Giant Cell Tumor Of Long Bones Research Articles

Retrospective Analysis of Giant Cell Tumor Lower End Radius Treated with En bloc Excision and Translocation of Ulna.

Background:Distal end of radius is third most common site for GCT of long bones and 1% of these metastasize mostly to lungs. Reconstruction methods commonly used are fibula (vascularized and nonvascularized), centralization of ulna, translocation of ulna, and endoprosthetic replacement. We report the outcome of series of twenty cases where we did en bloc excision of tumor with translocation of ulna.Materials and Methods:Twenty cases of giant cell tumor (GCT) of lower end of radius were included in this retrospective study. The mean age of patients was 33.15 years (range 21-55 years). We had 14 of Campanacci Grade III and 6 of Grade II. Preoperative radiographs and magnetic resonance imaging of the involved wrist and forearm were done.Results:Of all twenty patients, 14 were males and 6 were females. Mean followup duration was 3.9 years (range 1.5–17 years). Mean grip strength of involved side as a percentage of normal side was 71% (range 42%–86%) and the actual mean value for operated side was 29 kg as compared to 40 kg for normal side. The average range of forearm movement was supination 80.25° (60°–90°) and pronation 77.5° (70°–90°). No patient was dissatisfied as far as cosmesis was concerned.Discussion:In our opinion considering the propensity to recur with more aggressiveness after recurrence, en bloc excision with translocation of ulna has become a standard treatment option for GCT of lower end of radius, with advantages of better functional outcomes, retained vascularity, and elimination of risk of donor site morbidity.

Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites.

The treatment of giant cell tumor (GCT) of bone remains controversial. Intralesional surgery (curettage) results in a higher rate of local recurrence, but better functional results compared to resection. The aim of this study was to assess whether the use of curettage was successful in the treatment of GCT of long bones. We evaluated the influence of adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence. We retrospectively reviewed the records of patients treated for GCT of long bones between 1990 and 2013, using curettage. No patient had any treatment other than surgery. After detailed curettage, the bone cavity was filled with bone allografts and/or cement. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum follow-up was 24months. We enrolled 210 patients with GCT of long bones treated by curettage. The rate of local recurrence was 16.2% (34/210 patients). The median follow-up was 89.2months. In the multivariate analysis, no significant statistical effect on the local recurrence rate could be identified for gender, patient's age, Campanacci's grading, or cement versus bone allografts. The only independent risk factor related to the local recurrence was the site, with a statistically significant higher risk for patients with GCT of the proximal femur. Our observation on the correlation of tumor location and risk of local recurrence is new. We suggest that patients with GCT of bone in the proximal femur should be followed closely soon after surgery to identify any possible recurrence.

Long-term outcomes of ultrasonic scalpel treatment in giant cell tumor of long bones.

Giant cell tumors (GCTs) are generally benign, locally aggressive lesions with the potential to metastasize and a tendency of local recurrence. The present study aimed to investigate the advantages and long-term outcomes of application of ultrasonic scalpel in the treatment of GCT of long bones. This study retrospectively analyzed 32 cases of GCT of long bones, including 24 males and eight females. The age range was from 8 to 34 years old (mean age, 23.5 years old). The 32 cases were randomly divided into an observation group (n=10) and a control group (n=22). Patients in the observation group received curettage by ultrasonic scalpel combined with local methotrexate gelfoam adjuvant treatment, and then the cavity was filled with allograft and/or homograft bone. Patients in the control group eceived curettage by local methotrexate gelfoam adjuvant treatment and bone grafting. No local recurrence or pulmonary metastases were observed among patients in the observation group, however, six patients in the control group exhibited recurrence following surgery, although none of the patients demonstrated distant metastasis (P<0.05). Additionally, all 10 patients showed good bone knitting and rehabilitation without deformity and functional issues. The segmental bone graft was perfectly incorporated without obvious immune rejection, collapse and fracture. Curettage by ultrasonic scalpel with local methotrexate gelfoam adjuvant treatment and filling the site by allograft and/or homograft bone showed satisfactory results.

