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Choi WS, Lee SK, Kim JY, Kim Y. Diffuse-Type Tenosynovial Giant Cell Tumor: What Are the Important Findings on the Initial and Follow-Up MRI? Cancers (Basel) 2024; 16:402. [PMID: 38254890 PMCID: PMC10814250 DOI: 10.3390/cancers16020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT-evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT-extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent-if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients' quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative.
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Affiliation(s)
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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2
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Yadav SK, Kantiwal P, Rajnish RK, Garg A, Aggarwal D. Synchronous multicentric giant cell tumour of immature skeleton with epiphysiometaphyseal origin. BMJ Case Rep 2023; 16:e254216. [PMID: 36805875 PMCID: PMC9943917 DOI: 10.1136/bcr-2022-254216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Giant cell tumour of bone accounts for 5% of all primary bone tumours. Multicentric giant cell tumour is an infrequent variety be it either synchronous or metachronous accounting for less than 1% of all giant cell tumours. Synchronous multicentric giant cell tumour of foot and ankle with epiphysiometaphyseal origin is unheard of. We delineate a case of soap-bubble appearance lytic lesions at left distal tibia and talus in an early adolescent woman with biopsy proven giant cell tumour for its rarity and its successful management by extended curettage and allogenic impaction bone grafting.
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Affiliation(s)
- Sandeep Kumar Yadav
- Orthopedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prabodh Kantiwal
- Orthopedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Ashish Garg
- Orthopedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Divya Aggarwal
- Department of Pathology and LaboratoryMedicine, All India Institute of Medical Sciences, Jodhpur, India
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3
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Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J 2022; 104-B:1352-1361. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0401.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Aims We performed a systematic literature review to define features of patients, treatment, and biological behaviour of multicentric giant cell tumour (GCT) of bone. Methods The search terms used in combination were “multicentric”, “giant cell tumour”, and “bone”. Exclusion criteria were: reports lacking data, with only an abstract; papers not reporting data on multicentric GCT; and papers on multicentric GCT associated with other diseases. Additionally, we report three patients treated under our care. Results A total of 52 papers reporting on 104 patients were included in the analysis, with our addition of three patients. Multicentric GCT affected predominantly young people at a mean age of 22 years (10 to 62), manifesting commonly as metachronous tumours. The mean interval between the first and subsequent lesions was seven years (six months to 27 years). Synchronous lesions were observed in one-third of the patients. Surgery was curettage in 63% of cases (163 lesions); resections or amputation were less frequent. Systemic treatments were used in 10% (n = 14) of patients. Local recurrence and distant metastases were common. Conclusion Multicentric GCT is rare, biologically aggressive, and its course is unpredictable. Patients with GCT should be followed indefinitely, and referred promptly if new symptoms, particularly pain, emerge. Denosumab can have an important role in the treatment. Cite this article: Bone Joint J 2022;104-B(12):1352–1361.
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Affiliation(s)
- Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Wadia F, Chaudhary K, Anchan C, George S, Dhawale A. Metachronous multicentric giant cell tumour of bone in a 12-year-old girl: A case report and review of literature. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211021102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While giant cell tumour of bone is a relatively common tumour in adults, it is exceedingly rare in children. Multicentric metachronous giant cell tumour is an even rarer presentation of this tumour in skeletally immature patients. We present here the challenges in management of this rare tumour. A 12-year-old girl presented with a giant cell tumour affecting four different bones sequentially, three times within a 3-year period. The disease first appeared in the right distal fibula, then a year later in ipsilateral talus and calcaneus and finally a year later, in the T5 vertebral body, all requiring surgical treatment. Our strategy was to manage this lesion aggressively based on the limited literature available and present our own long-term surveillance strategy. Our patient responded well to treatment each time and has remained disease-free for 24 months from her last surgery. This is a rare case of metachronous multicentric giant cell tumour of bone in a skeletally immature patient requiring aggressive treatment and surveillance.
