Giant Cell Tumor Research Articles

Giant Cell Tumor of the Rib: A Report of Two Patients.

Giant cell tumor of the bone is a locally aggressive and rarely metastasizing tumor that typically affects the ends of long bones. Less than 1% of giant cell tumor of bone occur in the ribs. Our patients were a 32-year-old woman and a 45-year-old man and were detected following chest traumas. No bone alterations were detected in radiological studies performed immediately after local trauma. Six- and one- months, respectively, following chest trauma, both giant lytic heterogeneous masses arising on an anterior rib arc were radiologically observed. In the computerized tomography-guided needle biopsy, giant cell tumor of bone were diagnosed. Both tumors were completely removed by bloc resection including the adjacent ribs and posterior reconstruction were performed. One patient was preoperatively treated with denosumab. Neither local recurrences nor metastasis have been detected in follow-up. Despite its low frequency and its low degree of suspicion, giant cell tumor of bone should be included in the differential diagnosis of a rapid growing chest mass.

A rare case of giant cell tumor in navicular bone: a case report

A rare case of giant cell tumor in navicular bone: a case report

The tumor-stroma ratio in giant cell tumor of bone: associations with the immune microenvironment and responsiveness to denosumab treatment

BackgroundCurrently, there is limited understanding regarding the clinical significance of the tumor-stroma ratio (TSR) in giant cell tumor of bone (GCTB). Hence, we aimed to investigate the distribution of TSR in GCTB and explore its correlation with various clinicopathologic factors, immune microenvironment, survival prognosis, and denosumab treatment responsiveness.MethodsWe conducted a multicenter cohort study comprising 426 GCTB patients treated at four centers. TSR was evaluated on hematoxylin and eosin-stained and immunofluorescent sections of tumor specimens. Immunohistochemistry was performed to assess CD3+, CD4+, CD8+, CD20+, PD-1+, PD-L1+, and FoxP3+ TIL subtypes as well as Ki-67 expression levels in 426 tissue specimens. These parameters were then analyzed for their correlations with patient outcomes [local recurrence-free survival (LRFS) and overall survival (OS)], clinicopathological features, and denosumab treatment responsiveness.ResultsLow TSR was significantly associated with poor LRFS and OS in both cohorts. Furthermore, TSR was also correlated with multiple clinicopathological features, TIL subtype expression, and denosumab treatment responsiveness. TSR demonstrated similar predictive capabilities as the conventional Campanacci staging system for predicting patients' LRFS and OS.ConclusionThe results of this study provide evidence supporting the use of TSR as a reliable prognostic tool in GCTB and as a predictor of denosumab treatment responsiveness. These findings may aid in developing individualized treatment strategies for GCTB patients in the future.

Benign metastasizing tumor or benign epithelial inclusion in the node: A diagnostic dilemma

Generally metastasis implies malignancy, but there are some benign tumours which can also metastasize to lymph nodes, bone, and kidney. The benign tumours which can metastasize includes pleomorphic adenoma, leiomyoma, giant cell tumour of bone and meningioma. A 27 years old female presented to the cytology clinic with the submandibular swelling for past 3 months. Patient is a known case of pleomorphic adenoma post-surgery in the same region 6 years back. On examination two nodular swelling each measuring 1 x 1 which is firm mobile near scar site and left level III lymph node region. A non-guided fine needle aspiration cytology was performed from both the swelling. The Papanicolaou- and May-Grünwald Giemsa-stained smears from both sites showed features of pleomorphic adenoma. The interesting aspect of this article is cytological diagnosis of benign pleomorphic adenoma metastasizing to lymph nodes which is a rare entity.

