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Du Y, Li L, Hu X. Sonographic features of diffuse giant cell tumor of the tendon sheath in the shoulder: A case report. J Clin Ultrasound 2024; 52:338-340. [PMID: 38155537 DOI: 10.1002/jcu.23618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
A middle-aged woman presented to our hospital with a chief complaint of a mass on the left shoulder for 1 year. The initial lump was small with no pain or tenderness, and the patient had not sought medical attention for numbness in the left shoulder. Clinical examination showed a mass on the left shoulder measuring 11 × 8 × 3 cm approximately with no apparent skin damage or ecchymosis. No limitations in left shoulder joint movements were observed, and the patient exhibited normal movement of the left elbow joint, wrist joint, and metacarpophalangeal joint. Moreover, the left radial artery was palpable.
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Affiliation(s)
- Yan Du
- Ultrasonography Department, The Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University, Chongqing, People's Republic of China
| | - Li Li
- Pathology Department, The Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University, Chongqing, People's Republic of China
| | - Xiaoling Hu
- Ultrasonography Department, The Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University, Chongqing, People's Republic of China
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2
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Haefliger S, Bubbear J, Davies C, Cottone L, Amary F, Tirabosco R, Cortes-Ciriano I, O'Donnell P, Flanagan AM. Multifocal osteoclast-rich tumour in Paget bone disease and conventional giant cell tumour, two genetically distinct entities? Sequencing from a single case. Skeletal Radiol 2024; 53:175-178. [PMID: 37310481 PMCID: PMC10661784 DOI: 10.1007/s00256-023-04369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 06/14/2023]
Abstract
Paget disease of bone is a metabolic disorder with a strong genetic component, characterised by pronounced disorganised bone remodelling. Complications of this disease include an increased risk of developing bone neoplasms. Here, we describe the case of a 60-year-old Italian patient with Paget disease of bone, presenting with an osteoclast-rich tumour. Our analysis of this entity, based on the clinical, morphological and genetic data (whole exome sequencing), suggests that osteoclast-rich lesions in Paget disease of bone are genetically distinct from classical giant cell tumour of bone. We discuss the importance of differentiating these osteoclast-rich lesions.
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Affiliation(s)
- Simon Haefliger
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK
| | - Judith Bubbear
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK
| | - Christropher Davies
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
| | - Lucia Cottone
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
| | - Fernanda Amary
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK
| | - Roberto Tirabosco
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK
| | - Isidro Cortes-Ciriano
- European Molecular Biology Laboratory, European Bioinformatics Institute, Hinxton, Cambridge, UK
| | - Paul O'Donnell
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK
- Department of Radiology, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK
| | - Adrienne M Flanagan
- Research Department of Pathology, University College London, UCL Cancer Institute, WC1E 6BT, London, UK.
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Greater London, Stanmore, UK.
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Hu Y, Chen M, Richard SA, Huang S. Localized Giant Cell Tumor of the Tendon Sheath of the Upper Cervical Spine: A Case Report. Neurol India 2022; 70:764-766. [PMID: 35532655 DOI: 10.4103/0028-3886.344600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Giant cell tumor of the tendon sheath (GCTTS) is commonly seen in the appendicular skeleton, and rarely arises from the axial skeleton. We describe a rare case of GCTTS in an adolescent in the upper cervical spine. CASE PRESENTATION A previously healthy 16-year-old boy presented with a 6-month history of numbness of right upper extremity, and had experienced a neck pain 4 months ago. Spinal MRI demonstrated a small syrinx at C2 level and a well-circumscribed extradural mass with contrast enhancement extending from the posterior arch of C1 to C2. The extradural mass was totally resected, and the syrinx underwent clinical and imaging surveillance. DISCUSSION GCTTS should be considered in the differential diagnosis of the axial skeletal lesion although very rare. Gross-total resection is advocated in GCTTS of the upper cervical spine, and subtotal resection with meticulous lesion monitoring should be performed in unresectable cases.
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Affiliation(s)
- Yu Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Ghana
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, China
| | | | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Ghana
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Sethi R, Tsai G, Liao WJ, Horl L. Treatment of Giant Cell Tumor of Soft Tissue Disguised as Giant Cell Tumor of the Bone Involving the Distal and Proximal Phalanges of the Great Toe. J Am Podiatr Med Assoc 2021; 111. [PMID: 35294154 DOI: 10.7547/20-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Giant cell tumors are benign tumors that are locally aggressive and rare in the foot. Giant cell tumors involving bone in the foot have an incidence of 1.2% to 2.8%, whereas giant cell tumors of the tendon sheath constitute 3% to 5% of all giant cell tumors in the foot and ankle. We present a case of giant cell tumor of the soft tissue disguised as a giant cell tumor of bone in a healthy 29-year-old male patient. Through radiographic and magnetic resonance imaging evaluation, it was determined that this patient had a bone tumor invading the distal and proximal phalanges of his left great toe with the involvement of soft tissue. With the use of the evidence-based medicine and patient expectation, the decision was made to amputate the digit. To much surprise, when the histopathologic results were reviewed, it was determined that the excised lesion was consistent with giant cell tumor of soft tissue that did not involve the bone.
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5
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Tupputi U, Eusebi L, Stronati A, Carpagnano FA, Testini V, Bartelli F, Guglielmi G. A rare sacral localization of giant cell tumor in a young adult female: a case report. Acta Biomed 2021; 92:e2021128. [PMID: 34747377 PMCID: PMC10523047 DOI: 10.23750/abm.v92is1.10714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022]
Abstract
We reported the case of a 42-years-old woman who suffered from a giant cell tumor of sacrum. Although the giant cell tumor primarily affects the long bones, especially those of the knee joint, it can rarely affect the axial skeleton and the sacrum. The onset of symptoms is generally insidious and may include locoregional pain and swelling as well as movement deficits if nerve roots are involved at this level. In this case report we discuss on the radiographic imaging, computed tomography and magnetic resonance imaging features of this type of tumor in an unusual location of the disease.
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Affiliation(s)
- Umberto Tupputi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy.
| | - Laura Eusebi
- Radiology Unit, "Carlo Urbani" Hospital, Jesi, Italy.
| | - Andrea Stronati
- Medicine Unit, Chiaravalle ASUR Marche Area Vasta 2, Loreto, Italy.
| | - Francesca Anna Carpagnano
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy.
| | - Valentina Testini
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy.
| | | | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy; Radiology Unit, Barletta University Campus UNIFG, "Dimiccoli" Hospital, Italy.
