; 16:e59492. [PMID: 38826960 PMCID: PMC11144043 DOI: 10.7759/cureus.59492] [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] [Received: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Giant cell tumors (GCTs) of the bone are uncommon neoplasms that predominantly affect the metaphysis of long bones, with proximal humerus involvement being less frequent. We present the case of a 58-year-old male who presented with a two-month history of progressive right shoulder pain and difficulty in raising his arm. Clinical examination revealed a palpable swelling on the lateral aspect of the right arm. Radiological investigations, including X-ray and magnetic resonance imaging (MRI), confirmed the presence of a primary osseous neoplasm involving the proximal humerus, suggestive of a GCT. The patient underwent surgical excision of the tumor with bone grafting and bone cementing of the proximal humerus. Post-operative care included prescribed medications and physiotherapy. This case highlights the successful management of GCTs of the proximal humerus through a multidisciplinary approach, emphasizing the importance of meticulous surgical technique, appropriate reconstruction, and comprehensive post-operative care for optimal patient outcomes.
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Affiliation(s)
- Milind R Gharpinde
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shounak Taywade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhiram A Awasthi
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anmol Suneja
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang N, Li J, Ma J. Orbital Giant Cell Reparative Granuloma: A Case Report. Ophthalmic Plast Reconstr Surg 2024; 40:e97-e102. [PMID: 38738724 PMCID: PMC11107890 DOI: 10.1097/iop.0000000000002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 05/14/2024]
Abstract
Giant cell reparative granuloma has a very low incidence and is thought to be a response to trauma. While there have been only a few reported cases of orbital giant cell reparative granuloma, we recently observed such a case and analyzed 16 previously reported cases of this type. It is important to note that further investigation is necessary to fully understand the relationship between giant cell reparative granuloma and trauma.
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Affiliation(s)
- Nan Wang
- Department of Ophthalmic Oncology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Ophthalmic Oncology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianmin Ma
- Department of Ophthalmic Oncology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Gharpinde MR, Pundkar A, Shrivastava S, Chandanwale R, Patel H. Successful Surgical Management of a Giant Cell Tumor in the Proximal Tibia: A Case Report. Cureus 2024; 16:e59173. [PMID: 38807825 PMCID: PMC11129956 DOI: 10.7759/cureus.59173] [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] [Received: 04/13/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumors (GCTs) of the bone present unique challenges in management due to their locally aggressive nature and potential for recurrence. This case report describes the successful surgical management of a GCT located in the proximal tibia of a 28-year-old female. The patient presented with six months of pain and swelling following a traumatic injury to the knee. Diagnostic imaging confirmed the presence of a GCT, leading to preoperative prophylactic embolization to reduce intraoperative bleeding. Surgical excision of the tumor was performed, followed by reconstruction using autologous fibula grafts and plate fixation. Postoperative care included analgesia, antibiotics, and physiotherapy. Regular follow-up demonstrated satisfactory clinical outcomes without evidence of recurrence. This case highlights the importance of a multidisciplinary approach combining surgical expertise, preoperative planning, and postoperative rehabilitation to achieve favorable outcomes in managing GCTs.
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Affiliation(s)
- Milind R Gharpinde
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Pundkar
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rohan Chandanwale
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hardik Patel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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13
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Capucha T, Krasovsky A, Abdalla-Aslan R, Ginini JG, Noy D, Emodi O, Rachmiel A, Shilo D. Central giant cell granuloma of the jaws-long-term clinical and radiological outcomes of surgical and pharmacological management. Clin Oral Investig 2024; 28:200. [PMID: 38453790 PMCID: PMC10920455 DOI: 10.1007/s00784-024-05585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. MATERIALS AND METHODS This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. RESULTS Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. CONCLUSIONS Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. CLINICAL RELEVANCE There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.
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Affiliation(s)
- Tal Capucha
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Andrei Krasovsky
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | | | | | - Dani Noy
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Omri Emodi
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adi Rachmiel
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dekel Shilo
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel.
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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14
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Shirgaonkar R, Panigrahi MK, Girija A, Sharma P, Chappity P, Tripathy SR. A 37-Year-Old Man With Dyspnea, Bilateral Lung Consolidation, and a Tracheal Mass. Chest 2024; 165:e5-e10. [PMID: 38199745 DOI: 10.1016/j.chest.2023.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 01/12/2024] Open
Abstract
CASE PRESENTATION A 37-year-old man presented to the ED with symptoms of productive cough, self-reported fever, and shortness of breath for the past 15 days. He was placed on noninvasive mechanical ventilation for respiratory distress. IV piperacillin-tazobactam and inhaled bronchodilators were promptly administered, and he was subsequently transferred to the respiratory ICU for further care. He had no history of bowel and bladder disturbance, altered sensorium, swelling of feet, or abdominal distention. He never used tobacco and denied a history of TB. Medical history was notable for recurrent hospitalizations and administration of multiple courses of antibiotics in the past for similar complaints. He often used inhaled bronchodilators/corticosteroids when clinically stable to relieve symptoms.
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Affiliation(s)
- Rohit Shirgaonkar
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Aswathy Girija
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sagar Ranjan Tripathy
- Department of Pathology and Laboratory Sciences, All India Institute of Medical Sciences, Bhubaneswar, India
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15
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Akhlaghi P, Ghouchani A, Rouhi G. The effect of defect size and location on the fracture risk of proximal tibia, following tumor curettage and cementation: An in-silico investigation. Comput Biol Med 2023; 167:107564. [PMID: 37871436 DOI: 10.1016/j.compbiomed.2023.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/03/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Even though, proximal tibia is a common site of giant cell tumor and bone fractures, following tumor removal, nonetheless very little attention has been paid to affecting factors on the fracture risk. Here, nonlinear voxel-based finite element models based on computed tomography images were developed to predict bone fracture load with defects with different sizes, which were located in the medial, lateral, anterior, and posterior region of the proximal tibia. Critical defect size was identified using One-sample t-test to assess if the mean difference between the bone strength for a defect size was significantly different from the intact bone strength. Then, the defects larger than critical size were reconstructed with cement and the mechanics of the bone-cement interface (BCI) was investigated to find the regions prone to separation at BCI. A significant increase in fracture risk was observed for the defects larger than 20 mm, which were located in the medial, lateral and anterior regions, and defects larger than 25 mm for those located in the posterior region of the proximal tibia. Furthermore, it was found that the highest and lowest fracture risks were associated with defects located in the medial and posterior regions, respectively, highlighting the importance of selecting the initial location of a cortical window for tumor removal by the surgeon. The results of the BCI analysis showed that the location and size of the cement had a direct impact on the extent of damage and its distribution. Identification of critical regions susceptible to separation at BCI, can provide critical comments to surgeons in selecting the optimal cement augmentation technique, which may ultimately prevent unnecessary surgical intervention, such as using screws and pins.
