Management Of Giant Cell Tumor Research Articles

Giant Cell Tumor of Bone: 6 Years Institutional Retrospective Review

Abstract Introduction Surgery is the cornerstone for the management of giant cell tumors (GCTs). There are no definite guidelines for the management. The purpose of this series was to study the patient demography and results of the surgical intervention for skeletal GCTs in our population. Materials and Methods All the histologically diagnosed cases of GCT of bone from year 2012 to 2018 were retrospectively analyzed for patient demographics, site, and grade of the lesion, type of biopsy taken (if any), nature of surgical intervention, and final outcome with respect to complications. Results Seventeen cases of skeletal GCT were diagnosed on histopathology. The mean age at presentation was 31.5 ± 10.9 years with females affected 1.4 times more. Proximal tibia was the most common site (29.4%) followed by distal radius and distal femur in that order. About 58.8% of the lesions were of Campanacci grade 2 and remaining were grade 3 lesions. Ten patients had extended curettage, five had en bloc resection, and one had amputation as the primary treatment. Twenty percent patients (n = 3) had local recurrence of the pathology and one patient developed distant recurrence (lung metastasis). Conclusion Proximal tibia followed by distal radius was the most common site of GCT in our population. The tumor behavior and recurrence cannot be predicted with any grading system. The goal should be salvage of the joint by intralesional curettage, with resection reserved for distal radius GCTs, cases with extensive soft tissue extension or those with destruction of the articular cartilage and joint involvement.

The functional outcomes and complications of different reconstruction methods for Giant cell tumor of the distal radius: comparison of Osteoarticular allograft and three-dimensional-printed prosthesis

BackgroundEn bloc excision has been increasingly used for the management of giant cell tumors (GCTs) in the distal radius. An osteoarticular allograft has been used extensively for decades, and custom-made prosthesis reconstruction has been more recently applied. We aimed to compare the clinical outcomes of the two procedures.MethodsWe retrospectively analyzed 30 patients with Campanacci III or recurrent GCTs of the distal radius for follow-up at a mean of 33.2 months. In total, 15 underwent osteoarticular allograft reconstruction (allograft group) and 15 received cementless three-dimensional (3D)-printed prosthesis reconstruction (prosthesis group) between March 18, 2013, and May 20, 2018. All patients underwent by clinical and radiological examinations, including pre- and postoperative active range of motion (ROM) of the wrist, VAS score, grip strength, degenerative change of wrist, Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score. Complications were evaluated using the Henderson classification.ResultsBoth groups showed significantly increased ROM, grip strength, Mayo score and MSTS score postoperatively. Furthermore, the extension, flexion, MSTS, and Mayo score were significantly higher in the prosthesis group. There was no significant difference in grip strength and VAS between the groups. In allograft group, one patient had a late infection one had resorption of allograft without allograft bone fracture. and four had wrist subluxation. All patients had degenerative changes (mean 9 months). In the prosthesis group, three patients developed wrist subluxation, three had separation of the distal radioulnar joint, and none of the patients developed wrist degeneration.ConclusionsOur study compared the objective functional outcomes and complications of two reconstructive methods for Campanacci III or recurrent GCT in the distal radius. 3D-printed prosthesis replacement can partially preserve wrist function better than allograft reconstruction in the short-term. During the design of 3D-printed prosthesis, preoperative morphological assessment of the affected proximal row carpal is helpful to control postoperative dislocation. After allograft reconstruction, wrist degeneration, which has been demonstrated in all patients, severely influence their wrist function. Therefore, compared to allograft reconstruction, 3D-printed prosthesis reconstruction has irreplaceable advantages at early-stage application, especially in wrist function, however, further studied with a larger number of cases and longer follow-up.