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Pathak SK, Salunke AA, Virk JS, Kumar N. Giant cell tumour of EHL tendon sheath in young: a rare case report and review of the literature. BMJ Case Rep 2021; 14:e242980. [PMID: 34544702 PMCID: PMC8454440 DOI: 10.1136/bcr-2021-242980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Giant cell tumour of tendon sheath also known as benign synovioma is a slow-growing benign tumour originating from tendon sheath, ligaments or bursa. We present a case of swelling over the left foot of 7-month duration in 11-year-old boy diagnosed as giant cell tumour of tendon sheath. There was an extensive pressure effect of tumour mass on the second metatarsal evident by scalloping. Local excision was planned and executed, and reduction in scalloping was evident at 26-month follow-up with no recurrence. We conclude that en bloc resection of tumour with a hydrogen peroxide lavage may result in a favourable prognosis without recurrence.
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Affiliation(s)
| | | | | | - Naveen Kumar
- Orthopedics, Maharishi Markandeshwar University, Ambala, Haryana, India
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Awad P. Atypical Tenosynovial Giant Cell Tumor of the Foot and Ankle: A Case Report. J Am Podiatr Med Assoc 2021; 111:466698. [PMID: 34144578 DOI: 10.7547/18-038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tenosynovial giant cell tumor, also known as giant cell tumor of the tendon sheath (GCT-TS), is a solitary, nodular, firm, benign, soft-tissue tumor that arises from the synovial lining of a tendon. The etiology is unknown. It is a rare soft-tissue tumor, with an overall incidence of one in 50,000 individuals, and usually affects people aged between 30 and 50 years. Magnetic resonance imaging tends to be the imaging modality of choice, used for surgical preparation. Widely accepted treatment involves local excision with or without radiotherapy. The author presents a case study involving a patient with an abnormally large, longstanding GCT-TS, diagnosed with clinical examination and imaging modalities, surgically excised, and further confirmed by pathology reports. Topic of discussion includes a review of GCT-TS.
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Fan X, Wang W, Li C, Tang T, Han Y, An K. An osteoclast-like giant cell tumor embedded in the mural nodule of a pancreatic mucinous cystic neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e15246. [PMID: 31008959 PMCID: PMC6494236 DOI: 10.1097/md.0000000000015246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Mucinous cystic neoplasms (MCNs) are relatively rare lesions, accounting for 2%-5% of all exocrine pancreatic neoplasms. MCNs mainly occur in women (female:male ratio = 20:1), with a peak incidence in the 5th decade of life. Osteoclast-like giant cell tumors (OGCTs) are rare and relatively aggressive neoplasms, comprising <1% of all pancreatic carcinomas. Herein, we present a rare "combination tumor" case and discuss the impact of mural nodules in pancreatic MCNs considering malignant transformation. PATIENT CONCERNS A 54-year-old Mongolian man, without vomiting, nausea or jaundice, presented with abdominal distention since 3 months. He had a 7-year history of diabetes. Physical examinations indicated slight middle abdominal tenderness without rebound tenderness or rigidity. Laboratory results revealed that the level of carcinoembryonic antigen (CEA) was 1.16 ng/ml (normal: <5 ng/ml); CA-199: 30.02 U/ml (normal: <27 U/ml); hemoglobin: 143 g/L; fasting glucose: 7.71 mmol/L; and albumin: 43 g/L. Abdominal enhanced computed tomography revealed a 7 × 6 cm solid neoplasm in the pancreatic body with partial enhancement and heterogeneity. Endoscopic ultrasound revealed a solid-cystic space-occupying lesion in the pancreatic body. DIAGNOSIS The preoperative preliminary diagnosis was pancreatic solid-cystic tumor, possibly a solid pseudopapillary tumor. Postoperative pathological findings revealed a pancreatic borderline MCN with an OGCT embedded in a mural nodule of the capsule. Immunohistochemical results indicated a simultaneous dual origin from the epithelium and stroma. INTERVENTIONS The patient underwent open distal pancreatectomy and splenectomy. Postoperative blood glucose levels were closely monitored and regulated. We intravenously administered single-agent gemcitabine (1400 mg on day 1) as the first-time chemotherapy, 1 month after surgery. After the first chemotherapy, the patient refused to receive further treatment owing to personal reasons. OUTCOMES The patient showed uneventful recovery and was discharged 13 days after the initial surgery. Follow-up was performed 1, 3 and 6 months after surgery. At 6 months, abdominal computed tomography scan showed no signs of recurrence, regional lymphadenopathy, or other abnormalities. And laboratory tests showed a platelet count of 301 × 10/L, postprandial blood glucose of 12.9 mmol/L and CA-199 level of 20 U/ml. The patient had no obvious discomfort. LESSONS Although pancreatic MCNs are widely accepted as borderline tumors, malignant transformations may occur due to various risk factors (cyst size, mural nodules, septations, and tumor location). The combination tumor in this case was more likely to increase the possibility of malignant biological behavior, thereby worsening overall prognosis. Therefore, long-term follow-up must be maintained with strict monitoring.
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Affiliation(s)
- XiaoYu Fan
- Peking University China-Japan Friendship School of Clinical Medicine
| | - WenYue Wang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - ChaoFeng Li
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Tao Tang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - YongXin Han
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Ke An
- Peking University China-Japan Friendship School of Clinical Medicine
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Teng W, Lin P, Li Y, Yan X, Li H, Li B, Wang Z, Wu Y, Wang S, Zhou X, Wang Z, Ye Z. Bone combined cement grafting in giant cell tumor around the knee reduces mechanical failure. Int Orthop 2018; 43:475-482. [PMID: 29700587 PMCID: PMC6399200 DOI: 10.1007/s00264-018-3939-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022]
Abstract
Objectives The aims of our study are (1) to explore the risk factors of mechanical failure (MF), (2) to figure out an index to evaluate this risk, and (3) to select an optimal reconstruction strategy to reduce this risk. Methods We retrospectively reviewed 104 patients from Dec. 2008 to Mar. 2016, undergone extensive knee curettages in our institution. Radiographs and post-operative interviews were used to classified cases of MF. Relative factors (age, tumor location, the invaded area, etc.) were also collected and analyzed by SPSS software. Results Thick subchondral bony layer (p = 0.006) and combined grafting of the cement and bone (p = 0.006) had lower risk of mechanical failure. Mechanical failure appeared to happen in the femur (p = 0.012) more easily. The ROC curve (AUC = 0.722) reveals that less post-operative bony layer (≤ 3.3 mm) is more likely to cause mechanical failure. The Kaplan-Meier survival curve showing increased survival in those patients after a combination grafting surgery (HR, 3.799; p = 0.006). Conclusion Based on our study results, combined grafting of the cement and bone reduced the risk of mechanical failure in the knee due to the thin subchondral bone layer (SCB), especially in the femur.