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Affiliation(s)
| | - Azadeh Ghouchani
- Biomedical Engineering Department, University of Isfahan, Isfahan, Iran
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16
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Hua W, Guo T, Li X, Wu Q, Yang C. Total en bloc spondylectomy of thoracic giant cell tumor with secondary aneurysmal bone cyst: case reports and review of literature. Int J Neurosci 2023; 133:1309-1314. [PMID: 35698431 DOI: 10.1080/00207454.2022.2079499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Spinal giant cell tumor (GCT) combined with secondary aneurysmal bone cyst (ABC) is a locally aggressive primary bone tumor. Total en bloc spondylectomy has never been reported to treat thoracic GCT combined with secondary ABC. We retrospectively reviewed two cases of spinal GCT combined with secondary ABC. A 41-year-old male patient was presented with back pain due to irregular expansive bone destruction involving the T6 vertebral body and intraspinal space-occupying lesion. Total en bloc spondylectomy of T6 vertebra was performed with good neurological status after the surgery. A 29-year-old female patient was presented with right scapular region pain due to irregular expansive bone destruction involving the T5 vertebral body and intraspinal space-occupying lesion. Total en bloc spondylectomy of T5 vertebra was performed with good neurological status after the surgery. Adjuvant radiation therapy was applied after the surgery without local recurrence at the 12-month or 24-month follow-up. Spinal GCT combined with secondary ABC appears to have a high local recurrence rate. Therefore, total en bloc spondylectomy should be applied to treat thoracic GCT combined with secondary ABC.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Tabarestani TQ, Levine N, Sachs E, Scholl A, Colglazier R, French R, Al-Rohil R, Brigman B, Eward W, Visgauss J. Giant cell tumor of bone in the pediatric population: a retrospective study highlighting cases of metaphyseal only location and increased local recurrence rates in skeletally immature patients. Skeletal Radiol 2023; 52:2399-2408. [PMID: 37154873 DOI: 10.1007/s00256-023-04359-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To describe the presentation of giant cell tumors (GCT) of the bone in the pediatric population to (1) improve the differential diagnosis of pediatric bone tumors and (2) identify the origin of GCT. Understanding the origin of bone tumors assists in establishing appropriate diagnoses and recommending treatment options. This is particularly important in children, where evaluating the need for invasive procedures is balanced with the desire to avoid overtreatment. GCT have historically been considered epiphyseal lesions with potential metaphyseal extension. Therefore, GCT may be inappropriately excluded from the differential diagnosis of metaphyseal lesions in the skeletally immature. MATERIALS AND METHODS We identified 14 patients from 1981 to 2021 at a single institution who had histologic confirmation of GCT and were less than 18 years old at diagnosis. Patient characteristics, tumor location, surgical treatment, and local recurrence rates were collected. RESULTS AND CONCLUSIONS Ten (71%) patients were female. Eleven (78.6%) were epiphysiometaphyseal (1 epiphyseal, 4 metaphyseal, 6 epiphysiometaphyseal). Five patients had an open adjacent physis, of which three (60%) had tumors confined solely to the metaphysis. Of the five patients with open physis, four (80%) developed local recurrence while only one patient (11%) with a closed physis had local recurrence (p value = 0.0023). Our results illustrate that for the skeletally immature, GCT can (and in our results more commonly did) occur in the metaphyseal location. These findings suggest that GCT should be included in the differential diagnosis of primary metaphyseal-only lesions in the skeletally immature.
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Nicole Levine
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Elizabeth Sachs
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Ashley Scholl
- Department of Pathology, Duke University Hospital, Durham, NC, USA
| | - Roy Colglazier
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - Robert French
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - Rami Al-Rohil
- Department of Pathology, Duke University Hospital, Durham, NC, USA
| | - Brian Brigman
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - William Eward
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Julia Visgauss
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
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18
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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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19
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Anandan D, Kumar A, Jeyakkani MN, Inja DB, Jaiswal AK. Investigation of Giant Cell Tumor of Bone and Tissue Engineering Approaches for the Treatment of Giant Cell Tumor of Bone. ACS APPLIED BIO MATERIALS 2023; 6:3946-3958. [PMID: 37698377 DOI: 10.1021/acsabm.3c00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Primary bone tumors such as Ewing sarcoma, osteosarcoma, and chondrosarcoma, secondary bone tumors developed from progressive malignancies, and metastasized bone tumors are more prevalent and studied descriptively through biology and medical research. Less than 0.2% of cancer diagnoses are caused by rare bone-originating tumors, which despite being rare are particularly difficult due to their high death rates and substantial disease burden. A giant cell tumor of bone (GCTB) is an intramurally invasive but rare and benign type of bone tumor, which seldom metastasizes. The most often prescribed medication for GCTB is Denosumab, a RANKL (receptor activator of nuclear factor κB ligand) inhibitor. Because pharmaceutical drug companies rely on two-dimensional and animal models, current approaches for investigating the diverse nature of tumors are insufficient. Cell line based medication effectiveness and toxicity studies cannot predict tumor response to antitumor medicines. It has already been investigated in detail why molecular pathways do not reproduce in vitro, a phenomenon known as flat biology. Due to physiological differences between human beings and animals, animal models do not succeed in identifying side effects of the treatment, emulating metastatic growth, and establishing the link between cancer and the immune system. This review summarizes and discusses GCTB, the disease, its cellular composition, various bone tumor models, and their properties and utilization in research. As a result, this study delves deep into in vitro testing, which is vital for scientists and physicians in various fields, including pharmacology, preclinical investigations, tissue engineering, and regenerative medicine.
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Affiliation(s)
- Dhivyaa Anandan
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore 632014, Tamilnadu, India
| | - Amit Kumar
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre (BARC), Trombay, Mumbai 400085, Maharashtra, India
| | - Manasseh N Jeyakkani
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India
| | - Dan Barnabas Inja
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India
| | - Amit Kumar Jaiswal
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore 632014, Tamilnadu, India
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20
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Pena-Burgos EM, Serra-Del Carpio G, Tapia-Viñe M, Iglesias Urraca C, Cordero García JM, Ortiz-Cruz EJ, Pozo-Kreilinger JJ. Primary aneurysmal bone cyst of hands and feet: A series of 14 cases. Ann Diagn Pathol 2023; 66:152169. [PMID: 37295038 DOI: 10.1016/j.anndiagpath.2023.152169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Aneurysmal bone cyst (ABC) is a relatively rare, benign bone tumor that occurs exceptionally in the hands and feet. The objective of this article is to present clinical, radiological, histopathological features and management of a series of 14 primary ABC cases in these unusual locations. Eight cases occurred in hands and six in feet. We present the first reported subungual case to occur in the hand. The average age of the patients was 26 years (range 7 to 49), with half being over the age of twenty at diagnosis. The male to female ration was 9:5. In radiological terms, ABC appeared as an expansive lesion with internal septa and without cortical disruption. Twelve cases displayed the classic multicystic morphology and two cases were of the solid variant. "Blue bone" was detected in 50 % of the specimens. Treatment consisted of curettage, excision, or amputation in all cases. Recurrence rate was observed in 35 % of the cases, with the similar ABC morphology as the original samples. New therapeutic options have been proposed on their own or in combination with surgery to reduce local recurrence rates.