Case report of giant cell tumor of proximal tibia-managed in a rural tertiary care hospital

Giant cell tumour is seen in 4% of all bone tumours and it constitutes approximately 10% of all malignant bone tumours. Preponderance is greatest between the age groups of 20 to 55 years. It is more common in females than in males [1, 2]. Tumour is known to have high post excision recurrence rate & its activity ranges from borderline to malignant lesion. It is a locally aggressive destructive lesion. Since tumour has high recurrence rates after it is treated by combination of various modalities available to reduce the recurrence rates. Tumours treated with multiple modalities have proven to have a lower recurrence rate than those tumours treated with single modalities [3, 4]. Tumour arises from the epiphyses of long bones. Most common sites are proximal tibia, distal femur, and distal radius. Radiographically, these tumours are often seen as an expansile exophytic mass. Following the multiple treatment modality in the management of Giant cell tumours, this is one case scenario.

Diagnosis and management of giant cell tumour of talus: A case report

Diagnosis and management of giant cell tumour of talus: A case report

Navigation assisted primary total knee arthroplasty sixteen years after gaint cell tumor distal femoral cement augmentation

49 year old female who underwent curettage and cementation for distal femur Giant cell tumor (GCT) 16 years back, presented with severe knee osteoarthritis. She was managed with navigation assisted primary total knee replacement with cruciate retaining prosthesis. The possibility of cement augment loosening with drilling intramedullary canal was also ruled out when navigation system was employed. Theoretical contamination of the femoral canal by residual tumor can be avoided by using navigation. Primary cementation during management of GCT and employment of navigation system provides optimal outcomes.

Functional outcome of limb salvage surgery in gaint cell tumour around knee with mega-endoprosthetic reconstruction

Introduction: Giant cell tumors (GCTs) represent 3-4% of all primary tumors of bone [1]. These tumour are locally aggressive and predominantly affect the ends of long bones (usually the distal femur and proximal tibia) in young adults. The ideal aim in the management of GCT is to eradicate the tumor without sacrificing the joint. Wide resection should be the treatment of choice, especially for situations such as recurrences, pathological fractures and tumors which are frankly malignant tumorAim: To determine the functional outcome and complications of mega endoprosthesis in treatment of gaint cell tumour around knee joinMaterials and Methods: Retrospective study conducted from 2010 to 2016 with age ranging from 16 to 30 years with follow up period- 48 months. All patient with primary GCTs around knee who had met with inclusion criteria underwent surgery. All patient underwent definitive wide local resection and Mega-endoprosthetic reconstruction, Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Complications related to surgery such as Infection, Aseptic loosening, Dislocation, Skin necrosis and Fractures were evaluated. The diagnosis was based on histopathological features noted on a core biopsy. Patients with a high-grade GCT were subjected to computed tomography of the chest and bone scan for metastatic evaluation.Results: The average MSTS functional score was 75% (Range- 60% to 100%), 4-year survival rate was 100% in our study. Average range of movements at 4 years was 80 (70-90). Among the 8 patients, 2 had complications related to surgery. One had infection which required intravenous antibiotics treatment but infections did not subsided so patient underwent allograft bone transplant with arthrodesis. One had foot drop secondary to common peroneal palsy, Six months post-surgery, he was able to walk with a single crutch and coped well with his foot drop. Conclusions: Wide resection and endoprosthetic replacement should be considered as a preferred treatment option in treatment of aggressive gaint cell tumour around knee joint. Mega-endoprosthetic reconstruction provides good functional outcome in patients with these kind of tumour and can be considered as treatment of choice if and when the limb can be salvageable.

