Recurrence of giant cell tumor of bone: the role of MRI in diagnosis

Huge Osteoclastoma of Hyoid Bone: A Case Report

Giant cell tumors (GCT) of hyoid bone are very rare, and only few individual cases were reported in literature. We present such a case of GCT arising from left cornu of hyoid bone. The patient underwent trans-cervical complete excision of the tumour. Postoperatively, patient did well without recurrence or metastasis for 2 years follow up.

Tartrate-Resistant Acid Phosphatase 5b is a Useful Serum Marker for Diagnosis and Recurrence Detection of Giant Cell Tumor of Bone

Serum tartrate-resistant acid phosphatase (TRACP) 5b was investigated for use as a marker for diagnosis of giant cell tumor (GCT) of bone and for detection of its recurrence.

Four patients with GCT of bone who were initially referred to our hospital were classified as a primary group. Three patients who had local recurrence following curettage were classified as a local recurrence group. Five with no recurrence were classified as a no-recurrence group. Eighteen patients with primary and metastatic malignant bone tumors were also enrolled in the study as a control group. Serum TRACP 5b was measured before the biopsy in all patients and was measured periodically after the operation in patients with GCT of bone. Student t-tests were used for statistical analyses.

TRACP 5b was greater than 1500 Um/dL in all primary group patients. Mean TRACP 5b values decreased gradually with post-operative time, showing lower values until local recurrence. The mean value of TRACP 5b of the local recurrence group (753 ± 68.7 mU/dL) was significantly higher than that of the no-recurrence group (340.6 ± 78.3 mU/dL). The mean value of TRACP 5b of the control group (466.9 ± 130.3 mU/dL) was much lower than that of the primary group and markedly lower than that of the local recurrence group. However, no significant difference was found between the no-recurrence group and the control group.

Serum TRACP 5b is a useful and convenient marker for diagnosing GCT of bone and for predicting its recurrence.

Giant-cell tumours of bone of the hand and wrist: a review of imaging findings and differential diagnoses

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.

The effect of posterior cervical distraction on foraminal dimensions utilizing a screw-rod system

STUDY DESIGN

Cadaveric human cervical spine anatomic study using posterior lateral mass screw-rod instrumentation to assess foraminal enlargement via distraction techniques.

OBJECTIVES

To determine the role of posterior cervical distraction on foraminal dimensions and to ascertain the impact of this technique on segmental kyphosis.

SUMMARY OF BACKGROUND DATA

Management of cervical spondylotic radiculopathy includes removal of offending compressive structures and enlarging the neuroforamen via anterior discectomy with interbody fusion or posterior laminoforaminotomy.

METHODS

Six human cervical spines were prepared and posterior exposure performed. Lateral mass screws were inserted from C5 to C7 and a longitudinal rod attached. Distraction was applied between the screw heads at 2 mm intervals and accuracy confirmed with digitized calipers. Pre- and postdistraction computed tomography was performed including axial and reformatted images. Foraminal area, height, and width and sagittal alignment and disc heights were evaluated.

RESULTS

The results suggest that minimal posterior distraction of 4 to 6 mm at C5-C6 and C6-C7 may enlarge the neuroforamen by 10 to 18 mm. Foraminal height and width increased minimally from baseline to maximum distraction; however, these measurements did not reach statistical significance at either level. A decrease of segmental lordosis at C5-C6 was noted from baseline to 8 mm of distraction. Statistically significant kyphosis from baseline was present at 6 mm of distraction leading to overall 5.2 +/- 1.4degrees change in alignment. At C6-C7, statistically significant kyphosis was not present until 8 mm of distraction (4.62 +/- 2.23degrees).

CONCLUSIONS

This study suggests that posterior cervical instrumented distraction in the setting of foraminal stenosis is a reasonable supplement to direct laminoforaminotomy and nerve root decompression. Distraction leads to minimal segmental kyphosis, allowing this technique to serve as an adjunct for additional foraminal enlargement.

From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation

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.

Giant cell tumour of the hyoid--first reported case

Giant cell tumours of bone are most commonly found in the epiphyses of weight-bearing long bones. They are rarely found in the head and neck and only 17 cases involving the laryngeal framework have been reported. To date, there have been no reports of a giant cell tumour arising from the hyoid bone. We present such a case which presented as a lump overlying the greater cornu of the hyoid, review the literature and discuss the management of this locally aggressive tumour.