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Affiliation(s)
| | | | - M Tapia-Viñe
- La Paz University Hospital, Radiology Department, Spain
| | | | | | - E J Ortiz-Cruz
- La Paz University Hospital, Orthopaedic Surgery and Traumatology Department, Spain
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21
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Yakoub MA, Torrence D, Hwang S, Bartelstein M, Healey JH, Hameed M. Giant-cell-poor giant cell tumor of bone: report of two cases and literature review. Skeletal Radiol 2023; 52:1791-1798. [PMID: 36781420 PMCID: PMC10758227 DOI: 10.1007/s00256-023-04292-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive tumor that shows predilection for the metaphysis/epiphysis of long bones, with an incidence of 4-5% of primary bone tumors. GCTB shows two main populations of cells: mononuclear cells and non-neoplastic multi-nucleated giant cells, with or without fibrous background. On the other hand, giant-cell-poor GCTB are rare with only few reports in the literature. These cases offer a diagnostic challenge, given the absence of giant cells and such cases have consistently been shown to harbor the H3F3A gene mutation by sequencing. The H3.3 G34W mutation-specific monoclonal antibody has shown high specificity in the diagnosis of GCTB. Two cases of giant-cell-poor GCTB are presented in this study, in which giant cells were absent or sparse and the diagnosis of GCTB was confirmed by the expression of H3.3 G34W monoclonal antibody in the mononuclear cells by immunohistochemistry. Whether this represents a histologic variant of GCTB or partial involution of GCTB is not yet fully understood; however, an immune response, infectious/inflammatory reaction, and/or anti-tumor cytokine production have been purported to be factors inciting disease regression in GCTB.
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Affiliation(s)
- Mohamed A Yakoub
- Department of Pathology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Dianne Torrence
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meredith Bartelstein
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John H Healey
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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22
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Schoutens C, Verspoor FG. Heat treatment for giant cell tumors of bone: A systematic review. J Orthop Surg (Hong Kong) 2023; 31:10225536231202157. [PMID: 37726111 DOI: 10.1177/10225536231202157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
This systematic review evaluates the effects of heat treatments in de novo, residual and recurrent giant cell tumors of bone (GCTB). Studies were eligible for inclusion if one of the following treatments was administered: radiofrequency ablation (RFA), microwave ablation, argon cauterization, electrocauterization and hot liquid treatment. The primary outcome was recurrence. Secondary outcomes were complications, pain, function, and quality of life. Recurrence rates for microwave ablation as an adjuvant to intralesional curettage were 0%, 4% and 10% (3 retrospective single-group studies); for argon cauterization 4%, 8% and 26% (3 cohort studies); electrocauterization 0% to 33% (8 cohort studies); and hot liquid 9.5% and 24% (2 cohort studies). Follow-up was generally ≥24 months. Data on pain, function and quality of life were scarce. Complications included infection and secondary osteoarthritis. Current evidence does not demonstrate or exclude an effect of heat treatments on recurrence in GCTB. Further research should objectify if (subgroups of) patients benefit from these treatments.
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Affiliation(s)
- Carlijn Schoutens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Floortje Gm Verspoor
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Miry A, Tbouda M, Bouhajeb YY, Abbaoui S. Tuberculosis of the Tibial Plateau Mimicking a Giant Cell Tumor: A Case Report. Cureus 2023; 15:e43785. [PMID: 37731432 PMCID: PMC10507659 DOI: 10.7759/cureus.43785] [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: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Tuberculous osteomyelitis is infrequent and occurs most often in the femur, the tibia, and the small bonne of hands and feet. Herein, we report a 39-year-old female who presented with chronic pain and motion range reduction of the left knee joint for two years. A knee radiograph revealed a geographic lytic lesion of the epiphyseal and diaphyseal region of the tibia mimicking giant cell tumor (GCT). A minimally invasive biopsy of the lytic lesion was performed, and pathological assessment revealed granulomatous inflammation made of numerous caseating necrotizing epithelioid and giant cells granulomas, diagnostic of tibial plateau tuberculosis. This case underscores the importance of taking tuberculosis into consideration in lesions mimicking GCTs in the tibial plateau, especially in endemic regions.
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Affiliation(s)
- Achref Miry
- Pathology, Faculty of Medicine and Pharmacy of Agadir, Agadir, MAR
- Pathology, Souss Massa University Hospital, Agadir, MAR
| | - Mohammed Tbouda
- Pathology, Mohammed V Military Hospital, Agadir, MAR
- Pathology, Faculty of Medicine and Pharmacy of Agadir, Agadir, MAR
| | | | - Sanae Abbaoui
- Pathology, Souss Massa University Hospital, Agadir, MAR
- Pathology, Faculty of Medicine and Pharmacy of Agadir, Agadir, MAR
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24
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Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J, Botchu R. Primary Benign Neoplasms of the Spine. Diagnostics (Basel) 2023; 13:2006. [PMID: 37370901 DOI: 10.3390/diagnostics13122006] [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: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Nathan Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Karthikeyan P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Steven James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
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Al-Qassab S, Lalam R, Singh J, Tyrrell PNM. Imaging of Lower Limb Tumors and Tumor-Like Conditions. Radiol Clin North Am 2023; 61:361-373. [PMID: 36739150 DOI: 10.1016/j.rcl.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bone and soft tissue lesions are frequently seen in the lower limbs. Many are non-neoplastic but may mimic tumours. In this article, we discuss a practical approach for the diagnosis and management of the most common tumours and tumour-like conditions seen in the lower limbs.