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Affiliation(s)
- Farokh Wadia
- Department of Orthopaedics & Spine, Sir HN Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Kshitij Chaudhary
- Department of Orthopaedics & Spine, Sir HN Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Chetan Anchan
- Department of Orthopaedics & Spine, Sir HN Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Seena George
- Department of Histopathology and Laboratory Medicine, Sir HN Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Arjun Dhawale
- Department of Orthopaedics & Spine, Sir HN Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India
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Engellau J, Seeger L, Grimer R, Henshaw R, Gelderblom H, Choy E, Chawla S, Reichardt P, O'Neal M, Feng A, Jacobs I, Roberts ZJ, Braun A, Bach BA. Assessment of denosumab treatment effects and imaging response in patients with giant cell tumor of bone. World J Surg Oncol 2018; 16:191. [PMID: 30231890 PMCID: PMC6146657 DOI: 10.1186/s12957-018-1478-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/21/2018] [Indexed: 01/19/2023] Open
Abstract
Background Denosumab has been shown to reduce tumor size and progression, reform mineralized bone, and increase intralesional bone density in patients with giant cell tumor of bone (GCTB); however, radiologic assessment of tumors in bone is challenging. The study objective was to assess tumor response to denosumab using three different imaging parameters in a prespecified analysis in patients with GCTB from two phase 2 studies. Methods The studies enrolled adults and adolescents (skeletally mature and at least 12 years of age) with radiographically measurable GCTB that were given denosumab 120 mg every 4 weeks, with additional doses on days 8 and 15 of cycle 1. The proportion of patients with an objective tumor response was assessed using either Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST), European Organisation for Research and Treatment of Cancer response criteria (positron emission tomography [PET] scan criteria), or inverse Choi density/size (ICDS) criteria. Target lesions were measured by computed tomography or magnetic resonance imaging (both studies), PET (study 2 only), or plain film radiograph (study 2 only). Results Most patients (71.6%) had an objective tumor response by at least one response criteria. Per RECIST, 25.1% of patients had a response; per PET scan criteria, 96.2% had a response; per ICDS, 76.1% had a response. 68.5% had an objective tumor response ≥ 24 weeks. Using any criteria, crude incidence of response ranged from 56% (vertebrae/skull) to 91% (lung/soft tissue), and 98.2% had tumor control ≥ 24 weeks. Reduced PET avidity appeared to be an early sign of response to denosumab treatment. Conclusion Modified PET scan criteria and ICDS criteria indicate that most patients show responses and higher benefit rates than modified RECIST, and therefore may be useful for early assessment of response to denosumab. Trial registration ClinicalTrials.gov Clinical Trials Registry NCT00396279 (retrospectively registered November 6, 2006) and NCT00680992 (retrospectively registered May 20, 2008). Electronic supplementary material The online version of this article (10.1186/s12957-018-1478-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacob Engellau
- Department of Oncology, Lund University Hospital, SE-221 85, Lund, Sweden.
| | | | | | - Robert Henshaw
- MedStar Georgetown Orthopedic Institute, Washington, DC, USA
| | | | - Edwin Choy
- Massachusetts General Hospital, Boston, MA, USA
| | - Sant Chawla
- Sarcoma Oncology Center, Santa Monica, CA, USA
| | | | - Michael O'Neal
- CoreLab Partners (now known as Bioclinica), Princeton, NJ, USA
| | - Amy Feng
- Amgen Inc., Thousand Oaks, CA, USA.,Atara Biotherapeutics, Inc, San Francisco, CA, USA
| | - Ira Jacobs
- Amgen Inc., Thousand Oaks, CA, USA.,Pfizer Inc., New York, NY, USA
| | - Zachary J Roberts
- Amgen Inc., Thousand Oaks, CA, USA.,Kite Pharma, Inc., Santa Monica, CA, USA
| | - Ada Braun
- Amgen Inc., Thousand Oaks, CA, USA.,Pharmacyclics, Sunnyvale, CA, USA
| | - Bruce A Bach
- Amgen Inc., Thousand Oaks, CA, USA.,AbbVie, Redwood City, CA, USA
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Kito M, Matsumoto S, Ae K, Tanizawa T, Gokita T, Hayakawa K, Funauchi Y, Takazawa Y. Multicentric giant cell tumor of bone: Case series of 4 patients. J Orthop Sci 2017; 22:1107-1111. [PMID: 28869118 DOI: 10.1016/j.jos.