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Affiliation(s)
- Wangsiyuan Teng
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Peng Lin
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yong Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiaobo Yan
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hengyuan Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Binghao Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zhan Wang
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan Wu
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shengdong Wang
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xingzhi Zhou
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zenan Wang
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zhaoming Ye
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine, No.1511, Jianghong Road, Hangzhou, 310000, China.
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Takata M, Miyamoto Y, Maniwa Y. [Giant Cell Tumor of the Rib;Report of a Case]. Kyobu Geka 2018; 71:156-159. [PMID: 29483473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a rare case of giant cell tumor of the rib. A 33-year-old man was admitted to our hospital because of a recently appearing mass and pain in the right chest wall. Chest computed tomography and magnetic resonance imaging revealed a heterogeneous mass of 8-cm in diameter arising from and destroying the right 7th rib. The tumor was resected together with the 6th, 7th, and 8th ribs and the adjacent muscle and diaphragm. The pathological diagnosis was giant cell tumor of the bone. The patient has been free from recurrence or metastasis for 4 years after the operation.
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Affiliation(s)
- Masahiko Takata
- Department of Thoracic Surgery, Kitaharima Medical Center, Ono, Japan
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Gülenç B, Kuyucu E, Yalçin S, Çakir A, Bülbül AM. Arthroscopic Excision of Tendinous Giant Cell Tumors Causing Locking in the Knee Joint. Acta Chir Orthop Traumatol Cech 2018; 85:109-112. [PMID: 30295596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY Non-osseous giant cell tumors are locally aggressive tumors arising around joints. They are commonly located around synovial joints such as wrist and knee and occasionally cause mechanical symptoms. MATERIAL AND METHODS This retrospective case series includes 7 patients operated due to intraarticular lesion. The mean age of the patients was 28.7 (range 22-37) years. Mean follow-up period was 12 months. RESULTS All patients underwent arthroscopic debridement. They were followed monthly with clinical examination and magnetic resonance imaging (MRI) was obtained at third month for all patients. Patients were contacted through phone call and evaluated with the WOMAC score retrospectively. No recurrence was detected in any patient. CONCLUSIONS Arthroscopic debridement is a safe surgical technique that may replace open surgery in the treatment of intraarticular tendinous giant cell tumors. Key words:tendinous giant cell tumor, arthroscopy, knee locking.
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Affiliation(s)
- B Gülenç
- Istanbul Medipol University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Abstract
Giant cell-containing tumors of bone are characterized morphologically by the presence of numerous osteoclastic giant cells. Correlation of clinical, radiologic, and laboratory findings is required for accurate histopathologic diagnosis and treatment of a giant cell-containing tumor of bone. In differential diagnosis, it is particularly important to note the age of the patient and the skeletal location of the lesion. This article considers the range of neoplastic and nonneoplastic lesions, which histologically contain numerous osteoclastic giant cells, and focuses on several lesions that frequently enter into the differential diagnosis.
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Affiliation(s)
- Zsolt Orosz
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Sciences, Nuffield Orthopaedic Centre, Windmill Road, University of Oxford, Oxford OX3 7HE, UK
| | - Nicholas A Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Sciences, Nuffield Orthopaedic Centre, Windmill Road, University of Oxford, Oxford OX3 7HE, UK.
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13
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Zhang Y, Joyce M, Schils J, Bauer TW. Coexisting sarcoidal granulomatous inflammation and diffuse tenosynovial giant cell tumor of the knee after a total knee replacement: a case report. Skeletal Radiol 2016; 45:1735-1740. [PMID: 27717976 DOI: 10.1007/s00256-016-2492-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas, predominantly involving lung, mediastinal lymph nodes and other organs. Synovium involvement is infrequent, and as far as we know, involvement of a periprosthetic membrane has not been reported in the English literature. Intra-articular diffuse tenosynovial giant cell tumor ("conventional diffuse pigmented villonodular synovitis") is an uncommon, locally aggressive neoplasm with few previous case reports in which it arose in periprosthetic tissues after knee arthroplasty. We describe a unique case of an intraarticular mass next to a total knee prosthesis implanted 6 years ago in a patient with a history of pulmonary sarcoidosis. Clinically, this 67-year-old gentleman presented with progressive left knee pain, effusion and marked instability. MRI showed a large complex effusion with synovial thickening in the supra patella recess and the medial and lateral gutters. In addition, a large multilobulated mass with mixed low and high signal intensity was present in the posterior joint space, extending into the popliteal area. A two-stage operation was performed. Histologically, the mass from the posterior joint space showed characteristic features of diffuse tenosynovial giant cell tumor, while the synovium from the anterior compartment demonstrated sarcoidal granulomatous inflammation. Orthopaedic wear debris was found within the giant cells of these sarcoidal granulomata. The histologic features are different from those "usual" macrophage reactions to the particles of debris. In this article, we also included two optional links (highlighted in blue in the figures) to digital whole slide image (WSI), which allow the readers to navigate the entire microscope slides.
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Affiliation(s)
- Yaxia Zhang
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, 44195, USA.
| | - Michael Joyce
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Jean Schils
- The Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Thomas W Bauer
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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14
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Ciurea ME, Vreju AF, Popa DG, Ciurea RN, Pârvănescu CD, Chisălău AB, Roşu A, Ciurea PL. Ultrasonography role in the evaluation of a giant cell tumor of the flexor pollicis longus tendon. Rom J Morphol Embryol 2016; 57:299-302. [PMID: 27151725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hand tendons lesions represent a challenge for an accurate diagnosis, an optimal treatment strategy, the description of the lesion and its location being an important step. The non-invasive ultrasound evaluation was demonstrated to be an important diagnostic method in these types of lesions, especially in those situations where clinical evaluation failed to reveal the pathological changes and therefore has an important role in the adequate management.