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Affiliation(s)
- Sinan Al-Qassab
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK
| | - Radhesh Lalam
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK.
| | - Jaspreet Singh
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK
| | - Prudencia N M Tyrrell
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK
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Hoarau E, Quilhot P, Baaroun V, Lescaille G, Campana F, Lan R, Rochefort J. Oral giant cell tumor or giant cell granuloma: How to know? Heliyon 2023; 9:e14087. [PMID: 36923864 PMCID: PMC10008978 DOI: 10.1016/j.heliyon.2023.e14087] [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: 12/02/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The distinction between giant cell tumors and giant cell granulomas is challenging, as both entities have overlapping diagnostic criteria, especially in oral locations. The two entities have similar clinical and radiological presentations, but they differ in their prognoses. Objective The main objective of this study was to list the clinical, radiological, histological, and prognostic features of maxillomandibular giant cell tumors and giant cell granulomas cases n order to assess their value as a diagnostic referral factor that may allow the distinction between maxillo-mandibular giant cell granuloma and giant cell tumor. Study design Data of maxillomandibular giant cell granulomas and giant cell tumors were assessed through a scoping review and a pre-existing systematic review of literature. We have also realized a bicentric retrospective study. Results Various criteria facilitate the differential diagnosis like age, size, locularity and presence of necrosis zone but not the gender. The most discriminating factors was symptomatology (reported in 72% of GCTs while only 15% of GCGs) and the distribution pattern of giant cells in the stroma (homogeneously dispersed in 80% of GCTs versus grouped in clusters in 86.7% of GCGs). Recurrences were most described for giant cell tumors than giant cell granulomas. Malignant transformation and pulmonary metastasis were exclusively reported for giant cell tumors. Conclusion As clinical and radiological elements are not sufficient to distinguish between these two entities, immunohistochemistry and molecular genetics can be represent diagnostic biomarkers to distinguish giant cell granulomas and giant cell tumors in oral cavity. We have attempted to define the main criteria for the differentiation of giant cell tumor and giant cell granuloma and propose a decision tree for the management of single maxillomandibular giant cell lesions.
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Affiliation(s)
- E. Hoarau
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Aix Marseille Univ, APHM, Timone Hospital, Oral Surgery Department, Marseille, France
| | - P. Quilhot
- Médecine Sorbonne Université, Paris, France
- Department of Pathology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - V. Baaroun
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
| | - G. Lescaille
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
| | - F. Campana
- Aix Marseille Univ, APHM, INSERM, MMG, Timone Hospital, Oral Surgery Department, Marseille, France
| | - R. Lan
- Aix Marseille Univ, APHM, CNRS, EFS, ADES, Timone Hospital, Oral Surgery Department, Marseille, France
| | - J. Rochefort
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
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Cornellas L, Saez de Gordoa K, Bartolome A, Larque AB, Tomas X. Talar metastasis of mucinous lung adenocarcinoma with fluid-fluid levels: a rare presentation mimicking a benign tumor. Skeletal Radiol 2023; 52:257-262. [PMID: 35869327 DOI: 10.1007/s00256-022-04123-4] [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: 02/25/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
The differential diagnosis of bone tumors in the talus is broad and includes both benign and malignant conditions. Metastases, although very rare, are one of these conditions. The typical nonspecific clinical and radiological presentations of metastases are a diagnostic challenge, and a high level of suspicion is needed in order to perform an adequate diagnostic approach. Moreover, they can present with features which have classically been associated with benign conditions such as fluid-fluid levels. We present a rare case of talar metastasis of a mucinous pulmonary adenocarcinoma that presented with fluid-fluid levels and was initially misdiagnosed as a giant-cell tumor with areas of secondary aneurysmal bone cyst transformation.
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Affiliation(s)
- Lluria Cornellas
- Radiology Dpt. Hospital Clínic (UB), Villarroel 170, 08036, Barcelona, Spain.
| | | | - Alvaro Bartolome
- Radiology Dpt. Hospital Clínic (UB), Villarroel 170, 08036, Barcelona, Spain
| | - Ana Belen Larque
- Pathology Dpt. Hospital Clínic (UB), Villarroel 170, 08036, Barcelona, Spain
| | - Xavier Tomas
- Radiology Dpt. Hospital Clínic (UB), Villarroel 170, 08036, Barcelona, Spain
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Matham G, Divakar G, Deepti AN, Thomas B, Easwer HV, Kumar K. Unique presentation of occipital condyle giant cell tumor as occipital condyle syndrome - A review. J Neurosci Rural Pract 2023; 14:3-6. [PMID: 36891099 PMCID: PMC9945303 DOI: 10.25259/jnrp-2021-8-27(1975)] [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: 12/18/2021] [Accepted: 09/22/2022] [Indexed: 12/30/2022] Open
Abstract
Giant cell tumors (GCTs) of the skull are rare and only a few case series with limited number of cases have been reported till date. In the cranium, GCT usually occurs in the sphenoid and temporal bone, occipital condyle GCTs are very rare. We report a rare presentation of GCT of the occipital condyle manifested as occipital condyle syndrome. Despite gross total resection, they can recur aggressively; the presence of cortical breach might be an indicator of aggressiveness prompting early post-operative imaging and adjuvant therapy.
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Affiliation(s)
- Gowtham Matham
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - A. N. Deepti
- Department of Pathology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bejoy Thomas
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - H. V. Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Krishna Kumar
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Hess MC, Kafchinski L, Ransom E. Giant Cell Tumor of the Distal Radius: A Review. Orthop Clin North Am 2023; 54:75-88. [PMID: 36402513 DOI: 10.1016/j.ocl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant cell tumor of the distal radius presents a significant challenge in management due to high risk of recurrence and potential loss of function. Shared decision-making guides management, particularly for more advanced lesions. Intralesional curettage can optimize wrist function but at the cost of a higher recurrence risk. Wide resection decreases local recurrence but has higher complication rates regardless of reconstruction method. No functional difference exists between motion-preserving procedures and arthrodesis; therefore, patients should be clearly informed of the risks and benefits of each treatment option.
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Affiliation(s)
- Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Lisa Kafchinski
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA
| | - Erin Ransom
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA
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30
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Aassouani F, El Bouardi N, Charifi Y, Maadin K, Bouziane A, Haloua M, Lamrani MYA, Arifi S, Bouhafa T, Boubbou M, Maaroufi M, Alami B. A rare case of sphenoid giant cell tumor: Case report & review of imaging features post short-term denosumab treatment. Radiol Case Rep 2022; 17:3830-3834. [PMID: 35982722 PMCID: PMC9379972 DOI: 10.1016/j.radcr.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Giant cell tumors (GCTs) are locally aggressive but rarely malignant bone neoplasms that uncommonly involve the skull. In this report, we describe a tumor of the sphenoid sinus. Case presentation: A 51-year-old female was presented with headache, and bilateral decreased visual acuity, CT scan, and brain MRI revealed an infra-sellar enhancing tumor expanding to the sellar and supra-sellar region which proved to be a GCT. the patient had received 03 months of preoperative denosumab-based treatment and imaging follow-up showed regression in size and morphology modifications of tumor tissue. Conclusion: This is one of few reports to describe the appearance of sphenoid bone GCT, and the first report to highlight the effects of short-term denosumab treatment in GCTb in such a location.