Central giant cell granuloma of the jaws and giant cell tumor of long bones: A clinicopathological, cytometric and immunohistochemical comparative study

Aim: Central giant cell granuloma (CGCG) of the jaws and giant cell tumor (GCT) of bone share a number of similarities and dissimilarities in respect of their histopathological, cytometric and immunohistochemical features. The aim of this study was to compare CGCG of the jaws and GCT of long bones from clinicopathology, cytometry and immunohistochemistry aspects. Materials and Methods: 18 CGCG and 22 GCT of bones were compared. Clinical data were obtained on the age, gender, diagnosis, clinical course, treatment and follow up. Histopatholgical features of mononuclear cell; stroma and giant cells were assessed. Computer-assisted image analysis was used to measure the mean number of giant cells, mean number of nuclei per giant cell, fractional surface area and relative size index. Expression of cell differentiation markers (vimentin, CD68, CD34, S-100P, alpha-smooth muscle actin [αSMA]) and cell cycle related markers (PCNA, P53, Ki-67, bcl-2) were evaluated. Results: CGCG of the jaw showed an early age of presentation (55.6% <25 years) and the mandible was the more common anatomical location (77.8), whereas the femur and tibia were equally affected by GCT (36.4%). GCT showed higher mean number of giant cells, higher number of nuclei per giant cell, greater fractional surface area and relative size index. Both diseases showed similar cellular phenotype in respect of Vimentin, S100 protein, CD68 and CD34. There was increased immunoreactivity of GCT to Ki-67, P53 and αSMA. Conclusion: The findings suggested that the GCT and the CGCG may be variants of the same disease entity with age and site-specific features.

CENTRAL GIANT CELL GRANULOMA OF THE JAWS AND GIANT CELL TUMOR OF LONG BONES - AN IMMUNOHISTOCHEMICAL COMPARATIVE STUDY

Objective:This study investigated whether some components of the extracellular matrix and CD68 expression may drive the differences between the central giant cell granuloma (CGCG) of the jaws and giant cell tumor (GCT) of long bones, which present distinct evolution and clinical behavior.Material and Methods:Eight cases of CGCG and 7 cases of GCT were selected and immunohistochemically analyzed to verify the pattern of expression of CD68, tenascin (Tn) and fibronectin (Fn).Results:A large number of the mononuclear cells and multinucleated giant cells CD68+ was observed in both of the studied lesions, indicating histiocyte/macrophage origin. Seven cases of CGCG of the jaws showed intense staining of Fn, with uniform distribution predominantly. In all 7 cases of GCT of long bones the Fn displayed intense expression, with distribution pattern varying from uniform to reticulate/fibrillar. Six cases of CGCG were intensively stained by Tn, presenting focal expression in half of specimens, and reticulate/fibrillar pattern of expression in 4 cases. All cases of GCT of the long bones presented intense expression of Tn, uniform distribution, and reticulate/fibrillar pattern of expression in four cases.Conclusions:The immunoexpression of CD68 in mononuclear cells and multinucleated giant cells and staining patterns of Fn and Tn were similar in both entities. These findings indicate that these proteins could not be used to explain the differences between the CGCG of the jaws and GCT of the long bones.

Central giant cell granuloma of the jaws and giant cell tumor of long bones: an immunohistochemical comparative study

This study investigated whether some components of the extracellular matrix and CD68 expression may drive the differences between the central giant cell granuloma (CGCG) of the jaws and giant cell tumor (GCT) of long bones, which present distinct evolution and clinical behavior. Eight cases of CGCG and 7 cases of GCT were selected and immunohistochemically analyzed to verify the pattern of expression of CD68, tenascin (Tn) and fibronectin (Fn). A large number of the mononuclear cells and multinucleated giant cells CD68+ was observed in both of the studied lesions, indicating histiocyte/ macrophage origin. Seven cases of CGCG of the jaws showed intense staining of Fn, with uniform distribution predominantly. In all 7 cases of GCT of long bones the Fn displayed intense expression, with distribution pattern varying from uniform to reticulate/fibrillar. Six cases of CGCG were intensively stained by Tn, presenting focal expression in half of specimens, and reticulate/ fibrillar pattern of expression in 4 cases. All cases of GCT of the long bones presented intense expression of Tn, uniform distribution, and reticulate/fibrillar pattern of expression in four cases. The immunoexpression of CD68 in mononuclear cells and multinucleated giant cells and staining patterns of Fn and Tn were similar in both entities. These findings indicate that these proteins could not be used to explain the differences between the CGCG of the jaws and GCT of the long bones.

