Aggressive Giant Cell Tumor Research Articles

The Use of Fibular Autograft and Ankle Arthrodesis for Aggressive Giant Cell Tumor in the Distal Tibia: A Case Report

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.

Fresh-frozen Osteochondral Allograft Reconstruction of a Giant Cell Tumor of the Talus

The use of fresh-frozen osteochondral allografts has been reported for the treatment of talar fractures, osteochondral lesions, and tumors of the calcaneus. Currently, we are unaware of any reports in the literature addressing the use of fresh-frozen osteochondral allograft for the treatment of giant cell tumors in the talus. We report our attempt to eradicate an aggressive giant cell tumor of the talus while minimizing morbidity and loss of function via reconstruction with a fresh-frozen osteochondral allograft. This is the first report in the literature to propose such a treatment option for giant cell tumors in the talus. The patient was informed that a report of this case would be submitted for publication.

Giant cell tumor of the uterus: case report and response to chemotherapy

BackgroundGiant cell tumor (GCT) is usually a benign but locally aggressive primary bone neoplasm in which monocytic macrophage/osteoclast precursor cells and multinucleated osteoclast-like giant cells infiltrate the tumor. The etiology of GCT is unknown, however the tumor cells of GCT have been reported to produce chemoattractants that can attract osteoclasts and osteoclast precursors. Rarely, GCT can originate at extraosseous sites. More rarely, GCT may exhibit a much more aggressive phenotype. The role of chemotherapy in metastatic GCT is not well defined.Case presentationWe report a case of an aggressive GCT of the uterus with rapidly growing lung metastases, and its response to chemotherapy with pegylated-liposomal doxorubicin, ifosfamide, and bevacizumab, along with a review of the literature.ConclusionAggressive metastasizing GCT may arise in the uterus, and may respond to combination chemotherapy.

Resection arthrodesis for giant cell tumors around the knee

Background:Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent and extensive tumors. As the patients affected with GCT are young or middle-aged adults with a normal life expectancy, arthrodesis is an attractive option for reconstruction in these patients.Materials and Methods:Thirty-six patients of mean age 33.1 years with Campanacci Grade III giant cell tumors around the knee (20 distal femoral and 16 proximal tibial) were treated with wide resection and arthrodesis from January 1996 through January 2006. Arthrodesis was performed using plating with free fibular graft (n = 18), IM nail with free fibular graft (n = 8) and IM nail combined with ring fixator using bone transport (n = 10).Results:Fusion after the first surgery was achieved in 77.7%, 75% and 90% of the patients in the three groups respectively. Local recurrence was seen in two patients and repeat surgery for nonunion/ graft fracture had to be done in four patients and two patients in the plating and nailing groups respectively.Conclusion:Wide resection and arthrodesis in aggressive GCTs around the knee is a good treatment option. IM nail combined with a ring fixator seems to be a good method of arthrodesis with high fusion rates, least shortening and early rehabilitation.

Les tumeurs à cellules géantes de la base du crâne : revue de la littérature à partir de deux cas

Giant cell tumors of the skull base are rare neoplasms. This report reviews two cases of patients presenting with aggressive giant cell tumors that were irradiated by a combination of photons and protons. Two females 29 and 14 years old were initially managed with one and three extensive surgical resections respectively. Radiation therapy was recommended in respect to tumor aggressiveness. Combined proton and photon radiation therapy was performed based on a three-dimensional planning, and delivered a total dose of 59.4 CGE to 65.2 CGE respectively, administered in 5 sessions per week of 1.8–2 Gy/CGE (Cobalt Gray Equivalent). With 8 and 83 months follow-up, respectively, the youngest patient relapsed marginally 4 months post irradiation, while the second remained with NED. No complication developed in any of them. In conclusion, we have reviewed a total of 116 cases (114 previously published cases + 2 new cases) and discuss the role and modalities of radiation therapy in the management of giant cell skull base tumors.

Giant cell tumour of the neck of femur treated by total hip replacement.

Giant cell tumour of the bone is a relatively rare benign tumour whose true incidence and patho-aetiology are not fully established. The tumour is usually located in the epi-metaphysis of the long bones, predominantly in the distal femur, proximal tibia and distal radius with 50% occurring around the knee joint. The age group at presentation is commonly between 20 and 50 years with the peak in the 30 to 40 year age group. Although benign, the tumour is locally aggressive with tendency for local recurrence after excision. A very small proportion of giant cell tumours can have malignant cells in the lesion. Irradiation of the tumour has been associated with malignant transformation and must be avoided. Rarely the giant cell tumour can metastasise and still maintain the ‘benign’ histological pattern in the metastases. The proximal femur is an uncommon location for the occurrence of Giant Cell Tumour. The incidence at this site has been reported as less than 4%.1,2 Treatment of a locally aggressive giant cell tumour of the neck of femur is difficult because of the location and the high local recurrence.