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Muacevic A, Adler JR. A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass. Cureus 2022; 14:e29801. [PMID: 36337816 PMCID: PMC9619154 DOI: 10.7759/cureus.29801] [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] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Epithelioid hemangioma (EH) is an uncommon benign vascular tumor of mesenchymal origin. It mainly presents as expanding nodules around the ear, the forehead, and long bones. Only a handful of cases have been found in cervical, thoracic, lumbar, and sacral vertebrae as lytic lesions with pain and neurological impairment. We present the case of a 36-year-old female with an incidental finding of a sacral mass along with inguinal lymphadenopathy on imaging. Initially, there were no symptoms. The mass gradually progressed and later showed an extraosseous extension with involvement of sacral neural foramina and nerve roots causing severe low back pain and weakness of the left lower extremity. Differential diagnoses initially included secondary metastases and chordoma. However, the biopsy of the mass revealed findings consistent with an EH. To our knowledge, this is the first case of EH presenting as an isolated mass in the sacrum and the third case of EH involving the sacrum in continuation with other vertebrae. EH should be in our differential diagnoses when there is a sacral mass.
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Mishra S, Jain M, Gavhale S, Bansal S, Ghildiyal S, Mokashi M. Intrathoracic Extension of a Giant Cell Tumour of the Medial End of Clavicle: A Case Report with Review of Literature. Indian J Orthop 2022; 56:1834-1840. [PMID: 36187579 PMCID: PMC9485364 DOI: 10.1007/s43465-022-00726-0] [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: 06/02/2022] [Accepted: 08/11/2022] [Indexed: 02/04/2023]
Abstract
Introduction The clavicle is a very rare site for primary bone tumours, and Giant cell tumours of the clavicle are even rarer. Very few cases have been reported in the literature. Method The authors report a rare presentation of intrathoracic extension of a giant cell tumour of the medial end of the clavicle, in an 18-year-old female. The patient had painful swelling at the sternal end of the clavicle associated with a painful shoulder range of motion. Complete resection of the mass was done, preserving the lateral half of the clavicle. Result and Discussion At a 3-year follow-up, the patient has a good clinical outcome with no signs of recurrence. Being a very rare entity, no clear guidelines are available for the management of GCT of Clavicle. Adequate resection of the tumour mass remains the mainstay of treatment and has shown promising results. Denosumab has been proved to be effective in some studies, but the high cost of treatment is a major limitation in the Indian scenario. Conclusion Resection of the tumour mass with partial cleidectomy provided good results in this patient.
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Affiliation(s)
- Shaswat Mishra
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
| | - Manish Jain
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
| | - Sandeep Gavhale
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
| | - Sagar Bansal
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
| | - Sanjeev Ghildiyal
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
| | - Mitali Mokashi
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra India
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Yuan B, Zhang L, Yang S, Ouyang H, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center. Global Spine J 2022; 12:1449-1461. [PMID: 33499650 PMCID: PMC9393967 DOI: 10.1177/2192568220982280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. RESULTS Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid-fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. CONCLUSIONS Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.
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Affiliation(s)
- Bei Yuan
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Peking University Health Science Center, Haidian District, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Shaomin Yang
- Department of Pathology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Hanqiang Ouyang
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Liang Jiang
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Liang Jiang and Zhongjun Liu, Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. Emails: ;
| | - Feng Wei
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China,Liang Jiang and Zhongjun Liu, Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. Emails: ;
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Bocanegra-Becerra JE, Showing MGP, Tanta LAH. Surgical management of giant cell tumor invading the occipital bone: A case report and literature review. Surg Neurol Int 2022; 13:351. [PMID: 36128092 PMCID: PMC9479658 DOI: 10.25259/sni_382_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/23/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Giant cell tumor of bone (GCTB) rarely originates in the skull, particularly in the occipital bone. Although benign, it can severely destroy the surrounding tissue and undergo an unpredictable clinical course. We report the successful resection of a GCTB invading the occipital bone in a Hispanic adult woman and present a comprehensive review of the literature on this rare pathology by focusing on the occipital area.
Case Description:
A 40-year-old Hispanic woman presented with a 3-month history of neck pain and a bulging lesion on the retromastoid area. Brain magnetic resonance imaging (MRI) revealed an extradural, expansive, and contrast-enhancing lesion in the right occipital bone with multiple thin septa and evidence of bleeding. The patient underwent an uneventful gross total resection (GTR) of the lesion. The histopathological examination findings included numerous scattered osteoclast-type giant multinucleated cells. At a 10-month follow-up, the patient has not developed any neurological deficits, impairment of life functioning, or signs of recurrence in MRI.
Conclusion:
GCTB rarely originates in the skull, being the occipital bone the most infrequent site of presentation. When feasible, total surgical resection effectively reduces the risk of recurrence. Nonetheless, radiation and adjuvant therapies have been employed when GTR could not be achieved. A close follow-up with a brain MRI is advised to control recurrence.
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Affiliation(s)
| | | | - Luis A. Huamán Tanta
- Department of Neurosurgery, Instituto de Neurociencias de Lima,
- Clínica San Felipe, Lima, Perú
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Chanda R, Regi SS, Kandagaddala M, Irodi A, Thomas M, John M. Imaging Features of Craniofacial Giant Cell Granulomas: A Large Retrospective Analysis from a Tertiary Care Center. AJNR Am J Neuroradiol 2022; 43:1190-1195. [PMID: 35798384 PMCID: PMC9575421 DOI: 10.3174/ajnr.a7568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Craniofacial giant cell granulomas are rare lesions with varied appearances on imaging. We aimed to describe the imaging features of giant cell granulomas of the craniofacial bones. MATERIALS AND METHODS A retrospective analysis of the clinical features and imaging findings of 20 histopathology-proved cases of craniofacial giant cell granulomas, dating from 2006 to 2022, was performed. RESULTS Of the 20 cases, 10 each were seen in men and women. The epicenter of the lesions varied in location: in the maxilla in 8 patients, in the mandible in 5, in the temporal bone in 3, in the sphenoid/clivus in 3, and in the orbit in 1 patient. On the radiographs, the lesions appeared well-circumscribed, expansile, and lytic. On CT, the lesions were predominantly multiloculated, with thin septa, a soft-tissue component, and with expansion and remodeling of the underlying bone. On MR imaging, the solid component of the lesions was isointense on T1WI and hypointense on T2WI, with heterogeneous enhancement of the solid component and rim enhancement of the locules. Fluid-fluid levels were present in 3 patients. CONCLUSIONS Giant cell granulomas commonly present as locally aggressive, expansile, multiloculated lytic lesions, with solid as well as cystic areas. The solid component is typically hypointense on T2WI. Certain key imaging features of giant cell granulomas can aid the radiologist in narrowing the differential diagnosis.