GIANT CELL TUMOUR OF TENDON SHEATH IN THE FOOT: A RARE CASE REPORT

Giant cell tumor of the tendon sheath (GCT-TS) is predominantly encountered in the hand, ranking as the second most common solid tumor after ganglion cysts. Contrary to its prevalence in the upper extremity, GCT-TS manifestation in the foot is exceptionally rare. This report delineates a unique presentation of GCT-TS in the foot of a 25 y old female, who presented with a painful, progressively enlarging mass in the lateral aspect of her foot. This case underscores the diagnostic challenges and therapeutic considerations in managing such an atypical presentation of GCT-TS.

ISLET-1 expression in soft tissue neoplasms reveals high sensitivity but moderate specificity for desmoplastic small round cell tumors and potential utility as a diagnostic biomarker

ISLET-1 (ISL1) is a LIM-homeodomain transcription factor. Selective ISL1 expression is shown in neuroendocrine, non-neuroendocrine, and some soft tissue tumors including desmoplastic small round cell tumor (DSRCT). We assessed the specificity of ISL1 (clone EP283, 1:500, Cell Marque) in 288 soft tissue tumors, which included 17 DSRCTs and other histologic mimics. Positive staining threshold for ISL1 was set to >10 % of neoplastic cell nuclei at moderate intensity. ISL1 IHC was positive in 15/16 (94 %) DSRCTs with 75 % showing diffuse (>50 %) expression. ISL1 was positive in 1/10 (10 %) Ewing sarcomas (EWS), 7/13 (54 %) alveolar rhabdomyosarcoma (RMS), 14/22 (63 %) embryonal RMS, 7/14 (50 %) synovial sarcomas, 15/16 (93 %) neuroblastoma, 1/5 (20 %) Wilms tumor, 2/4 (50 %) olfactory neuroblastoma, and all 9 Merkel cell carcinomas. Other tumors, including all CIC::DUX4 sarcomas, were negative except 3/27 leiomyosarcomas, and 1 each of angiosarcoma, myxoid liposarcomas, inflammatory myofibroblastic tumor, malignant peripheral nerve sheath tumor, tenosynovial giant cell tumor, dedifferentiated LPS, and 1 ectomesenchymoma. In summary, among the soft tissue tumors tested, ISL1 is a highly sensitive but moderately specific marker for DSRCT and may be useful to distinguish from round cell mimics including EWS and CIC::DUX4 sarcomas. The oncogenic role of ISL1 in these tumors warrants further investigation.

Inflammatory Giant Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Next-generation Sequencing Study of 14 Cases.

A distinctive histological variant of poorly differentiated, sarcomatoid, non-small cell lung carcinoma characterized by a discohesive population of giant tumor cells associated with prominent interstitial inflammatory cell infiltrates is described. The tumors occurred in 7 women and 7 men, 42 to 72 years of age (mean: 56y). They predominantly affected the upper lobes and measured 1.3 to 9cm in greatest diameter (mean: 4.6cm). The tumor cells were characterized by large pleomorphic nuclei with prominent nucleoli, ample cytoplasm, and frequent abnormal mitoses, and were surrounded by a dense inflammatory cell infiltrate, often associated with emperipolesis. Immunohistochemical stains were positive in the tumor cells for cytokeratin AE1/AE3 and CK8/18 and negative for TTF1, napsin A, p40, and CK5/6. Next-generation sequencing was performed in all cases using the Oncomine Precision Assay; the most common abnormalities found included TP53 mutations (9 cases) and AKT1 amplification (8 cases), followed by KRAS mutations (4 cases) and MAP2K1/2 mutations (4 cases). Clinical follow-up was available in 13 patients. Three patients presented with metastases as the initial manifestation of disease; 8 patients died of their tumors from 6 months to 8 years (mean: 2.7y); 3 patients were alive and well from 4 to 6 years; and 2 patients had metastases when last seen but were lost to follow-up thereafter. The importance of recognizing this distinctive and aggressive variant of non-small cell lung carcinoma lies in avoiding confusion with a sarcoma or other types of malignancy.

Giant cell tumor arising in a cesarean scar: Addition to diagnostic dilemmas.

Giant cell tumor arising in a cesarean scar: Addition to diagnostic dilemmas.