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Affiliation(s)
- Marius Eugen Ciurea
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Romania;
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Abstract
An 87 year-old white female presented with a two-year history of intermittent discomfort in her left foot. PET-CT identified intense18F-fluorodeoxyglucose (FDG) uptake corresponding to the lesion. Histology of a fine needle aspiration and open biopsy were consistent with a benign giant cell tumor (GCT) of the bone. GCT of bone is an uncommon primary tumor typically presenting as a benign solitary lesion that arises in the end of the long bones. While GCT can occur throughout the axial and appendicular skeleton, it is exceedingly uncommon in the bone of the foot. While 18F-FDG has been established in detecting several malignant bone tumors, benign disease processes may also be identified. The degree of 18F-FDG activity in a benign GCT may be of an intensity that can be mistakenly interpreted as a malignant lesion. Therefore, GCT of the bone can be included in the differential diagnosis of an intensely 18F-FDG-avid neoplasm located within the tarsal bones.
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Affiliation(s)
- Wendi O'Connor
- Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC, USA ; Department of Pathology & Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Megan Quintana
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Scott Smith
- Department of Pathology & Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Monte Willis
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Jordan Renner
- Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
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16
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Nortjé CJ. Maxillo-facial radiology case 115. Hyperparathyroidism. SADJ 2013; 68:424-425. [PMID: 24660414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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Nicolescu R, Clifford PD, Robinson PG, Conway SA. Orthopaedic case of the month: a 51-year-old man with a painless wrist mass. Clin Orthop Relat Res 2013; 471:727-32. [PMID: 23054527 PMCID: PMC3563827 DOI: 10.1007/s11999-012-2637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Razvan Nicolescu
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine/JMH, 335 S. Biscayne Blvd., #2003, Miami, FL 33131, USA.
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Hamdi MF, Touati B, Zakhama A. Giant cell tumour of the flexor tendon sheath of the hand: analysis of 27 cases. Musculoskelet Surg 2012; 96:29-33. [PMID: 21674255 DOI: 10.1007/s12306-011-0148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/01/2011] [Indexed: 05/30/2023]
Abstract
Giant cell tumour of the tendon sheath (GCTTS) is a slowly progressing benign tumour arising from synovial cells of tendon sheaths. It is one of the most common soft tissue tumours in the hand. We report a retrospective study of 27 proven GCTTS of the hand. The mean length of follow-up was 4.5 years (17 months-8.5 years). Radiographic findings are useful and may prove of great diagnostic value. The positive diagnosis was provided by the pathology examination after complete excision that was performed in all patients. The recurrence was noted in two surgically managed cases. The excision should be meticulous and complete in order to avoid recurrence.
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Affiliation(s)
- M F Hamdi
- Department of Trauma and Orthopaedics Surgery, F. Bourguiba University Hospital, 5000, Monastir, Tunisia.
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19
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Simon SL, Inneh IA, Lee MS, Sullivan S, Ennis F. Tenosynovial giant cell tumor of the thigh: positron emission tomography findings. Am J Orthop (Belle Mead NJ) 2011; 40:E115-E117. [PMID: 21869945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tenosynovial giant cell tumors (TGCTs) are pigmented villonodular proliferative lesions originating from the synovium, bursa, or joint. TGCTs tend to be locally aggressive, and there is a chance for multiple occurrences, which often lead to impairment of joint function. In this article, we report the case of a diffuse-type extra-articular TGCT found in the thigh of a 36-year-old woman. Surveillance F-18 fluorodeoxyglucose positron emission tomography detected increased activity within the left thigh. This activity was confirmed with magnetic resonance imaging and with surgical excision and histopathologic determination of the tumor. This patient's case suggests that TGCTs may be discovered and followed after resection with positron emission tomography.
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Rosenkrantz AB, Melamed J, Stifelman M. Osteoclast-like giant cell tumor of the renal pelvis associated with urothelial carcinoma: computed tomography, gross, and histologic appearance. Urology 2011; 78:1310-2. [PMID: 21458035 DOI: 10.1016/j.urology.2011.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/17/2022]
Abstract
Osteoclastoma-like giant cell tumor of the renal pelvis, similar to the entity more commonly occurring in bone, is very rare, having been reported in twelve previous cases to our knowledge. This is the first report of this entity, to our knowledge, to include its cross-sectional imaging appearance. A hyperdense area within the lesion on non-contrast CT may correspond with extensive hemorrhagic content of the lesion identified histologically. As in most prior cases, an adjacent smaller urothelial carcinoma of the renal pelvis was also identified. In the limited reported cases, this entity has exhibited highly aggressive behavior with poor prognosis.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York 10016, USA.
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Rauramaa T, Pulkkinen J, Miettinen P, Kainulainen S, Seppä A, Kärjä V. Case report: osteoclast-like giant cell tumour of the pancreas without epithelial differentiation. J Clin Pathol 2010; 63:376-7. [PMID: 20354216 DOI: 10.1136/jcp.2009.069260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Sohn YM, Kim AH, Choi J, Kim EK, Moon HJ, Kim MJ, Park YN, Kwak JY. Giant cell tumor of a tendon sheath mimicking an axillary lymph node. J Clin Ultrasound 2010; 38:271-273. [PMID: 20091698 DOI: 10.1002/jcu.20661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A giant cell tumor of the tendon sheath (GCTTS) is 1 of the most common soft-tissue tumors of the hand and wrist, while the 2nd most frequent site is the ankle-foot complex. Although various solid tumors can develop in the axilla, GCTTS has not yet been reported. We describe the sonographic appearance of GCTTS in the axilla.
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Affiliation(s)
- Yu-Mee Sohn
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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Chiou HJ, Chou YH, Chiu SY, Wang HK, Chen WM, Chen TH, Chang CY. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color doppler ultrasonography. J Chin Med Assoc 2009; 72:307-15. [PMID: 19541566 DOI: 10.1016/s1726-4901(09)70377-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the usefulness of high-resolution grayscale and color Doppler ultrasound to distinguish benign from malignant soft-tissue masses on the basis of ultrasonographic patterns. METHODS We enrolled 398 female and 420 male patients aged 1-104 years (mean, 49.8 years). All presented with a palpable nodule or mass located superficially in the body. Each lesion was examined by grayscale and color Doppler ultrasonography to assess its echogenicity, margin, shape, composition, acoustic transmission, size and other patterns. Spectral Doppler was applied in lesions with positive color flow signals. The nature of all masses was confirmed by aspiration cytology, biopsy, surgical pathology or long-term clinical follow-up. RESULTS There were a total of 693 benign and 125 malignant masses. Five malignant and 14 benign histologies (including 6 types with inflammation-related, hematoma or pseudoaneurysm) occurred that had more than 10 subjects with each histology. Eight benign histopathologies included cysts, neoplasms, vascular and miscellaneous. Five malignant histologies included metastases, osteogenic sarcomas, lymphomas, malignant fibrous histiocytomas and liposarcomas. There were significant differences (p < 0.05) between the benign and malignant soft-tissue tumors in terms of parameters including tumor margin, shape and size. Benign lesions did not have infiltrated margins or a scalloped shape and malignant tumors tended to be large. However, there was no significant difference (p > 0.05) between the benign and malignant soft-tissue tumors in terms of echogenicity, composition and color Doppler features. CONCLUSION Ultrasonography with color Doppler imaging is a good modality for characterizing most soft-tissue masses, and tumor size > 5 cm and having infiltrated margin highly suggests malignancy.
