Giant Cell Tumor Patients Research Articles

A clinicopathological study of giant cell tumor of small bones

Background and purpose. Giant cell tumor (GCT) of the small bones (small-bone GCT) is usually rare and considered somewhat different from conventional GCT. The purpose of this study was to investigate and report the clinicopathological features of 11 cases with small-bone GCT.Materials and methods. Patient information was obtained with the help of questionnaires. X-rays and paraffin blocks obtained from several institutions were clinically, radiographically, and histologically evaluated.Results. Small-bone GCT was observed in younger patients compared to conventional GCT; 5 of the 11 (45%) patients were below 20 years of age, whereas the corresponding figure for all GCT patients is 16% in Japan. Excessive cortical bone expansion is a special feature. There were two cases of recurrence and one case of lung metastasis; the primary lesion was in the hand for all three cases. In contrast, no primary lesion of the foot recurred or metastasized. Varying degrees of positive p63 immunostaining were observed in all examined cases (n = 9) of small-bone GCT but were negative in case of giant cell reparative granuloma (GCRG) and solid variant of aneurysmal bone cyst (ABC). One case that demonstrated high-intensity positive staining had two episodes of recurrence.Conclusion. Small-bone GCT tends to develop in younger patients than does conventional GCT. Primary GCTs of the hand may be biologically more aggressive than those of the feet. The p63 immunostaining may be useful not only for differential diagnosis but also for prognostication of small-bone GCT.

The surgical Treatment and Outcome of Pathological Fracture in Patients with Giant Cell Tumor of Bone

Between 1992 and 2008, we treated 35 patients with giant cell tumor (GCT) of bone, seven of the 35 pre-sented with a pathological fracture. The fractures were located in the femur in five, and in the humerus and radius in one patient each. The surgical treatments were curettage in six cases and wide resection in the distal radius case. Two of the seven patients developed local recurrence, giving a local recurrence rate of 29%. The local recurrence rate in GCT patients without a pathological fracture was 21%. There was a tendency for there to be a higher recurrence rate associated with fractured GCT, but no statistically significant difference was observed between the two groups. Therefore, it was considered that a pathological fracture was not a risk factor for local recurrence in GCT.

Primary Malignant Giant-Cell Tumor of Bone Has High Survival Rate

Malignant giant-cell tumors (MGCT) comprise 2-9% of all giant-cell tumors (GCTs). The limited existing studies fail to distinguish primary, secondary, or postradiation cancers, making it difficult to design rational treatment strategies. This study compared malignant to benign GCTs and defined the clinical outcome of the patients in a large series of case-matched patients from a single institution. Clinical, radiological, and outcome features were compared between 26 malignant and 244 benign GCTs treated in our institution. Five postradiation cancers were excluded. We also performed a 1:2 case-matched comparison of patients with malignant and benign disease. Distal femur (P = 0.019), proximal tibia (P = 0.032), and distal tibia (P = 0.049) had a higher frequency of MGCT. Campanacci stage 1 tumors had a low probability of malignancy (P = 0.017). MGCT were less likely to have aneurysmal bone cyst changes. The 5-year recurrence-free status probability was 80% for malignant and 91% for benign cases in matched groups. The difference in the recurrence rate between benign and malignant groups was not statistically significant (P = 0.24). Functional impairment and limited activity were greater in MGCT patients than in benign GCT patients, whether treated by resection/amputation or curettage/cryosurgery. We found that malignant and benign GCT have similar epidemiology and that recurrence was higher in MGCT (20 v 9%). Local recurrence for MGCT was not statistically different for excision versus intralesional therapy, but there was little statistical power. Finally, the 16% mortality for patients with MGCT suggests low-grade malignancy.

The analysis of the treatment of giant cell tumor of the pelvis and sacrum

To discuss the surgical management, local recurrence rate and complications of giant cell tumor (GCTs) of the pelvic and sacrum. From December 1997 to December 2005 the data of 46 patients of GCTs of pelvic and sacrum treated were reviewed. There were 25 men and 21 women with the average age of 32 years old ranging from 17 to 64. Out of 46 patients,there were 24 tumors involved the sacrum and the others at the pelvis. According to the site of the tumors on the bone, they was classified into three regions: 8 patients involved region I (ilium), 10 region II (acetabulum) and 4 region III (ischiopubic). Two patients had lesions located at S(1-5), 4 at S(1-4), 12 at S(1-3), 5 at S(1-2) and 1 at S(3-5). Surgical management: 2 patients received 3 times of operations and 7 underwent 2 operations. There were 19 patients managed with intralesional marginal excision and 2 patients with intralesional marginal excision and adjuvant radiotherapy, another 3 patients with widely marginal excision as the treatment of sacral lesions. Nineteen patients underwent the enbloc excision except 2 involved ischium and 1 involved ilium for the managements of pelvic lesions. One recurrent patient with the large, ragged tumor died of serious infection in 2 weeks after the second surgery. The remain 45 patients had followed-up durations ranging from 12 months to 8 years. One patient of malignant giant cell tumor of sacrum died at 15 months after surgery. One patient with postoperation sarcoma underwent reoperation and radiotherapy but died at the 13th month. One patient with sacral lesion occurred pulmonary metastases in two years after surgery, and received chemotherapy with ADM, DDP and IFO. One year later there was no much change in metastatic tumor. One patient with acetabular lesion underwent curettage before local recurrence and pulmonary metastases were found in 2 years. The patient was treated with pulmonary radiation, widely marginal excision and hemi-pelvic prostheses reconstruction. There was no progression in metastatic lesion during the following up. The local recurrence rate of GCT at sacrum was 9/24 (37.5%), and at pelvis was 2/22 (9.1%). However, 2 patients with ischium lesions both recurred after curettage. Nineteen lesions with enbloc excision showed no recurrence at all. The treatment for GCT of the pelvic and sacrum should be more aggressive because of high incidence of local recurrence after intralesional excision. Although it might induce sacral nerve deficit, widely marginal excision is the best surgical procedure because of its low recurrence rate.

Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy

Giant cell tumour (GCT) is a benign, but aggressive, primary tumour of the bone. The recurrence rate after surgical treatment has been reported to be as high as 50%. Many surgical techniques have been employed in the treatment of this tumour. More aggressive interventions, such as en bloc resection and bulk allograft or prosthetic reconstruction, are generally understood to be associated with lower rates of local recurrence. However, because of lessened morbidity, intralesional techniques have come to be favoured for this condition. In addition to curettage, various adjuvant procedures and packing materials have been advocated in order to control and reconstruct long bone defects secondary to this neoplasm. We report our experience with 40 long bone GCT patients treated with curettage, burring, bone grafting and no adjuvants between 1997 and 2002. There was a local recurrence rate of 32.5%, with most recurrences noted within the first 30 months after surgery. Minor complications were found in 18% of patients. The risk of local recurrence in this study is acceptable (within the range that has been historically reported for curettage and bone grafting). In cases where more resources are available, the addition of adjuvant therapies, as noted in the recent literature, may be beneficial. The results of this study should be considered when designing multicenteric studies in the future.

Treatment of Giant Cell Tumor with Anhydrous Alcohol as a Novel Adjuvant

Purpose: As a treatment of giant cell tumors (GCT) of the long bone, anhydrous alcohol was used in our institution due to the potential complications associated with other previous adjuvants. Therefore, this study evaluated the feasibility and effectiveness of anhydrous alcohol as a new adjuvant in the treatment of a GCT. Materials and Methods: One hundred and three GCT patients were treated and followed up for an average of 6 years (range, 1-29.3 years) with a mean age of 33 years (range, 16-67 years). Curettage, additional burring, and reconstruction with a bone graft or cementing were performed in 69 patients. Among them, anhydrous alcohol was used as an adjuvant in 38 patients. Results: Four (10.5%) patients given the anhydrous alcohol treatment had a local recurrence, whereas 15 recurrences (48.4%) developed in 31 patients treated without the anhydrous alcohol (p=0.001). There were no anhydrous alcohol-related complications. According to Kaplan-Meier's analysis and the log rank test, the anhydrous alcohol adjuvant showed a significant effect (p=0.014) in preventing the recurrence of GCT. Conclusion: The data suggests that anhydrous alcohol can be used as an effective adjuvant without potential risks for the treatment of a GCT of the long bone.

Involvement of receptor activator of nuclear factor kappaB ligand/osteoclast differentiation factor in osteoclastogenesis from synoviocytes in rheumatoid arthritis.

To clarify the mechanism by which osteoclasts are formed in culture of rheumatoid synoviocytes by exploring the involvement of receptor activator of nuclear factor kappaB ligand (RANKL)/osteoclast differentiation factor (ODF). Osteoclast formation was evaluated in cocultures of rheumatoid synovial fibroblasts and peripheral blood mononuclear cells (PBMC) in the presence of macrophage colony stimulating factor and 1,25-dihydroxyvitamin D3 (1,25[OH]2D3) utilizing separating membrane filters. RANKL/ODF expression was examined by Northern blotting in synovial tissues from 5 rheumatoid arthritis (RA) patients and tissues from patients with giant cell tumor (GCT), osteosarcoma (OS), and osteoarthritis (OA). RANKL/ODF expression and the ability of synovial fibroblasts to support osteoclastogenesis were investigated in coculture with PBMC in the presence or absence of 1,25(OH)2D3, and soluble RANKL/ODF and osteoprotegerin (OPG)/osteoclastogenesis inhibitory factor (OCIF) were measured by enzyme-linked immunosorbent assay. The effects of OPG/OCIF on the osteoclastogenesis in the primary culture of rheumatoid synoviocytes and the coculture system were determined. Synovial fibroblasts did not induce osteoclastogenesis when separately cocultured with PBMC. Northern blotting revealed that RANKL/ODF was highly expressed in all tissues from RA and GCT patients, but not from OA or OS patients. Cultured rheumatoid synovial fibroblasts efficiently induced osteoclastogenesis in the presence of 1,25(OH)2D3, which was accompanied by up-regulated expression of RANKL/ODF and decreased production of OPG/OCIF. Osteoclastogenesis from synoviocytes was dose-dependently inhibited by OPG/OCIF. RANKL/ODF expressed on synovial fibroblasts is involved in rheumatoid bone destruction by inducing osteoclastogenesis and would therefore be a good therapeutic target.