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/21/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to retrospectively investigate patients with multicentric giant cell tumor (MCGCT) who were treated at our hospital and to clarify their clinical features, treatment policy, and follow-up method. METHODS Four patients with two or more giant cell tumor (GCT) that occurred in the same patient were treated at our institution between 1978 and 2015. These patients were evaluated for the following: frequency, age of onset, number and site of occurrence, time to occurrence of the next lesion, treatment, recurrence, malignant transformation, metastasis, and oncological outcome. RESULTS The rate of occurrence was 1.7%. The average age was 25.2 (17-44). The total number of lesions was three in two cases and two in two cases. All four cases had only one lesion during the initial visit. The most frequent site of occurrence was the proximal femur, followed by two lesions that occurred in the metaphysis. The interval between confirmation of the initial lesion and occurrence of the second lesion was in average 12.1 years (0.8-27.0). Initial presentations of lesions were treated by en bloc resection in one case and curettage in three cases. Local recurrences occurred in two cases that underwent curettage. The six lesions that occurred after the initial lesion were treated as follows: en bloc resection in four lesions, curettage and radiation therapy in one, and embolization and radiation therapy in one. Pathologically, no lesions presented malignancy. Pulmonary metastasis occurred in one case. The oncological outcome was NED in three cases and AWD in one case. CONCLUSIONS No lesions were malignant, and by providing the same treatment as solitary GCT, the oncological outcome was good. It is unnecessary to be concerned of its risks and postoperatively conduct long-term searches for focal lesions across the body.
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Affiliation(s)
- Munehisa Kito
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Seiichi Matsumoto
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keisuke Ae
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Taisuke Tanizawa
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tabu Gokita
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keiko Hayakawa
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yuki Funauchi
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yutaka Takazawa
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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7
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Eajazi A, Kheterpal A, Kattapuram S, Nielsen GP, Rosenthal DI. Multiple giant cell tumors of bone arising from multiple fatty tumors. Skeletal Radiol 2017; 46:117-121. [PMID: 27771752 DOI: 10.1007/s00256-016-2498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 02/02/2023]
Abstract
We describe a patient with a history of giant cell tumor who over the course of 18 years developed multiple fat containing osseous lesions in the pelvis and spine. Two of these lesions subsequently evolved into biopsy proven giant cell tumor of bone. To our knowledge, this phenomenon of giant cell tumors evolving from fat containing lesions has not been described.
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Affiliation(s)
- Alireza Eajazi
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Arvin Kheterpal
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Susan Kattapuram
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Gunnlaugur Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Warren 2, 55 Fruit Street, Boston, MA, USA
| | - Daniel Ira Rosenthal
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
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8
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Liu C, Tang Y, Li M, Jiao Q, Zhang H, Yang Q, Yao W. Clinical characteristics and prognoses of six patients with multicentric giant cell tumor of the bone. Oncotarget 2016; 7:83795-83805. [PMID: 27823978 PMCID: PMC5347806 DOI: 10.18632/oncotarget.13057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/26/2016] [Indexed: 12/31/2022] Open
Abstract
Multicentric giant cell tumor of the bone (MGCT) is a rare entity whose radiographic, pathological and biological features remain confusing. We retrospectively reviewed six patients (1 male, 5 female; average age, 22.33 years) treated for confirmed MGCT between 2001 and 2015. The patients' clinical information, images from radiographs (n = 14), CT (n = 13), MRI (n = 8), bone scintigraphy (n = 1) and PET-CT (n = 2), as well as histologic features, treatment and prognosis were analyzed. A total of 17 lesions were detected: 4 around the knee joint, 3 in the greater trochanter and head of the femur, 5 in the small bones of the feet, and 2 in flat bones. All these lesions occurred in an ipsilateral extremity. One patient had Paget's disease. On radiographs and CT, 12 lesions exhibited sclerotic margins or patchy sclerosis, 8 showed cortical discontinuity, and 5 showed soft tissue masses. On histopathology, 8 lesions showed signs of sarcomatous transformation and one had transformed into osteosarcoma. Ten lesions in 4 patients were initially treated with surgery, and 3 showed local recurrence. Seven lesions in 3 patients were treated with denosumab. All the patients are currently stable without metastasis. These results suggest MGCT tends to occur in uncommon sites with sclerosis. Because these lesions can be aggressive, patients should be carefully monitored for the recurrence or formation of other lesions, especially in an ipsilateral extremity.