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Affiliation(s)
- Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
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Ciudad MJ, Moreno MJ, Martínez Y, Vañó E. [Recurrence of giant-cell cubital tumor in soft tissue]. Radiologia 2009; 51:337-8. [PMID: 19457523 DOI: 10.1016/j.rx.2009.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 01/13/2009] [Indexed: 11/20/2022]
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Sirikulchayanonta V, Jaovisidh S. Including MIR of a primary bone leiomyosarcoma that radiologically mimics a giant cell tumor. J Med Assoc Thai 2008; 91:244-248. [PMID: 18389991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors present a case of a 42-year-old female who developed a leiomyosarcoma of the right proximal tibia that appeared radiologically similar to a giant cell tumor Histology revealed spindle cells running in whorl-like fashion with focal atypia and low mitotic figures. The immuno-stains revealed positive reactivity for alpha-smooth muscle (SMA), muscle actin and cytokeratin (AE1/AE3). The authors rendered a diagnosis of low-grade leiomyosarcoma of bone. The lesion was considered a primary lesion since the patient did not have other leiomyomatous tumors. The MRI showed hypo- to iso- signal intensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging. This was likely due to admixed fibrotic tissue in the lesion. The tumor cells were not positive for Ebstein-Barr virus by in-situ hybridization as seen in leiomyomatous tumors in immunodeficiency patients.
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Burgos-San Juan L, Silva-Abarca J, Fernández-Arancibia O, Burgos-de Cea ME. [Osteoclastic tumour of the pancreas]. Cir Esp 2008; 83:40-1. [PMID: 18208750 DOI: 10.1016/s0009-739x(08)70497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cheng JW, Tang SFT, Yu TY, Chou SW, Wong AMK, Tsai WC. Sonographic features of soft tissue tumors in the hand and forearm. Chang Gung Med J 2007; 30:547-554. [PMID: 18350738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND High-resolution sonography is well suited for screening soft tissue masses because of its safety, low cost, and real-time, dynamic imaging. The purpose of our study was to elaborate the preoperative sonographic features of soft tissue tumors of the hand and forearm and the corresponding histologic results. METHODS Thirty-one soft tissue tumors of the hand and forearm were evaluated by ultrasound preoperatively. The mobility, consistency, echogenicity, margin, and color Doppler signal of each tumor were assessed. Dynamic study was also performed. The pathologic diagnosis was obtained after subsequent surgery. RESULTS The pathologic diagnoses of these soft tissue lesions were lipoma (n = 6), ganglion cyst (n = 6), neurilemmoma (n = 3), neurofibroma (n = 3), giant cell tumor (n = 10), tenosynovitis (n = 2), and malignant lymphoma (n = 1). An adjacent tendon or communication duct extending to the joint space could be found in most giant cell tumors and ganglion cysts; a traceable nerve could be found in most nerve sheath tumors. All benign tumors appeared well-defined. The only malignant tumor appeared ill-defined without a color Doppler signal. CONCLUSION Sonography enables a reliable diagnosis of the cystic or solid nature of soft-tissue lesions, accurate estimation of the volume, and precise three-dimensional localization of the abnormality. Examiners should perform a dynamic examination and trace the adjacent structure to obtain more diagnostic clues.
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Affiliation(s)
- Ju-Wen Cheng
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic value of sonography in giant cell tumors of the tendon sheath. METHODS Sonographic findings and other clinical records were retrospectively reviewed and analyzed in 30 patients (45 lesions) with pathologically proven giant cell tumors of the tendon sheath. The sonographic findings were compared with those found at surgery. RESULTS The locations of the tumors included the hand (53.33%), wrist (10%), elbow (3.33%), knee (10%), and foot (23.33%). The sizes of the tumors ranged from 0.4 to 8 cm, with a mean size of 2.6 cm. All the lesions were shown as hypoechoic nodules with homogeneous or heterogeneous echogenicity. Thirty-two lesions (71.11%) had substantial flow, and 13 lesions (28.89%) had minimal flow. Thirty-four lesions were in contact with the tendon sheath; 5 were in contact with the joint; and 6 were in contact with both the tendon sheath and the joint. Bone erosions were found in 4 cases, and bone impressions were found in another 3 cases. CONCLUSIONS Sonography can provide exact information about a tumor and its relationship with the surrounding tissue, which indicates that it can be used as the first method to diagnose a giant cell tumor of the tendon sheath.
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Affiliation(s)
- Yuexiang Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd, 100853 Beijing, China.
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Shimada Y, Hongo M, Miyakoshi N, Kasukawa Y, Ando S, Itoi E, Abe E. Giant cell tumor of fifth lumbar vertebrae: two case reports and review of the literature. Spine J 2007; 7:499-505. [PMID: 17630149 DOI: 10.1016/j.spinee.2006.01.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 01/16/2006] [Accepted: 01/19/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT complete or total en bloc spondylectomy has been recommended for giant cell tumors of the spine. Wide local resection of the fifth lumbar vertebra carries potential risks of major complications because of its anatomical features. Only nine cases of the giant cell tumors involving the fifth lumbar vertebra have been reported in the literature. PURPOSE to present two cases of giant cell tumor of the fifth lumbar vertebra treated by single-stage combined anterior and posterior tumor resection over 7 years of follow-up. STUDY DESIGN Case report and a review of literature. METHODS A 33-year-old female and a 20-year-old female, each diagnosed with giant cell tumor of fifth lumbar vertebra, underwent single-stage tumor resection through a combined posterior and retroperitoneal anterior approach. RESULTS The resection of the fifth lumbar vertebra was completed in the first case without major perioperative complications. In the second case, massive bleeding during the anterior procedure for resection of the vertebral body interrupted the total resection of the tumor, resulting in possible residual tumor which required adjuvant radiotherapy. The patients recovered both clinically and neurologically after the operation. Spinal reconstruction was maintained, and no recurrence of the tumor was evident at the 7-year and 8-year follow-up, respectively. CONCLUSION There was no recurrence of the tumor after the combined single-stage anterior and posterior tumor resection and adjuvant radiotherapy for the second case for over 7 years follow-up. However, complete resection of the vertebra and tumor at the fifth lumbar vertebra is still challenging to accomplish.