Role of intravenous zoledronic acid in management of giant cell tumor of bone- A prospective, randomized, clinical, radiological and electron microscopic analysis

BackgroundThe primary treatment of Giant cell tumor of bone is surgical management. Bisphosphonates are antiresorptive drugs which inhibit osteoclast mediated bone resorption and shown to have inhibitory effect on various tumors. The present study aims to establish clinical, ultrastructural and radiological response of intravenous zoledronic acid on giant cell tumor of bone. MethodologyDesign - Prospective randomized controlled study. A group of 30 patients of GCT bone were randomized into two equal groups. Patients in control group did not receive any adjuvant therapy before surgery. Patients in bisphosphonate group received three doses of intravenous zoledronic acid at four weeks interval prior to definitive surgery. The evaluation was done based on size of swelling, VAS score, plain radiograph, MRI and histopathological and Transmission electron microscopic examination findings. ResultsSignificant reduction in VAS score (from mean 5.33 to 1.8), increased mineralization particularly at periphery of lesion in plain radiograph, statistically significant increase in mean apoptotic index, P value < 0.0001 (mean 41.46 in bisphosphonate group and 6.06 in control group) was noted in bisphosphonate group. No significant change in tumor volume is noted in MRI. No significant side effects were noted. DiscussionOne distinctive feature of pathogenesis of GCT bone is osteoclastogenesis which causes extensive bone destruction. Use of intravenous Zoledronic acid counteracts this bone destruction. Further, possible antiangiogenic effect of intravenous bisphosphonates inhibits tumor growth and provides symptomatic improvement. ConclusionIV Zoledronic acid alleviates pain, produce sclerosis and induce apoptosis hence decrease the rate of tumor progression and decrease the rate of local bone destruction, hence they are useful adjuvant to surgery in GCT.

Surgical Management of Giant Cell Tumor Involving the Lateral Skull Base.

The aim of the study is to discuss the current management options for intra- and extra-cranial communication giant cell tumor of the lateral skull base and perform a review of the literature. A total of 6 patients with giant cell tumor of the lateral skull base were retrospectively enrolled in the study. The principal complaints, imaging manifestations, surgical resection and reconstruction of intra- and extra-cranial communication defects for the diseases were discussed. There were 2 males and 4 females. The most of principal complaints were discomfort or pain in the temporomandibular joint in 5 cases (83.3%). Imaging examination showed invasion of the temporal bone alone in 3 cases (50.0%) and both temporal bone and sphenoid bone involvement in 3 cases (50.0%). C-shaped preauricular infratemporal fossa approach was used for tumour removal and gross total resection was done in all 6 cases. The pedicled temporal muscle fascial flap was used to reconstruct the intra- and extra-cranial communication defect of the lateral skull base. The conclusion is that giant cell tumor is a benign tumor but is also locally aggressive. Gross total resection is the most commonly recommended treatment choice for giant cell tumor of the skull and can achieve good treatment outcomes. The temporalis muscle flap is a good alternative choice for reconstruction of the defect.

Long-term outcome of giant cell tumors around the knee with associated pathological fractures treated by curettage and cementation

Objectives: The management of giant cell tumor (GCT) lesions around the knee is challenging. This study aimed to investigate the long-term outcome of treating GCTs around the knee with associated pathological fractures by curettage and adjuvant cementation with the use of high-speed burr. Methods: Fifty patients with a mean age of 28.3 years were included in the study. The tumor was located in the distal femur (40 patients) and proximal tibia (10 patients). Eighteen patients were Grade II Campanacci, whereas 32 patients were Grade III. The mean follow-up period was 65 months. Twenty-nine patients (58%) underwent extended curettage and bone cement. Twenty-one patients (42%) underwent extended curettage, bone cement, and internal fixation. High-speed burr was used in 45 patients (90%). Bone graft was used in 8 patients (16%). Functional evaluation was done using the Musculoskeletal Tumor Society (MSTS) scoring system for the lower extremity. Results: The overall MSTS score was excellent in 42 patients (84%), good in 5 patients (10%), fair in 2 patients (4%), and poor in 1 patient (2%). The overall local recurrence rate was 12% (6 cases) and a 10% complication rate. There were no cases of fracture nonunion or distant metastasis. Conclusions: GCTs around the knee with associated pathological fractures at diagnosis can be treated with extended curettage using high-speed burr and adjuvant cementation with favorable functional long-term outcome.

