Metastatic Giant Cell Tumor of Bone: A Case Report

Abstract

Giant cell tumor of bone is a relatively rare primary bone neoplasm. It was originally classified as benign tumor; however, it rarely presents as aggressive disease with the potential to distant metastasis mainly in lung. The objective of this study was to present and discuss a case of metastatic giant cell tumor. A young female patient with a recent history of resected bone lesion, hospitalized with dyspnea, was investigated and extensive lung metastasis was found. She received one cycle of chemotherapy until availability of molecular targeted therapy; however, she died due to disease complications 1 day after introduction of denosumab. This rare neoplasm is slightly predominant in females, typically occurring during the third or fourth decades of life, when bone maturity is reached. Accurate diagnosis is given by histopathological analysis. Microscopically the neoplasm is characterized by the presence of multinucleated giant cells of osteoclast type amid a richly vascular stroma of mononuclear cells. The standard treatment is curettage, filling with cement (polymethylmethacrylate) or bone graft. The possibility of recurrence is significant, and 15-50% of cases are treated with simple curettage. In cases where surgery is not possible, the systemic treatment can be attempted. The choice of the treatment regimen is based on case reports or series of cases. Recently a promising targeted therapy emerged, denosumab, a monoclonal antibody directed to the RANK ligand-L. In our case, besides the severity of the disease, inadequate follow-up after surgery and delayed access to specialized services may have contributed to the outcome. J Med Cases. 2014;5(11):557-560 doi: http://dx.doi.org/10.14740/jmc1947w