The effect of preoperative embolization on giant cell tumors of the bone localized in the iliosacral region of the pelvis

IntroductionGiant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. MethodsFive surgeries (January–December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. ResultsTumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. ConclusionCurettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.

Giant-cell Tumor of Dorsal Vertebra Presenting as a Posterior Mediastinal Mass: A Rare Case Report

Giant-cell Tumor of Dorsal Vertebra Presenting as a Posterior Mediastinal Mass: A Rare Case Report

Combining morphological and functional imaging parameters to diagnose primary bone neoplasms in the skull base, spine and sacrum.

Morphological magnetic resonance (MR) and computed tomography (CT) features are used in combination with histology for diagnosis and treatment selection of primary bone neoplasms. Isolated functional MRI parameters have shown potential in diagnosis. Our goal is to facilitate diagnosis of primary bone neoplasms of the skull base, mobile spine and sacrum, by a comprehensive approach, combining morphological and functional imaging parameters. Pre-treatment MR of 80 patients with histologically proven diagnosis of a primary bone neoplasm of the skull base, mobile spine and sacrum were retrospectively analyzed for morphological and functional MRI parameters. Functional parameters were measured in 4 circular regions of interest per tumor placed on non-adjacent scan slices. Differences in values of functional parameters between different histologies were analyzed with Dunn's test. Chordomas were the predominant histology (60.0%). Most neoplasms (80.0%) originated in the midline and had geographical (78.2%) bone destruction. Amorphous-type calcification (pre-existing bone) was seen only in chordomas. Homogeneous contrast enhancement pattern was seen only in chondrosarcoma and plasmacytoma. Ktrans and Kep were significantly lower in both chordoma, and chondrosarcoma compared to giant cell tumor of the bone (p = 0.006 - 0.011), and plasmacytoma (p = 0.004 - 0.014). Highest diffusion-weighted MRI apparent diffusion coefficient (ADC) values corresponded to chondrosarcoma and were significantly higher to those of chordoma (p = 0.008). We identified the most discriminating morphological parameters and added functional MR parameters based on histopathological features that are useful in making a confident diagnosis of primary bone neoplasms in the skull base, mobile spine and sacrum.

A Case Report on Cystic Giant Cell Tumour Over Dorsum of the 5th Metacarpophalangeal Joint Managed by Excision of the Tumour and Tendon Repair

A Case Report on Cystic Giant Cell Tumour Over Dorsum of the 5th Metacarpophalangeal Joint Managed by Excision of the Tumour and Tendon Repair

Pink and Blue of Bones- A Histopathological Analysis of Bony Neoplasm in a Tertiary Hospital of Bihar

Background: Bone lesions have low incidence with diverse presentation and due to the presence of their limited studies it has become a challenging task to reach an accurate diagnosis. Aim and Objective: This study aims in studying variety of bony lesions observed clinically and histopathologically. Further categorizing into non neoplastic, tumour-like, benign tumour or malignant tumour and determining its correlation with the age and gender predisposition of these lesions. Materials and Methods: An ambispective study was executed in Pathology department , PMCH, Patna from May 2020 to April 2024 in which a total of 102 cases were collected. The necessary information for the retrospective analysis, such as the patient's age, sex, lesion location, and diagnosis, was obtained from the requisition form and the histopathology data kept in the department of pathology from May 2020 to May 2022. And for prospective study all the radiological proven bony lesions which were excised during period of May 2022 to April 2024 and were sent for histopathological examination were examined. Results: Non-neoplastic lesions were more common than neoplastic lesions among the 102 specimens that underwent histological examination (53 versus 49). With 21.5% of cases, tuberculous osteomyelitis was the most prevalent non-neoplastic lesion. The most common benign neoplastic lesion detected was a giant cell tumor of the bone (11.76%), while the most common malignant lesion found was osteosarcoma (2.94%). Conclusion: To improve patient management and diagnosis accuracy, it is advised to utilize clinical, radiological, and histological findings in an integrated manner.

