Successful Treatment with Denosumab of a Giant Cell Tumor of Bone in the Iliac Bone of an 84-Year-Old Man

Diaphyseal giant cell tumour of mid-shaft tibia

SummaryGiant cell tumours of bone are benign and locally aggressive tumours that usually occur in young adults and at the epiphysial locations after physeal closure. Occurrence outside of epiphysial locations and appearance in geriatric patients is rare. We report a case of a woman in her late 60s with a giant cell tumour of the mid-shaft of the right tibia. Extended curettage and biological reconstruction were performed with autologous double-barrel fibular struts and tri-cortical iliac crest bone grafting. At the 28-month follow-up examination, we noted full bony union at both ends with successful consolidation of the fibular struts, and importantly, no evidence of recurrence or other complications was observed.

Diagnosis of bone giant cell tumor in elderly patient: A case report of an unusual case

Background

Giant cell tumor (GCT) of the bone in elderly patients is a very rare bone tumor.

Case presentation

Radiography of the left antebrachial revealed a lytic lesion, septated, having a soap bubble appearance in the distal epi-meta-diaphysis of the left radius, narrow transitional zone, type-IB geographic destruction, with cortical thinning, no periosteal reaction, no calcified matrix, with soft tissue involvement. MRI examination of the left antebrachial showed a lesion with partially ill-defined margins, irregular margins, in the left distal epi-meta-diaphysis, accompanied by soft tissue protrusion, which was hypointense on T1WI, iso to hyperintense on T2WI/FAT SAT which partially formed fluids level, the area of diffusion was limited on DWI. After the administration of contrast administration, improvement appeared, the lesion appeared to extend to the articular surface of the left radius bone. Histopathological examination showed the distribution and clusters of mononuclear cells, round oval nuclei, fine chromatin, the distribution of multinucleated giant cells with >10 nuclei similar to mononuclear cell nuclei. These findings were keys as giant bone tumor cells.

Discussion

A specific examination of the GTC in the elderly needs to be carried out to minimize misdiagnosis.

Conclusion

Giant cell tumor is also possible be found in elderly patients. Diagnosis is based on clinical findings, radiological examination, and confirmed by histopathology.

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Giant Cell Tumor (GCT) in the elderly is sporadic.

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Aspect radiology is very accommodating in diagnosing GCT in the elderly.

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The diagnosis of GCT in the elderly needs to be confirmed between radiological and histopathological findings.

Denosumab in Giant Cell Tumor of Bone: Multidisciplinary Medical Management Based on Pathophysiological Mechanisms and Real-World Evidence

Simple Summary

The widely accepted local therapy in extremity giant cell tumor of bone (GCTB) is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. Most GCTB patients with localized disease can be successfully treated with surgical curettage; patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice.

Abstract

(1) Despite the benign nature of the giant cell tumor of bone (GCTB), it shows a local recurrence rate of up to 50% and a chance of malignant transformation. The widely accepted local therapy in extremity GCTB is surgery, in the form of extended intralesional curettage with adequate disease clearance and retention of the limb, wherever possible. Denosumab, a human monoclonal antibody directed against the RANKL and associated inhibition of the RANKL pathway, is a relevant therapy option for advanced GCTB, to benefit tumor response and surgical down-staging. (2) The literature review of patients with GCTB treated with denosumab is performed via PubMed, using suitable keywords from January 2009 to January 2021. (3) Current indications for denosumab use are not definitively clear and unambiguous. Most GCTB patients with localized disease can be successfully treated with surgical curettage, and the role of denosumab in preoperative therapy in this patient population remains unclear. (4) However, patients with primary unresectable lesions or metastases may experience long-term clinical and radiological remission and pain control with denosumab treatment, and in this clinical situation, denosumab is currently the treatment of choice.