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Affiliation(s)
- R Chanda
- From the Departments of Radiodiagnosis (R.C., S.S.R., M.K., A.I.)
| | - S S Regi
- From the Departments of Radiodiagnosis (R.C., S.S.R., M.K., A.I.)
| | - M Kandagaddala
- From the Departments of Radiodiagnosis (R.C., S.S.R., M.K., A.I.)
| | - A Irodi
- From the Departments of Radiodiagnosis (R.C., S.S.R., M.K., A.I.)
| | | | - M John
- Otorhinolaryngology (M.J.), Christian Medical College, Vellore, India
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Tseng CS, Wong CE, Huang CC, Hsu HH, Lee JS, Lee PH. Spinal giant cell-rich osteosarcoma-diagnostic dilemma and treatment strategy: A case report. World J Clin Cases 2022; 10:7565-7570. [PMID: 36157995 PMCID: PMC9353892 DOI: 10.12998/wjcc.v10.i21.7565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/02/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell-rich osteosarcoma (GCRO) is a rare histological variant of osteosarcoma. Spinal GCROs are extremely rare, with challenging diagnosis and management. Herein, we present a case of spinal GCRO at T2, which was not diagnosed in initial biopsy but after T2 corpectomy. We detailed the clinical course, management strategy, and outcome after a 4-year follow-up.
CASE SUMMARY A 17-year-old female patient presented with back pain followed by ascending paresthesia. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a collapsed T2 vertebra with an enhancing osteolytic mass. CT-guided biopsy showed inconclusive morphology. Pathology from T2 corpectomy revealed GCRO. The patient subsequently received neoadjuvant chemotherapy followed by salvage operation of T2 costotransversectomy with grossly-total resection adjuvant chemoradiation. Upon treatment completion, she had complete GCRO remission. The 4-year follow-up spinal MRI showed no tumor recurrence.
CONCLUSION Spinal GCRO poses unique challenges in obtaining sufficient tissue diagnosis and complete surgical removal. However, long-term local control of spinal GCRO is possible following complete resection and adjuvant chemoradiation
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Affiliation(s)
- Chen-Sheng Tseng
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chia-En Wong
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hao-Hsiang Hsu
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Jung-Shun Lee
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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Matham G, Divakar G, AN D, Thomas B, HV E, K. K. Unique Presentation of Occipital Condyle Giant Cell Tumor as Occipital Condyle Syndrome—A Review. J Neurosci Rural Pract 2022. [DOI: 10.1055/s-0042-1751228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractGiant cell tumors (GCT) of the skull are rare and only a few case series with limited number of cases have been reported till date. In the cranium, GCT usually occurs in the sphenoid and temporal bone, and occipital condyle GCTs are very rare. We report a rare presentation of GCT of the occipital condyle manifested as occipital condyle syndrome. Despite gross total resection, they can recur aggressively; presence of cortical breach might be an indicator of aggressiveness prompting early postoperative imaging and adjuvant therapy.
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Affiliation(s)
- Gowtham Matham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Deepti AN
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Easwer HV
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Krishnakumar K.
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Borkowska AM, Szumera-Ciećkiewicz A, Szostakowski B, Pieńkowski A, Rutkowski PL. Denosumab in Giant Cell Tumor of Bone: Multidisciplinary Medical Management Based on Pathophysiological Mechanisms and Real-World Evidence. Cancers (Basel) 2022; 14:cancers14092290. [PMID: 35565419 PMCID: PMC9100084 DOI: 10.3390/cancers14092290] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The widely accepted local therapy in extremity giant cell tumor of bone (GCTB) is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. Most GCTB patients with localized disease can be successfully treated with surgical curettage; patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice. Abstract (1) Despite the benign nature of the giant cell tumor of bone (GCTB), it shows a local recurrence rate of up to 50% and a chance of malignant transformation. The widely accepted local therapy in extremity GCTB is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab, a human monoclonal antibody directed against the RANKL and associated inhibition of the RANKL pathway, is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. (2) The literature review of patients with GCTB treated with denosumab is performed via PubMed, using suitable keywords from January 2009 to January 2021. (3) Current indications for denosumab use are not definitively clear and unambiguous. Most GCTB patients with localized disease can be successfully treated with surgical curettage, and the role of denosumab in preoperative therapy in this patient population remains unclear. (4) However, patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice.
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Affiliation(s)
- Aneta Maria Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Bartłomiej Szostakowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Andrzej Pieńkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
| | - Piotr Lukasz Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.M.B.); (B.S.); (A.P.)
- Correspondence:
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Tahir I, Andrei V, Pollock R, Saifuddin A. Malignant giant cell tumour of bone: a review of clinical, pathological and imaging features. Skeletal Radiol 2022; 51:957-970. [PMID: 34562125 DOI: 10.1007/s00256-021-03913-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 06/03/2025]
Abstract
Giant cell tu mour accounts for up to 5% of all bone tumours and malignant giant cell tumour arises in < 10% of cases, representing sarcomatous transformation. Primary malignant giant cell tumour of bone occurs when sarcomatous tissue is observed within conventional giant cell tumour histologically on initial presentation. Secondary malignant giant cell tumour of bone occurs in a region of previously treated giant cell tumour, with most cases arising due to prior radiotherapy. Malignancy in giant cell tumour of bone does not have any unique clinical or imaging features compared to conventional aggressive disease. Historically, malignant giant cell tumour of bone has a poor prognosis which is worse in cases of secondary malignancy. This article aims to present the clinical, pathological and imaging features of MGCTB based on a review of the literature and illustrated by examples from our experience.