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Affiliation(s)
- Chenglei Liu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yawen Tang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Mei Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qingcheng Yang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiwu Yao
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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9
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Multifocal metachronous giant cell tumor: case report and review of the literature. Case Rep Med 2014; 2014:678035. [PMID: 24511316 PMCID: PMC3912820 DOI: 10.1155/2014/678035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/13/2013] [Accepted: 12/05/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Giant cell tumors (GCTs) of bone are known for their local aggressiveness and high recurrence rate. There are rare cases of multicentric GCT and most are synchronous. We herein review metachronous multicentric GCT reported in the literature. Material and Methods. A MEDLINE, Cochrane, and Google Scholar search was done to collect all cases of multicentric metachronous GCT specifying the clinical, radiological, and histological characteristics of each location and its treatment. Results. A total of 37 multifocal giant cell tumors were found in the literature. 68% of cases of multicentric giant cell tumors occur in less than 4 years following treatment of the first lesion. Thirty-seven cases of multifocal metachronous GCT were identified in the literature until 2012. Patients with multicentric GCT tend to be younger averaging 23. There is a slight female predominance in metachronous GCT. The most common site of the primary GCT is around the knee followed by wrist and hand and feet. Recurrence rate of multicentric GCT is 28.5%. Conclusion. Multicentric giant cell tumor is rare. The correct diagnosis relies on correlation of clinical and radiographic findings with confirmation of the diagnosis by histopathologic examination.
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10
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Multicentric giant cell tumor of bone: synchronous and metachronous presentation. Case Rep Orthop 2013; 2013:756723. [PMID: 24106628 PMCID: PMC3784266 DOI: 10.1155/2013/756723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/12/2013] [Indexed: 11/18/2022] Open
Abstract
A 27-year-old man treated 2.5 years ago for synchronous multicentric giant cell tumor of bone located at the right proximal humerus and the right 5th finger presented now with complaints of pain in his right hip and wrist of two-month duration. Radiology and magnetic resonance revealed multicentric giant cell tumor lesions of the right proximal femur, the left ileum, the right distal radius, and the left distal tibia. The patient has an eighteen-year history of a healed osteosarcoma of the right tibia that was treated with chemotherapy, resection, and allograft reconstruction. A literature review establishes this as the first reported case of a patient with synchronous and metachronous multicentric giant cell tumor who also has a history of osteosarcoma.
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11
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Abstract
The presentation of multicentric giant cell tumor in adolescents with an open physis is very rare. We report three cases of a multicentric giant cell tumor of the bone in adolescents, and a review of the literature is also presented.
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12
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Hamdi M, Khezami M, Kchelfi S. [Multicentric giant cell tumor in the upper extremity]. ACTA ACUST UNITED AC 2012; 31:101-5. [PMID: 22521924 DOI: 10.1016/j.main.2011.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 09/23/2011] [Accepted: 11/26/2011] [Indexed: 11/24/2022]
Abstract
Multicentric giant cell tumors of bone are rare; they represent less than 1% of all giant cell tumors. We report the case of a 24-year-old right-handed man, who presented in 1985 with a giant cell tumor of the upper end of the right humerus. After failure of conservative treatment (curettage and bone grafting), resection-arthrodesis of the shoulder with a free vascularised fibular autograft was performed. Three years later, the patient developed an osteolytic lesion of the lower end of the ipsilateral radius, involving the soft tissues and the wrist joint. He was treated with resection-arthrodesis of the wrist with a free vascularised fibular graft. View after 24 years for a new localization of the lower extremity of the humerus, which treated by curettage and bone grafting with a favorable postoperative (follow-up). The histologic study confirmed again the same diagnosis. After review of the literature, we report the uniqueness of this case report.