Management of giant cell tumor of fibular head with curettage: A case report

Management of giant cell tumor of fibular head with curettage: A case report

Surgical management of giant cell tumor of axis vertebra: review of fourteen cases in literature with a case illustration

Abstract Primary spinal giant cell tumor (PSGCT) considered as rare primary neoplasm, with predilection for subarticular location and commonly located at knee joint region, sacrum or distal radius, however, spinal involvent is uncommon and comparatively much rarer in the cervical spine. Further occurrence of giant cell tumor in the Axis vertebra is extremely uncommon and easily misdiagnosed and, thus, treatment is still debated and various treatment modalities and different surgical approaches were utilized during evolution of surgical management. Authors could collect only 14 cases of primary giant cell tumor affecting Axis vertebra in a detailed Pubmed and Medline search, out of which 12 cases were primary and rest two case was recurrent. So authors reviewed in total thirteen cases primary giant cell tumor of Axis managed surgically, including our case. Out of 13 PSGCT, twelve cases were managed with surgical resection and the rest one case was managed with monoclonal antibody using Denosomab monotherapy without any surgical intervention. In the surgical group (n=12), nine cases had two staged surgical procedure, first being posterior fixation followed by anterior approach with resection of tumor while, the rest three had one stage surgical resection including current case. Authors reports a unique case of spinal giant cell tumor developing in a- 38 - year male with history of renal transplant, presented with neck pain and difficulty in walking, neuroimaging revealed a osteolytic mass lesion involving body of axis vertebra with extension into right sided lamina, underwent two stage complete surgical intervention. Authors describes management of such rare locally recurring primary bony pathology affecting axis vertebra as it is not only interesting and challenging and different management modalities, various, surgical approaches and issue of renal osteodystrophy along with pertinent literature is also reviewed briefly.

Management of Giant Cell Tumour by Curettage and Bone Cement in Weight Bearing Bone - A Study Done in DMCH &amp; NITOR.

Giant cell tumour of bone (GCT) has been characterized as benign but often locally aggressive neoplasm that commonly occurs in proximity to weight bearing bone. Management of giant cell tumor of bone by curettage and bone cement in weight bearing bone is an effective method. This prospective experimental study was conducted among the patients with histologically proved giant-cell tumour who were admitted in the Department of orthopedic surgery, Dhaka Medical College Hospital (DMCH) and in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) over a period of 18 months from January 2010 to June 2011. A total of 18 consecutive patients with histologically proved giant-cell tumour were included in the study. Majority (55.6%) of patient was in 3rd decade and male female ratio was 1:1.3. More than one fourth (27.8%) of the patients had GCT in the lower end of right femur, 33.3% in lower end of left femur, 22.2% in upper end of right tibia, 16.7% in upper end of left tibia and all patients had painful gait and swelling. According to campanacci grading, Grade-2 was found in all patients, and giant cell tumour was found in all patients, as evaluated by pre-operative biopsy. Cosmetically near normal appearance was found in 88.9% and 88.9% were able to do normal daily work. According to Schatzker and Lambert (1979) criteria excellent outcome was found in 38.9%, good in 44.4%, fair in 11.1% and poor in 5.6%. Surgery in the form of intralesional curettage and filling the cavity with bone cement resulted in excellent relief of pain, cosmetically near normal appearance and patients were able to do normal daily work.Faridpur Med. Coll. J. Jan 2017;12(1): 9-13

Management of giant cell tumor of lower third tibia with curettage and reconstruction by cementation and locking plate: A case report