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Affiliation(s)
- Ismail Tahir
- Massachusetts General Hospital, 55 Fruit St., Boston, USA.
| | - Vanghelita Andrei
- Specialty Trainee in Histopathology, Department of Pathology, Royal National Orthopaedic Hospital, NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Robin Pollock
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
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Tsai WH, Zeng YH, Lee CC, Tsai MC. Mortality factors in recurrent parathyroid cancer: a pooled analysis. J Bone Miner Metab 2022; 40:508-517. [PMID: 35184206 DOI: 10.1007/s00774-021-01305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Parathyroid cancer is a rare disease with high recurrence rate. The prognostic factors for recurrent parathyroid cancer are yet to be ascertained. We aimed to establish the association between recurrent parathyroid cancer and previously reported prognostic factors. MATERIALS AND METHODS We conducted a PubMed search using the keywords 'parathyroid cancer', 'parathyroid neoplasm', and 'hypercalcemia' during 1966-2019 and included 3272 articles. We focused on 73 patients with recurrent parathyroid cancer from 55 studies. We conducted a survival analysis using the Cox proportional hazards model with 95% confidence interval. RESULTS For the 73 patients included in the analysis, the mean age (± standard deviation) was 44 ± 13.2 years, wherein 36 patients were women (49.3%). During the 5236 person-months at risk (mean follow-up 71.7 months, range 3-264), 38 patients died. The incidence of local recurrence, lymph-node metastasis, lung metastasis, and bone metastasis were 60.3, 12.3, 56.2, and 24.7, respectively. Bone metastasis, disease-free interval < 1 year, and total surgeries < 3 were significant prognostic factors in univariate analysis (log-rank test P = 0.0063, P = 0.0006, and P = 0.0056, respectively). In the multivariate-adjusted analysis, the mortality risk was significantly increased in patients with bone metastasis with a hazard ratio (HR) of 4.83 (95% CI 1.16-20.2; P = 0.03), disease-free interval <=1 year of 5.92 (95% CI 1.85-18.99; P = 0.003), and total surgeries <3 of 11.29 (95% CI 2.82-45.22; P = 0.001), considering these as possible predictive prognostic factors. CONCLUSION Bone metastasis, duration of disease-free interval, and total number of surgeries predict survival in recurrent parathyroid cancer.
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Affiliation(s)
- Wen-Hsuan Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
| | - Yi-Hong Zeng
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Ming-Chieh Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC).
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC).
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Rhou YJJ, Wang CJ, Nguyen M, Vanderniet JA, Munns CF, Coleman H, Kim J, Holmes-Walker DJ, Lim L, Girgis CM. Clinical and Radiologic Response of Central Giant Cell Granuloma to Denosumab: A 6-Year Prospective Observational Study. Calcif Tissue Int 2022; 110:464-474. [PMID: 35088118 DOI: 10.1007/s00223-021-00935-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022]
Abstract
Central giant cell granuloma (CGCG) is a rare lesion of the jaw occurring in young adults and adolescents. Surgery, the traditional mainstay of therapy, is associated with significant morbidity. Denosumab, a humanised monoclonal antibody to RANKL, is effective in a related entity, giant cell tumour of bone (GCTB), but experience in the more indolent CGCG is limited. This prospective observational study of all denosumab-treated CGCG at a tertiary referral centre (2015-2021) aimed to evaluate the safety, efficacy and recurrence risk using denosumab in CGCG at lower-frequency dosing than used for GCTB. All received standardised, time-limited courses of denosumab 120 mg with stepwise increase in dosing interval based on response. They were followed for up to 75 months using a radiation-minimising protocol: 3-monthly clinical, biochemical and radiological assessment (orthopantomograms, cone beam CT). Eight patients, median age 20.5 years [IQR 6], received 13 initial doses [IQR 10] of denosumab 120 mg. Radiologic response was seen after 5.5 doses [IQR 4.5]: ossification in all and size reduction in three. Recurrence occurred in four of seven completing therapy, observed 12 months post-cessation [IQR 6.5]. Larger baseline size, aggressive subtype and fewer than 12 initial doses were more common in the recurrence group. There was no osteonecrosis of the jaw. Hypocalcaemia occurred in one receiving modified dosing. This study represents the largest, most diverse cohort of denosumab-treated CGCG with the longest follow-up in literature. It demonstrates the efficacy of lower-frequency, time-restricted course of denosumab but highlights the risk of recurrence. Long-term follow-up is critical.
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Affiliation(s)
- Yoon Ji Jina Rhou
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
| | - Che-Jen Wang
- Department of Oral and Maxillofacial Surgery, Westmead Hospital, Sydney, NSW, Australia
- Dental and Maxillofacial Department, Prince of Wales Hospital, Sydney, NSW, Australia
- Department of Dental and Oral Surgery, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Minh Nguyen
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
| | - Joel A Vanderniet
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Hedley Coleman
- Department of Anatomical Pathology, Douglass Hanly Moir, Sydney, NSW, Australia
| | - James Kim
- Department of Oral and Maxillofacial Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Deborah Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lydia Lim
- Department of Oral and Maxillofacial Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Christian M Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia.
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Diagnosis and Treatment of Lumbar Giant Cell Tumor of the Spine: Update on Current Management Strategies. Diagnostics (Basel) 2022; 12:diagnostics12040857. [PMID: 35453904 PMCID: PMC9032786 DOI: 10.3390/diagnostics12040857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Giant Cell Tumor of the spine remains a difficult tumor to treat. Recent advances in adjuvant therapy such as denosumab and innovations in surgical technique in the last 5 years have given providers new options for treatment after a successful diagnosis of the tumor. (2) Methods: Articles published between 1927 and 2021 were selected from PubMed and Scopus searches using key words “Giant Cell Tumor” AND “Lumbar Spine” AND “Treatment”. Relevant articles were reviewed and selected by the authors. (3) Results: A total of 191 articles were discovered. Complete en bloc spondylectomy remains the most definitive treatment option; however, this surgery is challenging and carries a high rate of complication. New adjuvant therapies including denosumab offer a viable alternative to surgery. (4) En bloc spondylectomy remains the gold standard treatment for Giant Cell Tumor of the spine with the lowest published recurrence rate. The use of (neo)adjuvant denosumab improves recurrence rates. More data are needed to determine if denosumab alone is a viable standalone definitive treatment.
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Nagano A, Urakawa H, Tanaka K, Ozaki T. Current management of giant-cell tumor of bone in the denosumab era. Jpn J Clin Oncol 2022; 52:411-416. [PMID: 35199172 DOI: 10.1093/jjco/hyac018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/14/2022] Open
Abstract
Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab-a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand-was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.
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Affiliation(s)
- Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Hospital, Aichi, Japan
| | - Kazuhiro Tanaka
- Department of Endoprosthetic Surgery, Oita University, Yufu, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Jain S, Thiagarajan S, Panjwani P, Sathe P, Ramadwar M. The clinical challenges and dilemma in the management of uncommon maxillary sinus tumors - A report of two cases. J Oral Maxillofac Pathol 2022; 26:S116-S118. [PMID: 35450242 PMCID: PMC9017833 DOI: 10.4103/jomfp.jomfp_236_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 12/30/2022] Open
Abstract
Maxillary sinus is the common site for the nose and paranasal sinus tumors with diverse histopathological types and the treatment for each may differ. Making a histopathological diagnosis on occasion can be challenging. We had two patients presenting with upper alveolus growth in whom establishing the histopathological diagnosis was challenging. Through clinical evaluation, imaging (computed tomography and/or magnetic resonance imaging) and identification of key histopathological features helped in the management of these patients.