Epidemiología de los tumores musculoesqueléticos en una unidad de referencia

ObjectiveThe objective of this study was to perform an epidemiological analysis of patients presented to the Musculoskeletal Tumors Committee of a reference hospital. Material and methodA retrospective analysis of patients with sarcomas treated in a reference Sarcoma Unit between 2009 and 2022 was carried out. ResultsA total of 1978 patients were analyzed, of which 1477 (74.67%) were diagnosed as sarcomas. They were divided into 446 (30.20%) bone tumors and 1.031 (69.80%) soft tissue tumors. The most common benign bone tumor was enchondroma (27.23%), giant cell tumor (59.21%) was the most common tumor of intermediate malignancy and the malignant one was osteosarcoma (24.78%). The most frequently observed benign soft tissue tumor was lipoma (50.74%), the atypical lipomatous tumor (53.25%) was the most frequent tumor of intermediate malignancy and the malignant one was sarcoma of uncertain differentiation (38.10%). ConclusionOur study represents the first work on the epidemiology of sarcomas and other musculoskeletal tumors in our country, being very useful to adapt the resources destined for their diagnosis and treatment.

Preserving Approach in Management of Femur Giant Cell Tumor with Curettage and Bone Grafting in an Adult Patient: Case Report

Preserving Approach in Management of Femur Giant Cell Tumor with Curettage and Bone Grafting in an Adult Patient: Case Report

Surgical Management of Extradural Tumors at the Craniovertebral Junction – Insights from a Tertiary Care Center

Craniovertebral junction (CVJ) tumors are challenging due to their unique anatomical location. This study aimed to evaluate the complexities in dealing with such precarious CVJ extradural lesions over the decade. Twenty-seven patients of extradural CVJ tumors operated between 2009 and 2018 were included. The demographic details, neurological status, surgical approach, extent of resection, type of fixation, complications, and outcome at final follow-up were recorded for each patient. The mean age of the patients was 39.5±20years. Most (17/27) of the patients had involvement of a single level. Clivus was the most common (9/17) involved region followed by atlas (7/17) vertebrae. Majority of the patients (13/27) were operated through the posterior-only approach. About 15 patients (55.5%) had instability or extensive lesions that necessitated posterior fixation. None of the patients underwent anterior fixation. Gross and near total excision were achieved in 10 patients (37%) and 3 patients (11%) respectively while 14 patients underwent subtotal excision of tumor. On histopathological analysis, clival chordoma (8/27) was found to be the most common pathology followed by giant cell tumor (6/27), plasmacytoma (4/27), and multiple myeloma (2/27). Most patients (13 out of 27) had the same neurological status after the surgery. Six patients (22%) improved post-operatively with decreased weakness and spasticity. Thirteen (48%) patients underwent adjuvant radiotherapy. This retrospective study provides valuable insights into managing extradural CVJ tumors and highlights the importance of individualized approaches for optimal outcome.

A Short Course of Preoperative Denosumab Injection Followed by Surgery in High-Risk Giant Cell Tumors of the Extremities: A Retrospective Study

A Short Course of Preoperative Denosumab Injection Followed by Surgery in High-Risk Giant Cell Tumors of the Extremities: A Retrospective Study

Vimseltinib improves outcomes in tenosynovial giant cell tumour.

Vimseltinib improves outcomes in tenosynovial giant cell tumour.

Fine-needle aspiration cytology of diffuse type tenosynovial giant cell tumor with malignant trasformation and review of literature.

