Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

Surgical treatment of giant cell tumors of long bone combined with inserted microwave antennas induced hyperthermia

AIM：To evaluate the surgical treatment methods of giant cell tumors(GCT) of long bone in conjunction with inserted microwave antennas induced hyperthermia.METHODS:46patients,included the surgical procedures,the oncology results,the functions of the limbs and the complications were analyzed.RESULTS:Follow-up 3.5 to 9 years(mean 5.5years).All patients were evaluated according to oncological and orthopaedic criteria.Two tumors were recurred.Orthopaedic furction were perfect in 44 patients and were fair in 2.Infection was found in 2 patients.CONCLUSION:The surgical procedure to treat the giant cell tumors of long bone by inserted microwave antennas induced hyperthermia is a definitive surgical method which is safe and confident.

The surgical Treatment and Outcome of Pathological Fracture in Patients with Giant Cell Tumor of Bone

Between 1992 and 2008, we treated 35 patients with giant cell tumor (GCT) of bone, seven of the 35 pre-sented with a pathological fracture. The fractures were located in the femur in five, and in the humerus and radius in one patient each. The surgical treatments were curettage in six cases and wide resection in the distal radius case. Two of the seven patients developed local recurrence, giving a local recurrence rate of 29%. The local recurrence rate in GCT patients without a pathological fracture was 21%. There was a tendency for there to be a higher recurrence rate associated with fractured GCT, but no statistically significant difference was observed between the two groups. Therefore, it was considered that a pathological fracture was not a risk factor for local recurrence in GCT.

Heat Shock Protein 70 Expression in Giant Cell Tumor of Bone and Its Clinical Application

Objective: To provide a better prognosis after the treatment of giant cell tumor of bone which is a common benign aggressive bone tumor by the use of thermoablation, Hsp70 expression of the tumor was explored and the relationship between the relative amount of expression of this protein and tumor recurrence was studied. Methods: Avascular parts of tumor tissues were collected from 11 patients, 3 male and 8 female with an average age of 32.27 years and were sent for the analysis of protein contents by the use of Western blot. A comparative protein analysis was used for the detection of Hsp70 and beta-actin. Monoclonal antibody was used for the identification of Hsp70. The measurement was carried out two times in one patient. The relationship between ratios of Hsp70/beta-actin and tumor recurrence during 3-year follow-up was carried out. Results: Tumor recurrence was found in 4 patients, 36.6% and none had lung metastasis. Significant HSP expression was found in all specimens. No patient with the ratio of HSP70/beta-actin expression lower than 0.66 had tumor recurrence. Sensitivity of the test was 75% and specificity was 100%. Conclusion: Expression of Hsp70 was found in giant cell tumor of bone and high relative expression of this protein related to tumor recurrence.

Soft tissue recurrence of giant cell tumor of bone: A report of two cases and literature review

We investigated the clinical features of soft-tissue recurrence in giant cell tumor of bone （GCTB）. Among 106 cases with GCTB in our hospital, there were 2 cases occurring soft-tissue recurrence which histories were reported. These two soft-tissue recurrences occurred with the interval of 6.9 years and 2.5 years respectively from pdmary diagnosis. The clinical presentation was nonspecific masses in soft tissue. Radiographic ossification was not found at periphery or within the masses. Through pathological examination peripheral ossification was found in 1 case and malignant transformation occurred in the other case. Through retrieving and reviewing literatures in PubMed, 19 cases of soft-tissue recurrence with detailed materials were collected and analyzed. Soft-tissue recurrence of GCTB is a rare episode which reflects its locally aggressive nature, the reasons of which are tumor cells implantation and tumor residual. Ossification at periphery or in the masses can be considered as a pathognomonic character of this episode in radiographic and pathohistological examination. The prevention lies in determining tumor extension preoperatively, proper non-tumor manipulations, removing the tumor and irrigating operative wound as completely as possible.

Autograft-prosthesis composite for aggressive giant cell tumor of bone around knee

Objective： The aim of the research was to study the clinical feasibility of autograft-prosthesis composite for aggressive giant call tumor of bone around knee. Methods： Seven patients （5 males and 2 females, the mean age of 30.5 years old） with giant cell tumor of bone around knee underwent tumor resection and reconstructed with autograft-prosthesis composites since January 2006. Five lesions located at the distal femur and 2 at the proximal tibia. There were 3 patients with primary tumor and 4 with recurrent. Three patients with pathological fracture and all patients were of Campanacci Ⅲ. Results： All patients were done follow-up from 12 to 36 months. No recurrence, metastasis, and prosthesis loosening were found. The mean healing time between autograft and host bone was 5 months. The mean motion range of affected knee were 90° （70°-110°）. Conclusion： Our data documented the clinical feasibility of autograft-prosthesis composite for giant cell tumor of bone around knee which should be performed tumor resection and reconstructed with prosthesis. The long-term outcomes remain to be further proven.