Introduction: Giant cell tumour of bones is an unusual neoplasm that accounts for 4% of all primary tumours of bone, and it represents about 10% of malignant primary bone tumours with its different grades from borderline to high grade malignancy (1). GCT generally occurs in skeletally mature individuals with its peak incidence in in the third decade of life. Distal femur and proximal tibia are the commonest sites followed by distal radius (2), less than 4% of these tumours are known to affect the ankle joint, but the tumour’s biological behavior at this site is quite unpredictable. Moreover, restoring the ankle joint functionality following tumour resection is a challenging task. Case Summary: 27 year old female presented with pain over right ankle since last two years. Biopsy was suggestive of Giant Cell Tumor of lower third tibia. We managed this case with intralesional curettage using phenol and bone cement as an adjuvant and reconstruction of defect by cementation along with locking plate. Conclusion: In cases of GCT, the management depends upon the various factors such as site, age, involvement of the bone, extent of bone involvement and whether there is articular involvement or not. Extra-articular GCT can be managed with extended intralesional curettage. Bone cement plays a dual role as an adjuvant as well as an agent for reconstruction of the defect.

Denosumab: Current Use in the Treatment of Primary Bone Tumors.

Denosumab, a human monoclonal antibody that inhibits bone resorption by binding on the receptor activator of the nuclear factor kappa-β ligand, has recently emerged as an additional option in the treatment of musculoskeletal osteolytic tumors. This article focuses on the recent literature regarding the effectiveness of denosumab in the management of giant cell tumor, multiple myeloma, aneurysmal bone cyst, and osteosarcoma. The mechanism of action of denosumab in the management of these tumors and the associated side effects are discussed in detail. [ Orthopedics. 2017; 40(4):204-210.].

Management of Campanacci type III giant cell tumor

Objective: Giant cell tumor is an aggressive benign tumor of the bone, involving long bone. They are commonly present around knee joint. There are different treatment options and we assessed the treatment outcomes of various procedures. Methods: This case series was conducted using probability consecutive sampling technique in the Department Orthopedics Surgery, Combined Military Hospital, Lahore from December 2011 to March 2016 in a duration of five years four months. Our sample size was fifteen patients between 32 to 60 years of age with giant cell tumor. We included all patients with giant cell tumors newly diagnose on history, clinical examination, radiographs, magnetic resonance image (MRI) and bone biopsy. We excluded all patient with history of previous surgery, uncontrolled diabetes, chronic liver failure, chronic kidney disease and congestive heart failure. We managed all patients with various treatment option included resection arthrodesis with vascular fibular graft, mega prosthesis, and wide margin excision with bi-focal segment transport with external fixator device. We observed treatment effectiveness, limb length discrepancy, and post treatment complications. Our follow up period was four years. We followed all patients six monthly for one year and subsequently at one year. Results: There were 13 (86.7%) male and two (13.3%) females. Majority seven (46.67%) patients were present between 41 to 50 years of age with their mean±SD (30.66±13.87). Amongst three (20%) patients with involvement of proximal humerus, resection arthrodesis with vascular fibular graft was done, three (20%) patients with distal radius, two (66.66%) had resection arthrodesis with vascular fibular graft and one (33.34%) had mega prosthesis. Two (13.3%) had resection arthrodesis (50%) and mega prosthesis (50%). Majority five (33.3%) had proximal tibia involvement were treated with three (60%) resection arthrodesis and two (40%) with mega prosthesis. Among Two (13.3%) patients who had distal tibia involved were managed with wide margin excision, and bi focal segment transport with external fixator device. Out of the total 15 cases, nine (60%) had lower limb involvement and there was only one (11.11%) leg length discrepancy. Conclusion: We concluded from the study that management of giant cell tumors with mega prosthesis, segment trans port and resection with free fibular graft was equally good, but patient satisfaction was better in patients who had resection with mega prosthesis.