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Affiliation(s)
- M Hamdi
- Service d'Orthopédie-Traumatologie, Hôpital Militaire Principal d'Instruction de Tunis, 1008 Montfleury, Tunis, Tunisie.
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13
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Varshney A, Rao H, Sadh R. Multicentric GCT of tarsal bones in an immature skeleton: a case report with review of literature. J Foot Ankle Surg 2010; 49:399.e1-4. [PMID: 20554225 DOI: 10.1053/j.jfas.2010.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Indexed: 02/03/2023]
Abstract
Multicentric giant cell tumor of the foot is rare. Multicentric giant cell tumor of the tarsal bones in an immature skeleton is unheard of. We report a case of synchronous multicentric giant cell tumor involving the talus and calcaneum in a 14-year-old boy with open epiphyseal plate for its rarity and successful treatment by curettage and synthetic bone graft.
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Affiliation(s)
- Atul Varshney
- Department of Orthopaedics, Peoples College of Medical Sciences, Bhopal, India
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14
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Blanc-Lonjon J, Fabre S, Schmidt-Peynet C, Defasque A, Jorgensen C, Cyteval C. [Multifocal giant cell tumor of bone: a care report]. ACTA ACUST UNITED AC 2010; 91:72-4. [PMID: 20212381 DOI: 10.1016/s0221-0363(10)70010-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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15
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Rousseau MA, Ilharreborde B, Larousserie F, Babinet A, Tomeno B, Anract P. [Multicentric giant-cell tumor]. ACTA ACUST UNITED AC 2008; 93:848-53. [PMID: 18166958 DOI: 10.1016/s0035-1040(07)78469-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nearly all (99) giant-cell tumors are solitary. The multicentric presentation is exceptional and not well elucidated. We report the case of a patient presenting five foci identified over an eleven-year period (right tibia, left 4th metacarpal, sacrum, right femur, left femur). The proliferation index was identified for each focus. A review of the literature shows that the development of a new center after treatment for giant-cell tumor is a well-known event, with a wide variability in localizations, number and time to development. The most recent data suggest that each center would be independent progressing according to an individual course. Since histological transformation is not observed and multicenter forms are very exceptional, we suggest that it would not be necessary to propose specific screening for patients with a giant-cell tumor but that it would be good to inform the patient of the possibility of multicentric presentations.
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Affiliation(s)
- M-A Rousseau
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris.
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Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008; 134:969-78. [PMID: 18322700 DOI: 10.1007/s00432-008-0370-x] [Citation(s) in RCA: 267] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 02/15/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study. PATIENTS AND METHODS The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage (188 patients) usually followed by adjuvant local therapy. The effects of bone cement (PMMA), burring and hydrogen peroxide (H(2)O(2)) were statistically analyzed and the influence of a subchondral bone graft on the recurrence rate was evaluated. RESULTS PMMA alone (n = 52) reduces the likelihood of recurrence by the factor 8.2, additional high-speed burring (n = 39) by the factor 3.9 (compared to PMMA only). H(2)O(2) (n = 42) seems to have an additional effect comparable to that of phenol although it did not reach statistical significance. CONCLUSION The combination of all adjuncts (PMMA, burring, H(2)O(2) - n = 42) reduces the likelihood of recurrence by the factor 28.2 compared to curettage only and therefore should be recommended as a standard treatment. If the tumor reaches close to the articulating surface a subchondral bone graft (n = 42) can be performed without risking a higher recurrence rate. We add seven cases of pulmonary metastases and two cases of multicentricity to the literature. Bisphosphonates and interferon alpha may have a beneficial effect.
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Affiliation(s)
- Maurice Balke
- Department of Orthopedic Surgery, University of Muenster, Muenster, Germany.