Clinical Features of Giant Cell Tumor of Bone in Elderly Patients

Background: Giant cell tumor of the bone (GCTB) occurs most often in younger individuals aged between 20 and 40 years. However, it also occurs in a small proportion of elderly people. Therefore, it is necessary to determine the clinical characteristics of GCTB in elderly people, as only few reports have completely examined the characteristics of GCTB in elderly patients. Methods: This retrospective study enrolled 69 patients with benign GCTB. Patients’ information on age, sex, anatomical location and size, Campanacci grade, pathological fracture, treatment for primary tumors, local and distant relapse, and outcome was collected. We compared these clinical courses between the younger and older groups. We divided the age groups into three subgroups: ≤54 years and ≥55 years, ≤59 years and ≥60 years, and ≤64 years and ≥65 years. We compared the two groups in each subgroup. In addition, we examined factors affecting local recurrence and distant metastasis. Results: Tumor size was significantly larger in the older group between the two subgroups of 55 and 60 years. Kaplan-Meier curves for local recurrence-free survival and distant metastasis-free survival between the two subgroups of 65 years showed significant differences (p = 0.0183 and p = 0.0014). In the multivariate logistic regression analyses, female sex, curettage-only surgical procedure, and denosumab usage before surgery affected local recurrence. Conclusion: Age is unlikely to affect local recurrence and distant metastases in GCTB patients, but local recurrence and distant metastases may be noted in elderly patients aged ≥65 years with GCTB.

Primary Malignant Giant Cell Tumor of Bone:A Case Report

Primary malignant giant cell tumor of bone is clinically rare,lack of specificity,and often misdiagnosed.Currently,related literature about this tumor remains scarce.One case of primary malignant giant cell tumor of bone was diagnosed and treated in our hospital,and the treatment effect was satisfactory.There was no recurrence or metastasis in 2 years of followup.The report is as follows.

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella:A case report and review of the literature

BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant option for recurrent GCT.However,total patellectomy can lead to disruption of the knee.Therefore,exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling,and was diagnosed as having a GCT in the patella following curettage and autograft.Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture.Based on the combination of histological,radiological,and clinical features,a diagnosis of recurrent GCT in the patella was made(Campanacci grade III).After a multidisciplinary team discussion,three-dimensional(3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism.The patient was followed for 35 mo postoperatively.No evidence of local recurrence,pulmonary metastasis,or osteoarthritis of the right knee was observed.The active flexion arc was 0°-120°,and no extension lag was detected.A favorable patellar tracking and height(Insall-Salvati ratio 0.93)were detected by radiography.CONCLUSION We depict a case of a GCT at the right patella,which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement.The patella normal reconstruction,the precise-fit articular design,and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.

Malignant giant cell tumors of the tendon sheath of the right hip:A case report

BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.

Recurrent Giant Cell Tumor of the Distal End Radius: A Case Report and Surgical Treatment with Wide Resection and Reconstruction with Non-Vascularised Autologous Proximal Fibular Graft

Giant cell tumour of the distal radius is the 3rd most common site after proximal tibia and distal femur. It is locally aggressive and is associated with a high rate of recurrence. Although it is usually treated with various modalities of treatment, wide resection and reconstruction with proximal fibular autograft is most commonly accepted in recurrent cases. The following is a case report of such a case with surgical management.

Localized Giant Cell Tumor of the Tendon Sheath: A Rare Case of Anterior Knee Pain

This report describes a 61-year-old female with a giant cell tumor of the tendon sheath (GCT-TS). MRI showed that an elliptical abnormal signal was observed over the infrapatellar region of the right knee. We directly do arthroscopy to remove the tumor. An oval irregular mass of about 2.0 cm × 1.5 cm × 1 cm in the right knee joint was found. It was hard and had a dark red surface and the pedicle of the mass was connected with the joint capsule and infrapatellar fat pad. Nodular GCT-TS occurs less frequently in large joints than the small joints of the fingers and toes. The current report demonstrates the unique characteristics of the GCT-TS that extends around the ankle and invades the knee and proximal humerus.

Expect the unexpected:Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism

Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.

Traumatic giant cell tumor of rib: A case report

BACKGROUND Giant cell tumor(GCT)of the anterior rib origin is extremely rare.We report the first case of trauma-induced GCT of the rib.CASE SUMMARY A 22-year-old female developed a mass over the right anterior chest wall with pain 3 mo after a falling injury with blunt trauma of the right chest wall.Chest computed tomography(CT)showed a tumor originating from the right 6th rib with bony destruction,and a CT-guided needle biopsy revealed a GCT.We completely resected the tumor with chest wall and performed reconstruction.The pathological diagnosis was GCT of the bone.Twelve months after surgery,no signs of recurrence were observed.CONCLUSION GCT of the rib after trauma has not been reported.Meticulous history-taking and image evaluation are essential for the differential diagnosis of unusual chest wall tumors.