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Affiliation(s)
- Yoichi Shimada
- Rehabilitation Division and Spine Division, Akita University Hospital, 1-1-1 Hondo, Akita 0108543, Japan
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Abstract
STUDY DESIGN Level III retrospective case series with historical controls. OBJECTIVE To evaluate the mid- to long-term outcomes of serial arterial embolization as a primary treatment modality for large sacral giant-cell tumors (SGCT). SUMMARY OF BACKGROUND DATA Giant-cell tumors are potentially aggressive benign tumors that can cause significant morbidity and may occasionally prove lethal. Large GCTs in the sacrum present a significant challenge, and treatment methods, including surgical resection and radiation, are associated with morbid complications and high recurrence rates. This report presents the mid- to long-term follow-up results of our cases of SGCT treated with serial arterial embolization. METHODS Nine consecutive patients with biopsy-proven SGCTs received initial primary treatment with serial arterial embolization between 1984 and 2006. All patients underwent angiography and selective arterial embolization at the time of diagnosis, followed by repeat embolization every 6 weeks until no new vessels were noted, and then at 6 and 18 months following stabilization of the lesion. Patients were closely monitored with MRI and/or CT every 6 months for 5 years and annually thereafter. Functional outcomes were measured using the 1993 Musculoskeletal Tumor Society Rating Scale (MSTS93). RESULTS The mean duration of follow-up in this series was 8.96 years (median, 7.8 years; range, 3.8-21.2 years). No progression was noted in 7 of the 9 cases. Two cases experienced tumor progression of less than 1 cm early in the treatment course and continued to remain asymptomatic. Adjuvant radiation therapy provided local control in 1 of these cases, while radiation and chemotherapy failed in the other case with ultimate mortality. All patients demonstrated substantial pain relief. Cross-sectional MSTS93 scores were obtained in the 8 surviving patients at their most recent follow-up visit with a mean score of 29/30. CONCLUSIONS Serial arterial embolization is a useful primary treatment modality for large SGCTs given the favorable long-term results and potential morbidity of alternative treatments.
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Affiliation(s)
- Harish S Hosalkar
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19106, USA
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Hansen MA, Harper C, Yiannikas C, McGee-Collett M. A rare presentation of pigmented villonodular synovitis. J Clin Neurosci 2007; 14:386-8. [PMID: 17240150 DOI: 10.1016/j.jocn.2005.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 12/06/2005] [Indexed: 11/18/2022]
Abstract
Tenosynovial giant cell tumours are of two types, localised and diffuse. The diffuse type is also known as pigmented villonodular synovitis (PVNS). There have been 42 previously reported cases of PVNS in the axial skeleton, seven of which were reported in the thoracic spine. A young patient found to have thoracic PVNS and who presented with progressive lower limb weakness and parasthesiae over 3 weeks is reported. Computed tomography and magnetic resonance imaging demonstrated a posterior lesion at T6/7 with local bone invasion. The patient underwent complete resection of the tumour and has had an unremarkable postoperative convalescence with resolution of his signs and symptoms. Total surgical resection is the treatment of choice for this condition and close postoperative follow-up with serial imaging is important to monitor for local recurrence.
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Affiliation(s)
- Mitchell A Hansen
- Department of Neurosurgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia.
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Lüthje P, Nurmi-Lüthje I. Tenosynovial juxta-articular giant-cell tumour of the knee--an unusual location of the tumour. Acta Orthop Belg 2006; 72:772-4. [PMID: 17260619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We present a case of a physically active 46 year-old woman who was treated operatively for a juxta-articular tenosynovial giant cell tumour of the knee that caused mechanical symptoms. The preoperative diagnosis was retropatellar lipoma. The tumour was located in the infrapatellar fat pad. No recurrence was observed by MRI in 1-year follow-up.
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Affiliation(s)
- Peter Lüthje
- Department of Orthopaedics and Traumatology, Kuusankoski Regional Hospital, Finland.
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Popov SD, Leenman EE. [Solitary orbital fibrous tumor in a 12-year-old child]. Arkh Patol 2006; 68:42-4. [PMID: 17290895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Solitary orbital fibrous tumor was diagnosed in a 12-year old boy admitted to hospital for right-sided exophthalmos. MRI revealed orbital mass and surgical resection was performed. Histologically the tumor was composed of round or spindle cells with a lot of multinucleate giant cells and pseudovascular spaces. The neoplasm was regarded as a mixoid type of a solitary giant cell-rich fibrous tumor. Immunohistochemical analysis revealed coexpression of CD34, CD99, bcl-2, and CD99 (mic-2). The most important clinical, morphological, and immunohistochemical manifestations are presented in the paper. Major criteria for the differential diagnosis of solitary orbital fibrous tumor and the similar soft tissue tumors are discussed.
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De Schepper AM, Hogendoorn PCW, Bloem JL. Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions. Eur Radiol 2006; 17:499-502. [PMID: 16807700 DOI: 10.1007/s00330-006-0320-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 03/08/2006] [Accepted: 04/25/2006] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explain radiographic features of giant cell tumors of the tendon sheath (GCTTS), in particular, osseous extension, by correlating imaging findings with histology in order to increase the accuracy of radiological diagnosis. In a series of 200 consecutive osseous (pseudo) tumors of the hand, on radiography, six patients presented with an intrinsic osseous lesion caused by a histologically confirmed neighboring GCTTS. Available radiographs, computed tomography (CT), and contrast-enhanced magnetic resonance (MR) images were correlated with histology. Radiography showed osseous lesions consisting of well-defined cortical defects in four (one of whom also demonstrated cortical scalloping) and a slightly expansile, well-defined osteolytic lesion in two patients. MR obtained in four patients showed the extraosseous tumor invading/eroding bone and causing cortical scalloping (three and one patients, respectively). Extension depicted on MR was confirmed on the two available resection specimens. All lesions were polylobular (cauliflower or mushroom like) and neighboring tendon sheaths. Dense collagen and hemosiderin-loaded macrophages explained the high CT attenuation and the low MR signal intensity on T2-weighted images that was observed in all four MR and in all two CT scans. The high density of proliferative capillaries explained the marked enhancement observed in all four patients with gadolinium (Gd)-chelate-enhanced MR imaging. GCTTS is a soft tissue (pseudo) tumor that may invade bone and as a consequence mimick an intrinsic osseous lesion on radiographs. In such cases, specific MR and CT features that can be explained by histological findings can be used to suggest the correct diagnosis.
