Giant cell tumor of a rib following denosumab treatment

A rare case of giant cell tumor of the anterior rib presenting as a breast mass

Initial diagnostic ultrasound of a 22-year-old female patient presenting with a palpable breast mass revealed a suspicious mass initially thought to arise from the breast. However, follow-up diagnostic mammography was normal without evidence of the 5 cm mass seen on ultrasound, and pathology results from ultrasound-guided core needle biopsy raised suspicion for giant cell tumor, making chest wall origin of the mass more likely. Further CT and MRI imaging indeed revealed a locally invasive mass arising from the anterior fifth rib. The patient was treated with denosumab to decrease tumor burden before surgery, and subsequently underwent successful surgical resection of the tumor with mesh overlay and flap reconstruction of the chest wall defect. This case highlights the importance of keeping chest wall lesions in the differential for lesions presenting clinically as breast lesions. Despite the rarity of giant cell tumor of the anterior rib and its unusual presentation as a breast mass, appropriate diagnostic imaging work-up allowed for successful diagnosis and treatment in this case.

Giant cell tumor in queer location with lung metastasis!

Giant cell tumor (GCT) of bone accounts for ∼ 5 % of primary bone tumors, however involvement of rib is uncommon. We here discuss a rare case of giant cell tumor of anterior arc of rib mimicking malignant breast mass with associated lung metastasis in a 28 year old woman. CECT and MRI revealed large soft tissue mass with epicenter at 3rd rib and erosion of 3rd rib. CECT also revealed lung metastasis. Histopathology confirmed the diagnosis of giant cell tumor.

Giant Cell Tumor of Bone of the First Rib Successfully Treated with Combined Preoperative Denosumab Therapy and Surgery via a Transmanubrial Approach

Patient: Female, 27-year-old

Final Diagnosis: Giant cell tumor of bone

Symptoms: No symptom

Medication:—

Clinical Procedure: —

Specialty: Oncology

Malignant Sarcomatous Transformation of Benign Giant Cell Tumor of Bone after Treatment with Denosumab Therapy: A Literature Review of Reported Cases

Giant cell tumor of bone (GCTB) is a biologically benign and locally aggressive tumor that most often affects the epiphyseal and metaphyseal sites of long bones in the young adult population. Overexpression of receptor activator of nuclear factor kappa B ligand (RANKL) by cancerous mesenchymal stromal cells stimulates a signal transduction cascade that recruits and activates multinucleated osteoclast-like giant cells, resulting in pathologic bone resorption. Denosumab, an RANKL inhibitor that blocks the RANKL-mediated osteoclast activation, has been recently approved by the United States Food and Drug Administration (FDA) for the treatment of aggressive GCTB. Although uncommon, several studies reported drug-related malignant morphological transformation of benign GCTB following treatment with denosumab therapy. The aim of the article was to review the clinicopathological characteristics of all the reported cases of malignant sarcomatous transformation of GCTB after treatment with denosumab therapy in patients without any history of prior exposure to radiotherapy.