Malignant giant cell tumor in the left upper arm soft tissue of an adolescent:A case report

BACKGROUND Giant cell tumor of soft tissue(GCT-ST)is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper.GCT-ST has unpredictable behavior.It is mainly benign,but may sometimes become aggressive and potentially increase in size within a short period of time.CASE SUMMARY A 17-year-old man was suspected of having a fracture,based on radiography following left shoulder trauma.One month later,the swelling of the left shoulder continued to increase and the pain was obvious.Computed tomography(CT)revealed a soft tissue mass with strip-like calcifications in the left shoulder.The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus.The marrow cavity of the upper humerus was enlarged,and a soft tissue density was seen in the medullary cavity.Thoracic CT revealed multiple small nodules beneath the pleura of both lungs.A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus.The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images,and mixed hyperintensity on T2-weighted fat-saturated images.The final diagnosis of GCT-ST was confirmed by pathology.CONCLUSION GCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size.

Giant cell tumor involving radial diaphysis

Giant cell tumor (GCT) of the bone is a benign but locally aggressive & destructive lesion. This tumor is usually seen in patients over 20 years of age. Less than 2% are found in part with open epiphysis. The epiphyseal portion of the bone is characteristic site of giant cell tumor. In rare instances, giant cell tumor can occur in the diaphysis of long tubular bone without involving the epiphysis. Although age, clinical and radiological features are helpful, it is still the histology that helps to clinch the diagnosis. It is important to distinguish giant cell tumor of diaphysis from the giant cell rich lesions, more common in this site.

H3.3G34W、p63及SATB2免疫组织化学染色联合应用对骨巨细胞瘤的诊断价值

目的探讨H3.3G34W、p63及SATB2在骨巨细胞瘤(giant cell tumor of bone,GCTB)中的表达情况及其联合应用对GCTB的诊断作用和价值。方法收集西安交通大学附属红会医院病理科2020年至2022年诊断的54例GCTB、83例非骨巨细胞瘤(non-giant cell tumor of bone,NGCTB)(包含14例动脉瘤样骨囊肿、16例软骨母细胞瘤和53例非骨化性纤维瘤)患者的样本和病历资料,采用免疫组织化学EliVision法检测H3.3G34W、p63及SATB2的表达情况。通过χ^(2)检验判断H3.3G34W、p63及SATB2的阳性率在各组间是否存在统计学差异;通过Logistic回归分析建立包括H3.3G34W、p63及SATB2的联合诊断模型,通过受试者工作特征(ROC)曲线分析评价模型的诊断价值。结果H3.3G34W、p63及SATB2在GCTB组中阳性率分别为81.5%、90.7%、92.6%;在NGCTB组中阳性率分别为2.4%、28.9%、62.7%。与NGCTB组相比,GCTB组患者年龄显著较大[(41.222±14.849)vs.(16.566±9.439);P<0.001],女性比男性患病率更高(51.9%vs.48.1%,P<0.001)。与NGCTB组相比,GCTB组中H3.3G34W(81.5%vs.2.4%,P<0.001);p63(90.7%vs.28.9%,P<0.001)和SATB2(92.6%vs.62.7%,P<0.001)的阳性率更高。单因素Logistic回归分析构建单因素预测模型,同时行ROC曲线分析,表明年龄(AUC=92.9%,P<0.001)、性别(AUC=64.5%,P=0.004)、H3.3G34W阳性率(AUC=89.5%,P<0.001)、p63阳性率(AUC=80.9%,P<0.001)、SATB2阳性率(AUC=65.0%,P=0.003)是GCTB诊断的独立预测因素。进一步的多因素Logistic回归分析构建混合预测模型,并行ROC曲线分析,发现混合模型展现出比单因素模型更好的预测价值(AUC=98.4%,P<0.001)。结论H3.3G34W、p63及SATB2是有效诊断GCTB的分子标记物,且三者联合应用更能提高GCTB的诊断预测效能。