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Affiliation(s)
- Siddhanth Jain
- Department of Head and Neck Surgical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Poonam Panjwani
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pranav Sathe
- Department of Head and Neck Surgical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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De Salvo S, Pavone V, Coco S, Dell’Agli E, Blatti C, Testa G. Benign Bone Tumors: An Overview of What We Know Today. J Clin Med 2022; 11:699. [PMID: 35160146 PMCID: PMC8836463 DOI: 10.3390/jcm11030699] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
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Affiliation(s)
| | | | | | | | | | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (S.D.S.); (V.P.); (S.C.); (E.D.); (C.B.)
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Jaconelli T, Auplish S. A rare cause of shoulder pain. Postgrad Med J 2022; 98:e1. [PMID: 37063022 DOI: 10.1136/postgradmedj-2021-141112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tom Jaconelli
- Department of Emergency Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Sunil Auplish
- Department of Trauma and Orthopaedics, York Teaching Hospital NHS Foundation Trust, York, UK
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Wągrodzki M, Tysarowski A, Seliga K, Wojnowska A, Stepaniuk M, Castañeda Wysocka P, Makuła D, Pieńkowski A, Szostakowski B, Zub R, Rutkowski P. Diagnostic Utility of Genetic and Immunohistochemical H3-3A Mutation Analysis in Giant Cell Tumour of Bone. Int J Mol Sci 2022; 23:ijms23020969. [PMID: 35055156 PMCID: PMC8778699 DOI: 10.3390/ijms23020969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
To validate the reliability and implementation of an objective diagnostic method for giant cell tumour of bone (GCTB). H3-3A gene mutation testing was performed using two different methods, Sanger sequencing and immunohistochemical (IHC) assays. A total of 214 patients, including 120 with GCTB and 94 with other giant cell-rich bone lesions, participated in the study. Sanger sequencing and IHC with anti-histone H3.3 G34W and G34V antibodies were performed on formalin-fixed, paraffin-embedded tissues, which were previously decalcified in EDTA if needed. The sensitivity and specificity of the molecular method was 100% (95% CI: 96.97–100%) and 100% (95% CI: 96.15–100%), respectively. The sensitivity and specificity of IHC was 94.32% (95% CI: 87.24–98.13%) and 100% (95% CI: 93.94–100.0%), respectively. P.G35 mutations were discovered in 2/9 (22.2%) secondary malignant GCTBs and 9/13 (69.2%) GCTB after denosumab treatment. We confirmed in a large series of patients that evaluation of H3-3A mutational status using direct sequencing is a reliable tool for diagnosing GCTB, and it should be incorporated into the diagnostic algorithm. Additionally, we discovered IHC can be used as a screening tool. Proper tissue processing and decalcification are necessary. The presence of the H3-3A mutation did not exclude malignant GCTB. Denosumab did not eradicate the neoplastic cell population of GCTB.
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Affiliation(s)
- Michał Wągrodzki
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Correspondence: ; Tel.: +48-537484741
| | - Andrzej Tysarowski
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.T.); (K.S.); (A.W.); (R.Z.)
| | - Katarzyna Seliga
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.T.); (K.S.); (A.W.); (R.Z.)
| | - Aneta Wojnowska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.T.); (K.S.); (A.W.); (R.Z.)
| | - Maria Stepaniuk
- Department of Pathology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Patrycja Castañeda Wysocka
- Department of Radiology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.W.); (D.M.)
| | - Donata Makuła
- Department of Radiology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.W.); (D.M.)
| | - Andrzej Pieńkowski
- Department of Bone/Soft Tissue Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.P.); (B.S.); (P.R.)
| | - Bartłomiej Szostakowski
- Department of Bone/Soft Tissue Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.P.); (B.S.); (P.R.)
| | - Renata Zub
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.T.); (K.S.); (A.W.); (R.Z.)
| | - Piotr Rutkowski
- Department of Bone/Soft Tissue Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.P.); (B.S.); (P.R.)
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Parmeggiani A, Miceli M, Errani C, Facchini G. State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics. Cancers (Basel) 2021; 13:6298. [PMID: 34944917 PMCID: PMC8699510 DOI: 10.3390/cancers13246298] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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
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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Affiliation(s)
- Anna Parmeggiani
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
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Zhang XP, Lu XC, Wang LL, Wei JQ, Yan J, Shao XN, Che YY, Cheng JL. Giant Cell Tumors of Bone in Patients Aged 18 Years Old or Younger: Imaging Features and Tumor Characteristics. Int J Gen Med 2021; 14:8389-8397. [PMID: 34819747 PMCID: PMC8608021 DOI: 10.2147/ijgm.s330507] [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: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The majority of giant cell tumors of bone (GCTB) occur in adult patients, especially between the ages of 20 and 40. This study aims to investigate the imaging features of GCTBs in pediatric patients and compare their characteristics with adult cases. Methods Fifty-seven cases of patients aged 18 years old or younger were retrospectively analyzed, accounting for 12.8% of GCTBs in the First Affiliated Hospital of Zhengzhou University from 2001 to 2019. One hundred twenty-six adult patients (19 years of age and older) with GCTB occurring in long tubular bones were also included in this study. The following clinical information was identified from the medical records: age, sex, and follow-up data. Imaging features were reviewed by two musculoskeletal radiologists. Patient characteristics and imaging features between the two groups were compared. Results A total of 57 patients (32 females, 25 males) were included in the study. The patients’ ages ranged from 9 to 18 (median = 17 y). The majority of tumors occurred in tubular bones (n = 38, 66.7%) and the pelvis (n = 8, 14.0%). Imaging features were identified in GCTB cases occurring in the long tubular bones. Compared with adult GCTB patients, pediatric GCTB patients had a larger superior–inferior (SI) diameter (P = 0.005) and smaller left-to-right diameter/SI diameter ratio (P = 0.001). Epiphyseal involvement was relatively less common in pediatric patients with GCTBs than in adult patients (P = 0.009). The median age of patients without epiphyseal involvement was lower than the median age of patients with epiphyseal involvement (11 vs 17 y). Conclusion GCTB in the pediatric age group is rare. This study has found that, in pediatric patients with GCTBs, the epiphysis is relatively less involved, and the tumor is more likely to grow longitudinally. These findings are helpful in the diagnosis of GCTBs in the pediatric population.
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Affiliation(s)
- Xue-Ping Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Xin-Chang Lu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Lin-Lin Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Jie-Qin Wei
- Department of Radiology, The First People's Hospital of Nanning, Nanning, 530000, People's Republic of China
| | - Jing Yan
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Xiao-Ning Shao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Ying-Yu Che
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Jing-Liang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
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