Surgical Management of Giant Cell Tumors in Temporomandibular Joint Region Involving Lateral Skull Base: A Multidisciplinary Approach

Giant cell tumors (GCTs) in the temporomandibular joint (TMJ) region invading the lateral skull base are relatively uncommon. The management of these lesions is still controversial because of their proximity to vital neurovascular structures. Although sporadically reported, the clinical outcomes of such disease after surgery are still largely unknown. We retrospectively reviewed the records of 28 patients with resectable GCTs in the TMJ region involving the lateral skull base treated from 1994 to 2013. A multidisciplinary team, formed by oral and maxillofacial surgeons, neurosurgeons, and otorhinolaryngologists, had surgically treated all these patients by craniomaxillofacial resection. Clinical variables, different treatment modalities, and outcomes are compared. Representative cases also are presented. Our case series consisted of 15 male and 13 female patients with a median age of 41years. The median follow-up duration for our series was 5.4years (range, 0.8-18.5years). The average tumor size measured 8.6cm. Most of the GCTs (n= 19, 67.9%) extended through the skull base bones into the brain parenchyma and other surrounding soft tissues. Titanium meshes for cranioplasty of skull base bones was used in 9 patients (32.1%), whereas temporalis fascia (n= 5, 17.9%) or free flaps (n= 6, 21.4%) were used more frequently for duraplasty. A postoperative cerebrospinal fluid leak was found in only 1 patient. During follow-up, the local control rate reached 85.7%. Thoroughness of tumor resection (hazard ratio, 15.763; 95% confidence interval, 1.630-152.437; P= .017) was found to be associated with recurrence-free survival. Craniomaxillofacial surgery for GCTs in the TMJ region invading the skull base is feasible in selected patients. A meticulous plan via a multidisciplinary approach is mandatory for the success of such treatment.

Radiotherapy in the Management of Giant Cell Tumor of Bone

To evaluate the long-term treatment outcomes for patients with giant cell tumor of bone (GCTB) treated with radiotherapy with or without surgical resection. This retrospective review includes 34 patients with GCTB treated with megavoltage radiotherapy between January 1973 and January 2008 at the University of Florida. Patients' ages ranged from 16 to 85 years (median, 29). Tumor sizes ranges from 2.5 to 12 cm (median, 4.8 cm) in the maximum dimension. Twenty-one patients received radiation for gross disease, either de novo (22 patients) or recurrent (12 patients). Thirteen patients were treated with postoperative radiation after gross total resection. The median dose was 45 Gy in both the definitive and adjuvant settings. The median follow-up was 16.8 years. The 5- and 10-year local-control (LC) rates were 85% and 81%, respectively. Six patients developed an isolated local recurrence (2/13 treated postoperatively and 4/21 who were treated for gross disease). All 6 patients who developed a local recurrence were successfully salvaged with surgery; therefore, the ultimate LC rate was 100%. Both the 5- and 10-year freedom from distant metastasis rates were 91%. Three patients developed lung metastases, including 1 patient who experienced GCTB transformation into a high-grade sarcoma. The 5- and 10-year progression-free survival rates were both 78%. Moderate-dose radiotherapy for GCTB provides a long-term LC >80%, justifying its role as an alternative to morbid surgery.

A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR. A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR. One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC. Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

Introduction: Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR.Methods: A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR.Results: One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC.Conclusions: Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

Pre-operative Selective Arterial Embolization as a Neoadjuvant Therapy for Proximal Humerus Giant Cell Tumor of Bone: Radiological and Histological Evaluation

The management of giant cell tumor of the proximal humerus that extends to the joint is challenging. Here, we report a case of proximal humerus giant cell tumor with cortical bone destruction extending to the shoulder joint. Pre-operative selective arterial embolization induced peripheral tumor ossification. Subsequently, the lesion was removed by intralesional curettage, and the cavity was filled with cement. Macroscopically, the inner wall of the cavity was found to be lined with a thick fibrous membrane. Histologically, massive fibrosis and resultant remodeling of the destroyed cortical bone were induced, which was consistent with the peripheral ossification on the plain radiograph. We believe that selective arterial embolization can be an effective neoadjuvant therapy for giant cell tumors of the extremities, especially for tumors with large cortical defects or joint involvement.