Tenosynovial giant cell tumors (TGCTs) arise from the synovium of joint, bursa, and tendon sheath. Diffuse type often affects large joints, has higher recurrence rates, metastases, and malignant transformation potential compared to the localized type. The cytopathology of TGCT, a fibrohistiocytic neoplasm distinct from other giant cell-rich soft tissue tumors, is rarely reported. Here we describe cytomorphology of a case of TGCT that was initially diagnosed on fine-needle aspiration cytology (FNAC) consisting of a mixture of singly scattered polygonal or spindle mononuclear cells with hemosiderin laden macrophages, inflammatory cells, and a population of multinucleated osteoclast-like giant cells. Persistent symptoms and repeat excision were consistent with high-grade malignant transformation of the TGCT. Atypical cytologic features in a recurrent, infiltrative, or a metastatic lesion should raise suspicion for malignancy.

Effectiveness of the Use of Denosumab When Performing Intralesional Surgery in Patients with Gigant Cell Tumors of the Bones of the Knee Joint

In intralesional resection of giant cell tumors, local recurrence rate can be as high as 60–65 %. Some authors attribute recurrences to the presence of an extraosseus component and pathologic fractures, others focus on the effectiveness of bone cavity processing. Currently, denosumab is widely used in treatment of giant cell tumors of the bone. Most frequently, it is used in neoadjuvant regimen at dose 120 mg. This regimen allows to decrease the volume of extraosseous tumor component, form bone margins, and, as a result, make radical resection easier. However, the number of publications on increased risk of local tumor recurrence after neoadjuvant denosumab administration has been growing.Aim. To evaluate the effectiveness of various denosumab administration regimens in intralesional tumor resection in patients with giant cell tumors of the bones forming the knee joint.Materials and methods. The prospective study included outcomes of integrated treatment of 65 patients (34 (52.3 %) women and 31 (47.7 %) men) who underwent surgery at the Division of Bone Oncology of the National Scientific Research Center for Traumatology and Orthopedics named after R.R. Vreden due to giant cell tumors of the knee joint between 2017 and 2023. Mean patient age was 37.5 ± 9.79 years (95 % confidence interval 35.11–39.96; range 19–61 years). Mean follow-up duration was 40.2 ± 13.3 months (95 % confidence interval 36.87–43.46; range 18–68 months). To perform comparative analysis, the patients were divided into 2 groups depending on treatment type. The Group 1 (control) included 32 patients who subcutaneously received 120 mg denosumab prior to surgery (4 injections once a week and then once a month; total number of injections was 6 or more) with subsequent intralesional tumor resection, defect reconstruction with cement in combination with external fixation using a lockable condylar plate. The Group 2 (treatment) included 33 patients who underwent the same surgery as patients of Group 1 and then received subcutaneous injections of 120 mg denosumab (1 injection once a month for 3 months after surgery). Classification and analysis of complications were performed using the International Society of Limb Salvage (ISOLS) 2014 system. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS) at 3, 6, and 12 months.Results. Mean time of recurrence diagnosis in the Group 1 was 9.1 months, in the Group 2 – 14.3 months. Evaluation of the probability of local tumor recurrence depending on treatment type showed statistically significant differences (p = 0.001). Odds of local recurrence in the Group 2 were 10.6 times lower than in the Group 1, and odds of revision surgical intervention in this patient group was 14.5 times higher (with higher probability, this surgery involved oncological endoprosthesis) (p = 0.011). No statistically significant differences in development of distant metastases and probability of death depending on treatment type were found (p = 0.492). According to the obtained data, there are statistically significant differences in functioning of the knee joint per the MSTS scale in the Groups 1 and 2 at 6 and 12 months (p = 0.021 and p = 0.021, respectively). Functional outcomes were better in the Group 2. No significant differences in knee joint functioning per the MSTS scale at 3 months depending on treatment type were found (p = 0.764).Conclusion. Administration of denosumab in the postoperative period allows to improve oncological outcomes due to decreased number of local recurrences (2 (6.1 %) cases), maintenance of excellent local control and good functional results, and to decrease the probability of revision surgical intervention to a minimum. In our study, administration of this drug prior to surgery (intralesional tumor resection) significantly increased the risk of local tumor recurrence (p = 0.001).