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Affiliation(s)
- A M De Schepper
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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Sautot-Vial N, Rahili A, Karimdjee-Soihili B, Benizri E, Avallone S, Benchimol D. Hepatobiliary and pancreatic: Osteoclast-like giant cell tumor of the pancreas. J Gastroenterol Hepatol 2006; 21:1072. [PMID: 16724999 DOI: 10.1111/j.1440-1746.2006.04523.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- N Sautot-Vial
- Digestive Surgery, CHU Nice, Nice, Côte d'Azur, France
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Abstract
Giant-cell tumor of the tendon sheath is a common benign lesion of the synovial membrane that frequently occurs in the hand. It is related to pigmented villonodular synovitis and the occurrence of pigmented villonodular synovitis or giant-cell tumor of the tendon sheath in the axial skeleton is very rare. To data, only three cases of giant-cell tumor of the tendon sheath involving cervical spine have been reported, compared with 26 cases of pigmented villonodular synovitis. Pigmented villonodular synovitis involving the thoracic spine is also extremely rare and our case represents the first reported case of a giant-cell tumor of the tendon sheath involving the thoracic spine. A 26-year-old man presented with left back pain without neurological deficit. Computed tomography and magnetic resonance imaging (MRI) revealed an osteolytic and expansive lesion in the left facet joint between the seventh and eighth thoracic vertebrae. A complete facetectomy and excision of the lesion followed by a posterior arthrodesis between Th5 and Th9 was performed. Postoperatively, the patient recovered with complete relief of symptoms, there was no evidence of recurrent disease or regrowth of the residual lesion, as investigated by plain radiographs and MRI within a follow-up period of two years. Although giant-cell tumor of the tendon sheath in the thoracic spine may be extremely uncommon, it should be considered in the differential diagnosis, especially when a benign lesion appears to originate in the face joint. Considering the high rate of recurrence, every effort should be made to achieve total excision.
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Affiliation(s)
- Minoru Doita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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Yang SC, Chen LH, Fu TS, Lai PL, Niu CC, Chen WJ. Surgical treatment for giant cell tumor of the thoracolumbar spine. Chang Gung Med J 2006; 29:71-8. [PMID: 16642729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Giant cell tumor (GCT) of the bone has historically been regarded as an extremely unpredictable bone tumor. The anatomical characteristics of spinal GCT still present challenges to surgeons. Controversy remains regarding the proper treatment of patients with grade III tumors. METHODS Eleven patients with grade III GCT of the thoracolumbar spine were treated between 1992 and 2002 at a medical center by the authors. Three patients were initially treated at other institutions. Adjuvant radiotherapy was employed for local recurrence in these three patients. The other eight patients were initially treated with marginal excision. The site, size, and extent of each lesion dictated the surgical approach. RESULTS Five patients had tumor recurrence. One patient, who received radiotherapy, had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiple metastases throughout the lung. Neurological status, measured using the American Spinal Injury Association scale, of one patient was worse after undergoing the procedure than preoperatively and three patients showed improvement. The other seven patients were classified as with the same grade postoperatively. CONCLUSION Wide excision of GCT of the thoracolumbar spine is difficult and there is a risk of neurological deficit and spinal instability. Meticulous marginal excision with associated reconstruction may obtain good local control and preserve functional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achieved favorable prognoses.
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Affiliation(s)
- Shih-Chieh Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taipei, ROC
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Camargo OPD, Croci AT, Oliveira CRGMCD, Baptista AM, Caiero MT. Functional and radiographic evaluation of 214 aggressive benign bone lesions treated with curettage, cauterization, and cementation: 24 years of follow-up. Clinics (Sao Paulo) 2005; 60:439-44. [PMID: 16358131 DOI: 10.1590/s1807-59322005000600002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Treatment with curettage, cauterization, and methylmethacrylate of aggressive benign bone lesions is a method now widely accepted in most orthopedic oncology centers. However, one of the controversies regarding this technique is the possible complications that may arise from the use of methylmethacrylate, which has caused some authors to remove it 2 years after the surgery and replace it with bone graft. The objective of this paper is to present a functional and radiographic evaluation of 214 patients presenting with aggressive benign bone lesions treated with curettage, cauterization, and methylmethacrylate from 1974 to 1998, with some of them having 24 years of follow-up. These patients were clinically and radiographically evaluated for the incidence of late osteoarthrosis, range of motion, and pain in the involved joint. METHOD This study comprised 214 patients, with an average follow-up duration of 10.6 years (range: 2 to 24 years. All cases involved aggressive benign lesions. The patients were evaluated according to the Musculoskeletal Tumor Society Score (MSTS) functional evaluation system, and the complications are described. RESULTS The MSTS functional evaluation was excellent in 166 cases (78%), good in 26 (12%), fair in 11 (5%), and poor in 11 (5%). The following complications were observed: late osteoarthrosis, 25 cases (12%); infection, 12 (6%); pathologic fracture, 11 (5%); and local recurrence, 19 (9%). CONCLUSION Based on clinical assessment, no significant deleterious effects directly related to the use of methylmethacrylate were observed. The functional evaluation performed in 1998 (up to 24 years of follow-up) did not show significant change when compared to the evaluation performed in 1985.
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Affiliation(s)
- Olavo Pires de Camargo
- Department of Orthopedics, Hospital das Clinicas, São Paulo University Medical School, São Paulo, SP, Brazil.