膝关节骨巨细胞瘤刮除填充术后继发骨关节炎的危险因素分析及预测模型的建立

目的:分析膝关节周围骨巨细胞瘤(giant cell tumor of bone, GCTB)局灶刮除联合填充术后出现骨关节炎的危险因素,建立预测模型并进行验证。方法:2017年7月至2022年7月,回顾性分析我院骨科收治的膝关节周围GCTB患者的临床资料,根据术后是否继发骨关节炎,将患者分为有骨关节炎组和无骨关节炎组。对两组患者的年龄、性别、肿瘤位置、Campanacci分级、视觉模拟评分(visual analogue scale, VAS)、美国骨肿瘤协会(Musculoskeletal Tumor Society, MSTS)功能评分、软骨下是否植骨、软骨下残留骨厚度、肿瘤横断面百分比进行单因素分析和多因素Logistic回归分析,通过绘制列线图建立预测模型并进行模型内部验证,通过ROC曲线下面积(area under the ROC curve, AUC)和校准曲线评价列线图预测模型的预测效能,最终使用决策曲线分析(decision curve analysis, DCA)和临床影响曲线(clinical impact curve, CIC)评估该模型的临床效用。结果:共纳入87例患者,平均年龄(34.9±9.6)岁(18~54岁),随访时间为17~68个月,平均40个月。无骨关节炎组64人,有骨关节炎组23人。单因素Logistic回归分析显示,两组患者的年龄、性别、肿瘤位置、Campanacci分级、VAS评分、MSTS评分比较差异均无统计学意义(P均>0.05);而两组软骨下是否植骨、软骨下残留骨厚度、肿瘤横断面百分比比较差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,软骨下是否植骨、软骨下残留骨厚度、肿瘤横断面百分比是术后继发骨关节炎的独立危险因素。通过绘制列线图建立预测模型并进行模型内部验证,模型的表观曲线与校准后的偏差曲线吻合较好,预测模型的AUC为0.827(95%CI:0.743~0.911)。DCA曲线显示,在0~0.5的阈值区间具有最大效益。CIC曲线表明,预测模型可以在阈值概率范围内有效区分出膝关节周围GCTB术后继发骨关节炎的高危患者。结论:基于软骨下是否植骨、软骨下残留骨厚度、肿瘤横断面百分比建立的列线图预测模型可以准确预测术后继发骨关节炎的风险概率,有助于早期识别高危人群并施以提前干预措施以延缓软骨的损伤并改善患者的预后。

以骨肉瘤形态为主的原发性恶性骨巨细胞瘤7例临床病理分析

目的探讨以骨肉瘤形态为主原发性恶性骨巨细胞瘤(primary malignant giant cell tumor of bone,PMGCTB)的临床病理学特征。方法回顾性分析7例PMGCTB的临床病理特征。结果7例PMGCTB中,女性4例,男性3例,年龄9~66岁(平均39.5岁,中位年龄35岁)。发生部位以股骨骨端最常见(3/6),临床表现为病变部位的疼痛和肿胀。影像学表现为溶骨性占位、溶骨和硬化混合性占位为主;多数骨皮质破坏伴软组织肿块形成(5/7)。组织学均以普通型骨肉瘤形态为主,破骨细胞样多核巨细胞完全消失或少量存在。免疫表型:6例肿瘤细胞H3F3A G34W核阳性、1例H3F3A G34V核阳性,所有肿瘤均表达SATB2、p63,p53呈野生型,Ki67增殖指数10%~50%。所有病例均发现H3F3A基因改变,6例为H3F3A p.G34W突变,1例为H3F3A p.G34V突变。结论PMGCTB罕见,当缺乏经典骨巨细胞瘤组织学特征时诊断更具挑战性,需结合影像学、免疫表型及分子检测,并注意与骨肉瘤及其他高级别肉瘤相鉴别。

基于MR影像组学的骨巨细胞瘤分期诊断模型的构建与评估

目的:探讨MR影像组学对骨巨细胞瘤(GCTB)分期诊断的预测价值。方法:回顾性分析2017年1月至2023年11月西安市红会医院GCTB患者的MRI数据,其中1期18例,2期67例,3期42例,分别在T_(1)WI、T_(2)WI序列上逐层勾画感兴趣区(ROI)获得三维ROI,每个ROI提取组学特征。将数据集经随机分层抽样法按照7∶3的比例分为训练集和测试集。通过深度学习网络构建GCTB分期诊断模型,探究哪些影像特征与GCTB分期诊断具有相关性。结果:经过特征筛选,构建GCTB分期影像诊断、临床特征以及两者融合模型,共建立3个相关模型。在训练集上,影像组学模型AUC达到了0.79(95%CI:0.75-0.83),临床特征模型达到了0.75(95%CI:0.72-0.79),融合模型取得了0.85(95%CI:0.82-0.91);在测试集中,影像组学模型和临床特征模型的AUC分别为0.77(95%CI:0.72-0.85)、0.84(95%CI:0.82-0.90),融合模型的AUC值为0.86(95%CI:0.82-0.92),均高于单独构建的模型。训练集和测试集中,融合模型的AUC与影像组学模型的AUC差异无统计学意义(P均>0.05)。结论:影像组学模型具有较好的预测GCTB分期诊断的能力,融合模型可进一步提高预测性能,可以较准确的识别GCTB的不同分期,使得临床医师能够尽早制订治疗决策。