Effect of interferon alpha-2b on porcine mesenchymal stem cells

Purpose: In patients with aggressive giant cell tumors of the jaws, treated by curettage and adjuvant interferon, resultant defects have exhibited rapid and exuberant bone formation. The relationship between this regenerative phenomenon, the nature of the angiogenic tumor and interferon treatment is not understood. There are 4 potential explanations: 1) interferon alpha promotes differentiation of mesenchymal stem cells (MSCs) into osteoblasts; 2) interferon alpha stimulates osteoblast proliferation and/or metabolic activity; 3) interferon alpha suppresses osteoclasts (bone resorption) and upsets the homeostasis between bone formation and resorption; or 4) interferon alpha affects tumor cells in such a way as to release some osteogenic growth factor. We hypothesize that interferon promotes bone formation by enhancing mesenchymal stem cell (MSC) differentiation into osteoblast and by stimulating osteoblast activity. This is a preliminary study to determine the effects of interferon alpha on MSCs in culture.

Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws

Purpose: Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. Materials and Methods: Patients with a biopsy-confirmed giant cell lesion satisfying criteria for “aggressive giant cell tumor” were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m2) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. Results: Eight patients (7 females), with a mean age of 18.7 ± 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. Conclusion: Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1103-1111, 2002

3-D-Conformal Radiation Therapy for Pediatric Giant Cell Tumors of the Skull Base

Giant cell tumors (GCT) of the base of skull are rare neoplasms. This report reviews the treatment of four pediatric patients presenting with aggressive giant cell tumor, using fractionated and combined, conformal proton and photon radiation therapy at Massachusetts General Hospital and Harvard Cyclotron Laboratory. Three female patients and one adolescent male, ages 10-15 years, had undergone prior, extensive surgical resection(s) and were treated for either primary (two patients) or recurrent (two patients) disease. Gross residual tumor was evident in three patients and microscopic disease suspected in one patient. Combined proton and photon radiation therapy was based on three-dimensional (3-D) planning, consisting of fractionated treatment, one fraction per day at 1.8 CGE (cobalt-gray equivalent) to total target doses of 57.6, 57.6, 59.4, and 61.2 Gy/CGE. With observation times of 3.1 years, 3.3, 5.3, and 5.8 years, all four patients were alive and well and remained locally controlled without evidence of recurrent disease. Except for one patient with partial pituitary insufficiency following radiotherapy for sellar recurrent disease, thus far no late effects attributable to radiation therapy have been observed. 3-D-conformal radiation therapy offers a realistic chance of tumor control for aggressive giant cell tumor in the skull base, either postoperatively or at time of recurrence. Conformal treatment techniques allow the safe delivery of relatively high radiation doses in the pediatric patient without apparent increase of side effects.

Association of HLA-DRB1 alleles with giant cell tumour of bone.

AIM: To examine the possible influence of the MHC class II antigens alleles in the formation of the multinucleate aggressive giant cell tumour of bone. METHODS: HLA class II antigen...

En bloc resection of tumors of the distal end of the ulna.

The operative treatment of malignant tumors and aggressive benign tumors involving the distal end of the ulna often necessitates en bloc resection. The oncological and functional results for eight patients in whom a neoplasm involving the distal end of the ulna had been treated with en bloc resection without reconstruction of the osseous defect were reviewed retrospectively at a mean of seventy-nine months (range, twenty-three to 271 months). Four patients had a giant-cell tumor; two, a low-grade osteogenic sarcoma; one, a hemangioendothelioma; and one, a soft-tissue epithelioid sarcoma with osseous involvement. The amount of bone that was removed from the distal end of the ulna ranged from 3.1 to 9.0 centimeters. In the four patients who had a malignant tumor, a minimum of 7.5 centimeters was removed in order to achieve an adequate wide margin proximally. In the patients who had a benign tumor, a maximum of 6.6 centimeters was resected. Extraperiosteal resection was performed in three of the patients who had a malignant tumor and in one of the patients who had an aggressive giant-cell tumor. Subperiosteal resection was performed in the three patients who had a benign tumor and in one patient who had a parosteal osteogenic sarcoma. None of the patients had local or systemic evidence of recurrence of the tumor. The functional result was excellent for six patients and good for two. Grip strength was reduced by a mean of 15 per cent compared with the strength on the contralateral side, and this reduction did not appear to be related directly to the amount of bone that had been resected. The findings of this study support the concept that routine reconstruction of the osseous defect is not necessary after en bloc resection of a neoplasm of the distal end of the ulna.

Use of a Prosthesis for the Distal Portion of the Radius Following Resection of a Recurrent Giant-Cell Tumor

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