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.

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.

Oncological and functional results following operation for giant cell tumour of bone

Objective：Giant cell tumours（GCT） represent one of the most common benign tumours of bone. However, despite its benign nature they are aggressive lesions that have a tendency to recur. This study aims to report experience with the treatment of GCTs, and reviews the relationship between surgical management and clinical outcome. Methods：A retrospective review was performed with 70 patients （32 males and 38 females） who presented to our institution between 1991 and 2001 with GCT of bone. An evaluation of the oncological and functional results was conducted and patients were divided into three groups according to the treatment method; Group Ⅰ ：（46 patients） intralesional curettage and adjuvant therapy and packing with filling materials. Group Ⅱ ：（18 patients） en-bloc resection and arthrodesis or reconstruction. Group Ⅲ ：（6 patients） amputation. Results：The mean follow-up period was 10 years （range, 5-15 years）. The overall rate of local recurrence was 14%, 22% in Group Ⅰ, and only 4% in Group Ⅱ and Group Ⅲ. According to the Musculoskeletal Tumour Society（MSTS） score for functional outcome, the mean overall score for Group I was 27.9 （out of 30）, 15.9 for Group Ⅱ. Of note, the 9 patients within Group Ⅱ who received endoprosthetic reconstruction, the mean overall MSTS functional score was 25.5. Conclusion：Intralesional curettage with adjuvant therapies and filling agents is often associated with a relatively high recurrence rate, however joint function is well preserved. Patients with more extensive, biologically aggressive, and/or recurrent tumours are best treated with en-bloc resection.

Osteoclastic and pleomorphic giant cell tumors of the pancreas:A review of clinical,endoscopic,and pathologic features

Giant cell tumors of the pancreas come in three varieties-osteoclastic,pleomorphic,and mixed histology.These tumors have distinctive endoscopic,clinical,and cytological features.Giant cell tumors have a controversial histogenesis,with some authors favoring an epithelial origin and others favoring a mesenchymal origin.The true origin of these lesions remains unclear at this time.These are also very rare tumors but proper identification and differentiation from more common pancreatic adenocarcinoma is important.The risk factors of these tumors and the prognosis may be different from those associated with standard pancreatic adenocarcinoma.Recognition of these differences can significantly affect patient care.These lesions have a unique appearance when imaged with endoscopic ultrasound(EUS),and these lesions can be diagnosed via EUS guided Fine Needle Aspiration(FNA).This manuscript will review the endoscopic,clinical,and pathologic features of these tumors.

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 mo, making him the longest survivor with an OGCT of the liver to date.

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.

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.

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.

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.

DNA gel electrophoretic and microaut oradiographic studies on apoptosis in bone tumor cells after exposure with ^(153)Sm-EDTMP

The apoptosis in bone tumor cells is studied after 153Sm-EDTMP irradiation. Fragmented DNA is analyzed by agarose gel electrophoresis. Experimental observations show that 153Sm-EDTMP exposure induces the internucleosomal DNA damage in bone tumor cells the DNA ladder pattern formation in bone tumor cells is shown. At the same time, the microautoradiographic study indicates that 153Sm-EDTMP could permeate through cell membrane and displays membrane-seeking condensation in bone tumor cells. Soon afterwards 153Sm-EDTMP could be phagocytized by the tumor cells and distributed ill cytoplasm as well as nucleus in the form of phagosome. With the prolongation of observing time, the membrane-bounded apoptotic bodies are observed.

Electron microscopic observations and DNA chain fragmentation studies on apoptosis in bone tumor cells induced by ^(153)Sm-EDTMP

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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.

Atraumatic groin pain secondary to an aneurysmal bone cyst:A case report and literature review

BACKGROUND Bone lesions can present the multi-displinary team with a challenge by way of diagnosis as some lesions share many radiological and histological characteristics.Giant cell tumours of the bone(GCTB)are relatively common,benign bone tumours.Aneurysmal bone cysts(ABC)are less common benign osteolytic lesions that are histologically similar to GCTBs but produce blood filled cavities.Both GCTBs and ABCs are locally aggressive and are typically found on meta-epiphyseal regions of long bones with pelvic tumours being less common.CASE SUMMARY A 17-year old female presented with atraumatic right groin pain and was initially diagnosed with a GCTB on the right superior pubic ramus of the pelvis.The patient was treated successfully with a wide excision,curettage and bone graft and underwent open reduction and internal fixation of the right hemi-pelvis.Following further intra-operative histological investigations,the lesion was diagnosed as an ABC.CONCLUSION This patient has had an uncomplicated post-operative course,has returned to comfortable weight bearing and will be reviewed for minimum 5 yr in the outpatient setting to monitor for reoccurrence.

