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.

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.

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.

Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Giant cell tumor of the bone(GCTB)is a benign,locally aggressive neoplasm that is relatively rare,with a propensity to result in progressive bone destruction,and is associated with a high risk of recurrence.There is no widely held consensus regarding its ideal treatment.Worldwide,there are varying techniques ranging from intralesional curettage to resection of the lesion,supplemented with combinations of numerous adjuncts and fillers,depending on the resected amount and integrity of bone,as well as the preference of the surgeon.This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals.The mean follow-up period was 37.3 months(SD=2.84).The extended curettage(EC)group had a mean Musculoskeletal Tumor Rating Scale(MSTS)score of 28.18(SD=7.51)which is considered as an excellent outcome,while the resection(RS)group had an mean MSTS score of 19.67(SD=11.02),which is considered as a good outcome.EC resulted to a total of eight complications(47%),while RS had one complication(33%).Prevalence of recurrence was noted to be 11.75%among those who underwent EC,while no recurrence was noted among those in the RS group.Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts,however were both were noted to result in excellent functional outcomes.Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC,there is still report of excellent functionality.It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.

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.

Multicentric giant cell tumor of bone:a report of nine cases and literature review

Objective:The aim of this study was to investigate the clinical,radiographic and histiopathologic features of multicentric giant cell tumor of bone.Methods:All the clinical data of twenty tumors in nine patients of multicentric giant cell tumor that underwent surgical treatment in our department from 1990 to 2010 were retrospectively reviewed,which included three males and six females.The patients ranged from 15 to 45 years at diagnosis,with an average age of 22.3 years.Three of the patients were younger than twenty years of age.Most tumors arose in long bones,especially around the knee.Radiographically,the tumors in long bones usually manifested as expansive lytic lesions involving the metaphysis and extending into the epiphysis.Three tumors in three patients were confined to the metaphysis,and one tumor exhibited bone-forming lesions.All tumors were treated with curettage or resection.Results:The typical "giant cell" could be found in the oncologic examination in all cases.In some areas,such as the fibrohistiocytic regions,reactive bone forming and aneurysmal bone cyst-like changes could be found.Follow-up averaged 3.5 years,ranging from 6 months to 12 years.There was a recurrence of three tumors,and one patient died of pulmonary metastasis.Conclusion:Multicentric giant cell tumor occur often in younger patients than do solitary giant cell tumor.They are frequently present around the knee,and confined to the metaphysis.Each tumor arose independently,rather than being in multiple sites of metastatic lesion that develop from a single tumor.The risk of recurrence depends on the type of surgery that is performed.

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.

Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery:A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.

Management of a rare giant cell tumor of the distal fibula: A case report

BACKGROUND Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached.Thus,an appropriate treatment strategy is still important to discuss.CASE SUMMARY A 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital.He had never been treated prior to coming to our hospital.Preoperative imaging revealed a 10 cm×6 cm mass located in the body of the distal fibula.Pathological biopsies confirmed it was a giant cell tumor.Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function.The cardiologist and anesthesiologist determined that he could tolerate the operation,but the operation should be as short and minimally invasive as possible.With the patient’s consent,we performed a tibiotalar fusion and followed up with him for 2years,finding no recurrence and a satisfactory recovery.CONCLUSION Tibial talus fusion is an effective method for the treatment of distal fibula tumors.

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.

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.

High circulating tumor cell concentrations in a specific subtype of gastric cancer with diffuse bone metastasis at diagnosis

AIM: To clarify the biological feature contributing to gastric cancer with diffuse bone metastases at diagnosis.METHODS: The participants visited the Department of Clinical Oncology, Akita University Hospital, from January 2014 to August 2015. The selection criterion for gastric cancer with diffuse bone metastases at diagnosis includes over 29 hot spots of bone scintigraphy. Circulating tumor cell were collected from 20 m L of peripheral venous blood drawn using a Cell Search kit and a Cell Tracks Auto Prep system by SRL, a clinical laboratory. The endpoints of this study were correlations between circulating tumor cells(CTC) count and therapeutic outcomes. RESULTS: Among 39 patients with gastric cancer, 5 patients met the criterion. The incidence of this subtype was 12.8%. CTC counts ranged from 235 to 6440 cells/7.5 m L of peripheral blood(median of 1724). These values were much higher than common gastric cancers(2 cells). In chemo-sensitive cases, CTC counts decreased within 14 d(median) from 275, 235 and 1724 to 2, 7 and 66, respectively. On the other hand, CTC counts increased after treatment failure or insensitive case from 2, 7 and 6440 to 787, 513 and 7885, respectively. The correlation between CTC count and survival time showed a trend, but did not reach significance(Y = 234.6- 0.03 X, P = 0.085).CONCLUSION: High CTC count is a biological hallmark of this subtype, and can be used as a direct and definitive indicator of therapeutic outcome.

Osteoclast-like giant cell tumors of the pancreas and liver

Osteoclast-like giant cell tumors （OGCT） are rare abdominal tumors, which mainly occur in the pancreas. The neoplasms are composed of two distinct cell populations and frequently show an inhomogenous appearance with cystic structures. However, due to the rarity of these tumors, only very limited clinical data are available. Imaging features and sonographic appearance have hardly been characterized. Here we report on two cases of osteoclast-like giant cell tumors, one located within the pancreas, the other within the liver, in which OGCTs are extremely rare. Both patients were investigated by contrast sonography, which demonstrated a complex, partly cystic and strongly vascularized tumor within the head of the pancreas in the first patient and a large, hypervascularized neoplasm with calcifications within the liver in the second patient. The liver OGCT responded well to a combination of carboplatin, etoposide and paclitaxel. With a combination of surgical resection, radiofrequency ablation and chemotherapy, the patient＇s survival is currently more than 15 too, making him the longest survivor with an OGCT of the liver to date.

Subchondral bone grafting reduces degenerative change of knee joint in patients of giant cell tumor of bone

Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subchondral bone,surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis.In this study,we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis.Methods We retrospectively analyzed 76 patients with GCT around the knee.The mean age at first diagnosis was 31.1 years.Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone.Patient follow-up was a median duration of 35 months,ranging from 18 to 113 months.Results The local recurrence rate was 5.3％ （4/76）.Secondary degenerative changes occurred in 30.3％ （23/76） of the patients.Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients （P ＜0.001）.Of these 57 patients,56.5％ （13/23） treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting,the rate decreased to 29.4％（10/34）,with a statistically significant difference （P=0.041）.Conclusions GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage.Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.

Three-dimensional printed talar prosthesis with biological function for giant cell tumor of the talus:A case report and review of the literature

BACKGROUND Giant cell tumors(GCT)are most commonly seen in the distal femur.These tumors are uncommon in the small bones of the hand and feet,and a very few cases have been reported.A giant cell tumor of the talus is rarely seen clinically and could be a challenge to physicians.CASE SUMMARY We report a rare case of GCT of the talus in one patient who underwent a new reconstructive surgery technique using a three-dimensional(3D)printing talar prosthesis.The prosthesis shape was designed by tomographic image processing and segmentation using technology to match the intact side by mirror symmetry with 3D post-processing technologies.The patient recovered nearly full range of motion of the ankle after 6 mo.The visual analogue scale and American Orthopaedic Foot and Ankle Society scores were 1 and 89 points,respectively.CONCLUSION We demonstrated that 3D printing of a talar prosthesis is a beneficial option for GCT of the talus.