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Chang CC, Chang ST, Chang HY, Lin GM, Lai MH, Chiang SL. Multicentric giant cell tumours in an adolescent with haemophilia. Haemophilia 2007; 13:199-201. [PMID: 17286774 DOI: 10.1111/j.1365-2516.2006.01423.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
''Multicentric giant cell tumour (GCTs) of the extremity is prone to be distributed over the age range of 20-40 years, but is rare in haemophilia and in the age before 20. We report a case of a 15-year-old haemophilia boy who presented initially with two radiolucent loci in the right femur and tibia revealed from the X-ray films and then another lesion in the posterior femoral shaft shown from MRI by one year. Differential diagnosis of GCTs should be appraised in various aspects. Radiological diagnostic pitfall was avoided by the pathology disclosed GCTs without malignancy. The early diagnosis of GCTs in haemophilia may be delayed unless appearance of symptoms of pathologic fracture. Coincident multicentric GCTs do occur in haemophilic patients and their incidence might be underestimated, as it might not be judged because immediate symptoms of pain would resolve with appropriate factor replacement."
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Affiliation(s)
- C-C Chang
- Department of Physical Medicine and Rehabilitation, Haemophilia Care and Research Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Dhillon MS, Prabhudev Prasad AP, Virk MS, Aggarwal S. Multicentric giant cell tumor involving the same foot: A case report and review of literature. Indian J Orthop 2007; 41:154-7. [PMID: 21139770 PMCID: PMC2989141 DOI: 10.4103/0019-5413.32049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Multicentric giant cell tumour (GCT) is extremely rare; no case has been previously reported where two lesions occurred in the same foot at different sites. We report a case involving the calcaneus and subsequently the 3(rd) toe of the same foot and review the reported literature. In established cases of multicentricity, the histopathology has to be properly reviewed and the patient has to be followed up for a longer time with serial whole body assessment to pick up any subsquent lesions. The treatment of the local disease does not differ from a standard GCT.
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Affiliation(s)
- Mandeep S Dhillon
- Department of Orthopedics, PGIMER, Chandigarh, India,Correspondence: Dr. M. S. Dhillon, 1090/2, Sector 39 - B, Chandigarh, India. E-mail:
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Kotru M, Singh N. The value of recognizing suspect diagnoses in the triple diagnosis of giant cell tumor of bone. Indian J Orthop 2007; 41:97-100. [PMID: 21139759 PMCID: PMC2989148 DOI: 10.4103/0019-5413.32038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Giant cell tumor (GCT) of bone is the most frequently over-diagnosed neoplasm in orthopedic pathology because giant cells are a common component of many neoplastic and nonneoplastic conditions of bone. Triple diagnosis, requiring substantial individual and collective inputs by orthopedic surgeons, radiologists and pathologists, is the preferred method for the workup of patients with suspected bone neoplasms. At each stage in triple diagnosis, deviations from the typical must be regarded as clues to alternate diagnoses: the greater the deviation, the more a diagnosis of GCT must be considered suspect. A suspect diagnosis must trigger renewed analysis of the available data and a diligent search to exclude alternate diagnoses.This review lists suspect diagnoses of GCT with a brief overview of each.
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Affiliation(s)
- Mrinalini Kotru
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India
| | - Navjeevan Singh
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India,Correspondence: Dr. Navjeevan Singh, Professor of Pathology University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India. E-mail:
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Meyer A, Bastian L, Bruns F. Benign giant cell tumor of the spine: an unusual indication for radiotherapy. Arch Orthop Trauma Surg 2006; 126:517-21. [PMID: 16810546 DOI: 10.1007/s00402-006-0174-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Giant cell tumors are rare primary bone tumors. Multicentricity as well as spinal localization is extremely rare. CASE REPORT We report about a 64-year-old female patient presenting with history of three osseous and one pulmonal manifestation of a benign giant cell tumor that have manifested metachronously within 23 years. The two periphery bone and the one pulmonal manifestation were treated surgically with success. Now, a further osseous lesion occurred at the seventh vertebra of the thoracic spine and was treated by dorsal instrumentation and replacement of the seventh vertebra. Nine months later, local recurrence of this benign giant cell tumor developed at the thoracic spine and was treated with radiotherapy with a total dose of 45 Gy. Three months after salvage radiotherapy definite local progress occurred localized within the former radiation treatment field. Due to neurological deficits a laminectomy and a stabilization of the destroyed sixth vertebra with bone cement was carried out. Histopathological examination again showed benign giant cell tumor without suspicion of malignancy. CONCLUSION In the literature the use of radiation therapy remains an appropriate therapy option in benign giant cell tumors with minimal adverse sequelae if primary surgical treatment is not feasible or fails. In cases of definitive radiotherapy a total dose > 45 Gy should be discussed.