Recurrence Factors in Giant Cell Tumors of the Spine

Background： Giant cell tumors （GCTs） are benign, locally aggressive tumors. We exalnined the rate of local rectirrence of spinal GCTs and sought to identify recurrence factors in patients who underwent surgery. Methods： Between 1995 and 2014, 94 mobile spine GCT patients were treated at our hospital, comprising 43 male and 51 female patients with an average age of 33.4 years. Piecemeal intralesional spondylectomy and total en bloc spondylectomy （TES） were performed. Radiotherapy was suggested for recurrent or residual GCT cases. Since denosumab was not available before 2014 in our country, only interferon and/or zoledronic acid was suggested. Results： Of the 94 patients, four underwent conservative treatment and 90 underwent operations. Seventy-five patients （79.8%） were followed tip for a minimum of 24 months or until death. The median follow-up duration was 75.3 months. The overall recurrence rate was 37.3%. Ten patients （13.3%） died before the last follow-up （rnedian： 18.5 months）. Two patients （2.6%） developed osteogenic sarcoma. The local recurrence rate was 80.0% （24/30） in patients who underwent intralesional curettage, 8.8% （3/34） in patients who underwent extracapsular piecemeal spondylectomy,and 0 （0/9） in patients who underwent TES. The risk factors for local recurrence were lesions located in the cervical spine （P = 0.049）, intralesional curettage （P 〈 0.001 ）, repeated surgeries （P 0.014）, and malignancy （P 〈 0.001 ）. Malignant transformation was a significant risk factor for death （P 〈 0.001 ）. Conclusions： Cervical spinal tumors, curettage, and nonintact tumors were risk l;actors for local recurrence. Intralesional curettage and malignancy were the most important significant factors for local rectirrence and death, respectively.

Metachronous multicentric giant cell tumor of bone with retroperitoneal metastasis

Giant cell tuenor （GCT）of bone is a benign but locally aggressive tumor that usually involves the epiphysis of long bones.1Rarely,these tumors metastasize to the lung, and these metastases generally have the same benign histological appearance as the primary tumor. Multicentric giant cell tumor （M-GCT） is rarer. We herein report a case of M-GCT involving the left distal radius, with retroperitoneal metastasis, and subsequent lesions in the left proximal and distal femur. The patient and family members were informed that data concerning the case would be submitted for publication, and they consented.

Bioactive glass selectively promotes cytotoxicity towards giant cell tumor of bone derived neoplastic stromal cells and induces MAPK signalling dependent autophagy

Giant cell tumors of bone(GCTB)are associated with massive bone destructions and high recurrence rates.In a previous study,we observed cytotoxic effects of three different compositions of bioactive glasses(BGs)towards GCTSC but not bone marrow derived stromal cells(BMSC)indicating that BGs represent promising candidates for the development of new therapeutic approaches.In the current study we aimed to investigate the molecular mechanisms that are involved in BG induced cytotoxicity.We observed,that BG treatment was not associated with any signs of apoptosis,but rather led to a strong induction of mitogen activated protein kinases(MAPK)and,as a consequence,upregulation of several transcription factors specifically in GCTSC.Genome wide gene expression profiling further revealed a set of fifteen genes that were exclusively induced in GCTSC or induced significantly stronger in GCTSC compared to BMSC.BG treatment further induced autophagy that was significantly more pronounced in GCTSC compared to BMSC and could be inhibited by MAPK inhibitors.Together with the known osteogenic properties of BGs our findings support the suitability of BGs as therapeutic agents for the treatment of GCTB.However,these data have to be verified under in vivo conditions.

Gene expression disparity in giant cell tumor of bone

The aim of this paper was to study the differential gene expression of giant cell tumor of bone(GCTB)by gene chip technology.Total RNA of 8 fresh GCTB specimens(Jaffe I∶6 cases,II∶1 case,III∶1 case;Campanacci I∶6 cases,II∶1 case,III∶1 case;Enneking Staging G0T1-2M0,5 cases,G1T1-2M0:2 cases,G1T2M0:1 case)and 4 normal bony callus specimens(the control group)were extracted and purified to get mRNA and then reverse transcribed to complementary DNA,respectively.Microarray screening with a set of 8064 human cDNA genes was conducted to analyze the difference among the samples and the control.The hybridization signals were scanned.The gene expression disparity between the GCTB samples and normal bony callus was significantly different(P<0.01),and the disparity of over 5-fold was found in 47 genes in the GCTB specimens,with 25 genes up-regulated and 22 down-regulated including the extracellular matrix and transforming-related genes,oncogene and its homolog genes,cytokine and its receptor genes.Specific gene spectrum associated with GCTB can be identified by cDNA microarray,which will be the foundation of progressive etiology elucidation,diagnosis and treatment of GCTB.