Benign giant-cell tumor of bone with metastasis to mediastinal lymph nodes. A case report of resection facilitated with use of steroids.

Abstract

Benign giant-cell tumor of bone is an aggressive lesion that behaves in an unpredictable fashion. These benign tumors often recur locally and, although it is rare, may even metastasize. The frequency of metastases is approximately 2 to 3 per cent12,19. Most metastases are to the lung; metastases to other sites, including the regional lymph nodes, the scalp, and the pelvis, are extremely rare. This report describes a patient who was referred to our institution because of a local recurrence of benign giant-cell tumor that was later complicated by metastasis to the mediastinal lymph nodes. A fifty-nine-year-old man was first seen at another institution in March 1986. He reported that he had had pain in the right wrist for five months. Radiographic evaluation revealed a large, well delineated, lucent tumor of the distal part of the radius that was consistent with a diagnosis of benign giant-cell tumor. The patient was taken to the operating room, where excision of the tumor by curettage followed by iliac bone-grafting was performed. In December 1986, a local recurrence developed and the patient was referred to our institution. Wide en bloc resection of the right radius was performed, and an arthrodesis of the wrist was done with an intercalary fibular graft. In May 1992, the patient sustained a comminuted fracture of the fibular graft that caused malalignment of the wrist and was complicated by non-union. The fracture was treated with open reduction and internal fixation as well as bone-grafting. Histopathological evaluation of multiple biopsy specimens revealed no evidence of local recurrence of the tumor. At that time, a radiograph of the chest demonstrated a large mediastinal mass. A computed tomography scan of the chest (Fig. 1-A) revealed a mass that measured 8.5 by …