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Affiliation(s)
- A Meyer
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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21
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James SLJ, Davies AM. Giant-cell tumours of bone of the hand and wrist: a review of imaging findings and differential diagnoses. Eur Radiol 2005; 15:1855-66. [PMID: 15868123 DOI: 10.1007/s00330-005-2762-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 03/15/2005] [Accepted: 03/29/2005] [Indexed: 10/25/2022]
Abstract
Giant-cell tumour of bone (GCTOB) is a benign, locally aggressive, primary bone tumour. Involvement of the distal radius accounts for between 10 and 12% of cases of GCTOB, with the bones of the hand and wrist being rarely affected. GCTOB most commonly affects skeletally mature patients between the ages of 20 and 40 years, with the peak incidence being in the third decade. Women are affected slightly more commonly than men. GCTOB involving the bones of the hand most commonly occurs in a central location, which differs from the usual eccentric location seen in GCTOB at other sites. The radiographic features of GCTOB in the hand and wrist are presented. The role of bone scintigraphy, computed tomography and magnetic resonance imaging is discussed. Evaluation of the postoperative patient is also addressed, including the role of dynamic contrast-enhanced magnetic resonance imaging. A comprehensive review of the potential differential diagnoses that should be considered when GCTOB is suspected in the hand and wrist is also presented.
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Affiliation(s)
- S L J James
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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Cağlar K, Büyük S, Caygür A, Tuğcu S, Ulutekin E. Synchronous multicentric giant cell tumor in a 16-year-old boy. Pediatr Hematol Oncol 2005; 22:175-80. [PMID: 15805004 DOI: 10.1080/08880010590907339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Synchronous multicentric giant cell tumor of the bone is a rare variant of a lesion appearing during childhood. The authors report clinical, radiological, and pathological features of a 16-year-old boy who was diagnosed with synchronous multicentric giant cell tumor, which originated in the right distal femur and the left fibula.
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Affiliation(s)
- Kudret Cağlar
- Pediatric Oncology Unit, Department of Pediatrics, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, North Cyprus, Mersin, Turkey.
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Rousseau MA, Handra-Luca A, Lazennec JY, Catonné Y, Saillant G. Metachronous multicentric giant-cell tumor of the bone in the lower limb. Case report and Ki-67 immunohistochemistry study. Virchows Arch 2004; 445:79-82. [PMID: 15278449 DOI: 10.1007/s00428-004-1011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 03/03/2004] [Indexed: 10/26/2022]
Abstract
Multicentric giant-cell tumors of the bone (GCTs) are rare. Little is known about the mechanisms by which these tumors spread and how 1% of GCT turn out to be multicentric. We report the case of a 19-year-old woman with metachronous multiple and recurrent GCTs that were unusual in their pattern of progression along the right lower limb over a 23-year period. Histology showed no evidence of malignant transformation. The treatment was repeated curettage and packing with cement. This did not permit a wide surgical margin, but avoided amputation and preserved full limb function. We tested the proliferation index marker Ki-67 in the tumor specimens. Ki-67 expression was limited to the mononuclear cell component of the tumors. The proliferation index was similar in each new tumor and higher in recurrences for each location. In this case, proliferation was initially low in the new tumor location, despite the time difference and independent from the initial clone evolution. Proliferation index increased in recurrent GCTs after marginal margin resection.
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Affiliation(s)
- Marc-Antoine Rousseau
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital La Pitié Salpêtrière, Université de Paris VI, 47 bd de l'Hôpital, 75013, Paris, France
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Abstract
Metachronous multicentric giant cell tumors of bone are rare. The case of a 47-year-old woman who had a giant cell tumor of the ilium develop 24 years after resection of a giant cell tumor of the proximal tibia is reported. The initial and current surgical approaches for this patient are described. A literature review is presented to show that this patient had the longest disease-free interval documented for a patient with metachronous multicentric giant cell tumors.