Giant cell tumor of the mandible in a patient with Paget’s disease

Giant cell tumor (GCT) is a rare complication of PD. Thepresent study reports a new case of GCT involving themandible and maxilla in a patient with PD.A 53-year-old man from Naples, Southern Italy, hadpolyostotic PD of bone since 1987. On admission, physicalexamination disclosed bilateral enlargement of the skull thaton radiology showed the typical “cotton wool” appearance.Laboratory investigations disclosed altered serum levels ofalkaline phosphatase (1380 IU/L; normal range, 30 to 135IU/L), whereas serum calcium levels were within normalrange, as were calcitonin and parathyroid hormone.In August 2001, he had a right scapular lesion that wassurgically removed and histologically diagnosed as GCT. InDecember 2001, he presented a rapidly enlarging mass of theleft mandible body. On radiology, the lesion presented as ahuge osteolytic lesion invading the surrounding soft tissues(Fig 1A). The surrounding mandibular bone showed radiologicfeatures indicating Pagetic involvement. The lesion was surgi-cally removed. Under general anesthesia, surgery was under-taken through an intraoral approach in the gingiva along theentire mandibular arch. The heavily bleeding tumor was iso-lated and excised, and the residual mandibular bone was sub-mitted to careful curettage. The left alveolar nerve, completelyinvolved by the tumor, was sacrificed. A local hematoma wasdrained on the fourth postoperative day. Despite radical surgi-cal treatment, the lesion recurred twice, in June 2002 and inApril 2003. In May 2003, the patient had a swelling of the rightorbital region. Radiology disclosed a large osteolytic lesioninvolving the ethmoid bone and extending to the orbital tissues.An incisional biopsy revealed a new localization of GCT, andthe lesion was surgically removed.At histology, all the lesions had the same appearance. Alow-power view disclosed multiple giant cells uniformlydistributed throughout the lesion (Fig 1B). Giant cells hadnumerous nuclei and lay in a background of oval to spindlemononuclear cells. Mitotic figures were abundant. No areasof hemorrhage or necrosis were seen, nor was osteoid ma-terial present. The lesion diffusely invaded the periman-dibular soft tissues. The histologic picture was identical tothat usually observed in GCT of long bones. The bonetissue surrounding the lesion showed the typical featuresof Paget’s disease withenlarged marrow spaces containinginflammatory infiltrate and giant cells (Fig 1C).

Giant-Cell Tumors of Long Bones

To The Editor: We read with interest Treatment of Giant-Cell Tumors of Long Bones with Curettage and Bone-Grafting (81-A: 811-820, June 1999), by Blackley et al. Of fifty-three patients with giant-cell tumor who were primarily treated at our clinic, forty-seven were followed for four to forty-three years (mean, sixteen years). In forty patients (85 percent), the tumor was located in a long bone. Fourteen (35 percent) of these forty patients were treated with curettage and bone-grafting; twelve (30 percent), with …

Treatment of giant-cell tumors of long bones with curettage and bone-grafting.

The use of curettage, phenol, and cement is accepted by most experts as the best treatment for giant-cell tumor of bone. The present study was performed to evaluate whether equivalent results could be obtained with curettage with use of a high-speed burr and reconstruction of the resulting defect with autogenous bone graft with or without allograft bone. The prospectively collected records of patients who had a giant-cell tumor of a long bone were reviewed to determine the rate of local recurrence after treatment with curettage with use of a high-speed burr and reconstruction with autogenous bone graft with or without allograft bone. All of the patients were followed clinically and radiographically, and a biopsy was performed if there were any suspicious changes. Fifty-nine patients met the criteria for inclusion in the study. According to the grading system of Campanacci et al., two patients (3 percent) had a grade-I tumor, twenty-nine (49 percent) had a grade-II tumor, and twenty-eight (47 percent) had a grade-III tumor. Seventeen patients (29 percent) had a pathological fracture at the time of presentation. The mean duration of follow-up was eighty months (range, twenty-eight to 132 months). Seven patients (12 percent) had a local recurrence. Six of these seven were disease-free at the latest follow-up examination after at least one additional treatment with curettage or soft-tissue resection (one patient). One patient had resection and reconstruction with a prosthesis after a massive local recurrence and pulmonary metastases. Despite the high rates of recurrence reported in the literature after treatment of giant-cell tumor with curettage and bone-grafting, the results of the present study suggest that the risk of local recurrence after curettage with a high-speed burr and reconstruction with autogenous graft with or without allograft bone is similar to that observed after use of cement and other adjuvant treatment. It is likely that the adequacy of the removal of the tumor rather than the use of adjuvant modalities is what determines the risk of recurrence.