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Taylor KF, Yingsakmongkol W, Conard KA, Stanton RP. Multicentric giant cell tumor of bone: a case report and review of the literature. Clin Orthop Relat Res 2003:267-73. [PMID: 12771839 DOI: 10.1097/01.blo.0000063784.32430.b0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Multicentric giant cell tumor of bone is the rare variant of a lesion that is relatively common in a skeletally mature population. An otherwise healthy 13-year-old boy presenting with this entity was followed up for 6 years. During this period, the patient was diagnosed with and treated for six individual lesions. One recurrence required resection, Ilizarov bone lengthening, and subsequent ankle arthrodesis. He remains fully active and free of distant metastasis.
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Villanueva García E, Díez Risueño M. Tumor de células gigantes localizado en la falange proximal del pulgar. Caso clínico y revisión bibliográfica. Rev Esp Cir Ortop Traumatol (Engl Ed) 2003. [DOI: 10.1016/s1888-4415(03)76086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics 2001; 21:1283-309. [PMID: 11553835 DOI: 10.1148/radiographics.21.5.g01se251283] [Citation(s) in RCA: 280] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The radiologic features of giant cell tumor (GCT) and giant cell reparative granuloma (GCRG) of bone often strongly suggest the diagnosis and reflect their pathologic appearance. At radiography, GCT often demonstrates a metaepiphyseal location with extension to subchondral bone. GCRG has a similar appearance but most commonly affects the mandible, maxilla, hands, or feet. Computed tomography and magnetic resonance (MR) imaging are helpful in staging lesions, particularly in delineating soft-tissue extension. Cystic (secondary aneurysmal bone cyst) components are reported in 14% of GCTs. However, biopsy must be directed at the solid regions, which harbor diagnostic tissue. These solid components demonstrate low to intermediate signal intensity at T2-weighted MR imaging, a feature that can be helpful in diagnosis. Multiple GCTs, although rare, do occur and may be associated with Paget disease. Malignant GCT accounts for 5%-10% of all GCTs and is usually secondary to previous irradiation of benign GCT. Treatment of GCT usually consists of surgical resection. Recurrence is seen in 2%-25% of cases, and imaging is vital for early detection. Recognition of the spectrum of radiologic appearances of GCT and GCRG is important in allowing prospective diagnosis, guiding therapy, and facilitating early detection of recurrence.
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Affiliation(s)
- M D Murphey
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Rm M-133A, Washington, DC 20306, USA.
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Sanghvi V, Lala M, Desai S, Chaturvedi P, Rodrigues G. Synchronous multicentric giant cell tumour: a case report with review of literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1999; 25:636-7. [PMID: 10556015 DOI: 10.1053/ejso.1999.0723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synchronous multicentric giant cell tumour (MGCT) is a rare occurrence. We report a young woman who presented with a synchronous skull and lower shaft femur giant cell tumour, who had previously received radiotherapy to both the sites, it being deemed inoperable at initial assessment.
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Affiliation(s)
- V Sanghvi
- Head & Neck Service "C", Department of Surgical Oncology, Mumbai, India.
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Affiliation(s)
- Y K Park
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, Korea.
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Abstract
STUDY DESIGN This is a case report of a patient with two giant cell tumors, the first in thoracic spine and the second, two years later, in the sacrum. OBJECTIVES To report the first patient in whom multifocal primary giant cell tumors have been found in the spine. SUMMARY OF BACKGROUND DATA There have been no similar previous reports. METHODS The diagnoses were made by biopsy. RESULTS Curative removal of both tumors was achieved. CONCLUSIONS More than one primary giant cell tumor in the spine can develop.
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Affiliation(s)
- C B Kos
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Tan BS, Doust BD, Mansberg VJ. Multicentric giant cell tumour and phaeochromocytoma. AUSTRALASIAN RADIOLOGY 1996; 40:360-3. [PMID: 8826754 DOI: 10.1111/j.1440-1673.1996.tb00422.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- B S Tan
- Department of Radiology, St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia
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