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Abstract
STUDY DESIGN A report of 3 cases of upper sacral tumors excised by occluding the abdominal aorta with a balloon dilation catheter (BDC). OBJECTIVE To investigate the feasibilities of reducing intraoperative hemorrhage and improving the safety of surgical excision of sacral tumors assisted by occluding the abdominal aorta with a BDC. SUMMARY OF BACKGROUND DATA Surgical excision of upper sacral tumors has been considered a high-risk and difficult operation, with multiple complications because of its massive and uncontrollable intraoperative hemorrhage. However, until now and to our knowledge, no report on resection of sacral tumors assisted by occluding the abdominal aorta with a BDC is available. METHODS A BDC was used to occlude the abdominal aorta for 40-65 minutes in assisting with resection of upper sacral tumors in 3 cases. RESULTS After the abdominal aorta was occluded, much less intraoperative hemorrhage was found, and the volume of blood loss was only 100-200 mL. This procedure assisted the surgeon in identifying clearly the surgical margin and sacral nerves surrounded by the tumors. In addition, intraoperative contamination was also minimized. The blood pressure remained stable during the operation. CONCLUSION To occlude the abdominal aorta with a BDC may effectively reduce intraoperative hemorrhage, thus assisting the surgeon in the complete and safe resection of upper sacral tumors.
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Affiliation(s)
- Chuan Mi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People's Republic of China.
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Abstract
BACKGROUND Mixed giant cell tumor (MGCT) of the pancreas is a rare malignant neoplasm. The tumor contains pleomorphic giant cells (PGC), pleomorphic mononuclear cells (PMC) and osteoclastic giant cells (OGC). We describe the first fine needle aspiration biopsy (FNAB) diagnosis of this tumor. CASE A 76-year-old woman was discovered (on imaging studies) to have an apparently inoperable mass in the head of the pancreas. Computed tomography-guided FNAB showed a malignant neoplasm with features of an MGCT. PGC/PMC, OGC and spindle cells were present. The PGC/PMC expressed epithelial antigens, pancytokeratin, CAM 5.2, AE1/AE3 and epithelial membrane antigen (EMA). The spindle cells focally stained for EMA. OGC were negative for the epithelial antigens. OGC, PGC/PMC and the spindle cells were positive for the mesenchymal marker vimentin. CONCLUSION FNAB was instrumental in making the diagnosis of a rare pancreatic tumor, MGCT. Immunocytochemistry was helpful in making a definitive diagnosis and suggested that MGCT is a carcinosarcoma like neoplasm. The morphology and immunocytochemical profile raise the possibility that osteoclastic giant cell tumor and pleomorphic giant cell tumor may be different morphologic and biologic expressions of the same tumor.
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Affiliation(s)
- Amobi M Ezenekwe
- Department of Pathology, Saint Louis University School of Medicine, Missouri, USA
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Rao UNM, Goodman M, Chung WW, Swalski P, Pal R, Finkelstein S. Molecular analysis of primary and recurrent giant cell tumors of bone. ACTA ACUST UNITED AC 2005; 158:126-36. [PMID: 15796959 DOI: 10.1016/j.cancergencyto.2004.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 09/24/2004] [Accepted: 09/27/2004] [Indexed: 10/25/2022]
Abstract
The status of microsatellite markers located on chromosomes 1p36, 3p25, 5q23, 9p22, 10q23, 10q24, 17p13, and 19q12 was used to determine loss of heterozygosity (LOH) in primary giant cell tumors (GCT) of bone in 12 patients. The cases included primary, locally recurrent, and metastatic GCT; three tumors were classified as malignant GCT, based on their morphological features. Microdissection was performed on 24 paraffin-embedded tissue samples. An average of three separate topographic sites were microdissected from each tumor. Case selection in each instance was based on the availability of paired samples of tumor in primary GCTs and their corresponding recurrences, and the presence of normal tissue. The number of cases studied is too small for statistical studies, and thus the analysis is descriptive. All cases were informative for >80% of the markers used. Both primary GCTs and local recurrences and lung metastases displayed LOH of three or more markers, and intratumoral heterogeneity was frequent. Fractional allelic losses (FAL) were not different in recurrent and nonrecurrent GCT. FAL was greatest (>30%) in the metastatic group of GCT. Allelic losses of 1p, 9q, and 19q regions were frequent in all groups. LOH of 17p (in proximity to the p53 locus) and 9p occurred exclusively in the pulmonary metastases from GCT. LOH of 9q and 19q was present in primary as well as recurrent GCTs and in one malignant GCT. Involvement of 1p (including MYCL) and 9q regions has not been previously reported in GCT of bone. The pattern of LOH evident in the 17 markers used in the present study suggests that GCT with malignant features may follow an evolutionary pathway similar to the usual primary GCT of bone.
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Affiliation(s)
- Uma N M Rao
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian Shadyside, Room WG02.9, 5230 Centre Avenue, Pittsburgh, PA 15213, USA.
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Erdogan B, Aydin MV, Sen O, Sener L, Bal N, Yalçin O. Giant cell tumour of the sixth cervical vertebrae with close relationship to the vertebral artery. J Clin Neurosci 2005; 12:83-5. [PMID: 15639421 DOI: 10.1016/j.jocn.2004.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Accepted: 02/09/2004] [Indexed: 10/26/2022]
Abstract
Giant cell tumours of the vertebral column are rare and cervical vertebrae involvement is even less common. As these lesions may be closely related to the vertebral artery, therapeutic decision-making may be complex. Reviewing the literature, we found that there was no consensus on treatment or outcome assessment for these rare and difficult lesions. We present a case of a giant cell tumour of the sixth cervical vertebrae involving the posterior elements, neural foramina and transverse foramina and closely related to the vertebral artery. Radiological evaluation and therapeutic solutions are also discussed.
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Affiliation(s)
- Bulent Erdogan
- Department of Neurosurgery, Faculty of Medicine, Baskent University, Adana, Turkey.
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Wagner RI, Ergnian SM, Keller IM, Sokolova IA. [Giant-cell cervical neurinoma extending into the thoracic cavity]. Vopr Onkol 2005; 51:242-4. [PMID: 16223011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Miszczyk L, Spindel J, Blamek S, Syguła M, Koczy B. [Lung dissemination of giant cell tumor of femur. The case report]. Przegl Lek 2005; 62:944-6. [PMID: 16541735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The case of 32 years old patient suffering for giant cell bone tumor of left femur was reported. After surgery (curettage and filling of tumor bed with bone cement followed by arthroplasty), a dissemination to lungs was found. Patient was treated by palliative lungs radiotherapy (10 x 1.1 Gy) and six cycles of chemotherapy (every four weeks) based on cisplatin (35 mg/m2) and doxorubicin (30 mg/m2) obtaining significant regression of metastases. Because of four persistent lung metastases, the extracranial radiosurgery using one fraction of 16 Gy was done.
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Affiliation(s)
- Leszek Miszczyk
- Zakład Radioterapii, Centrum Onkologii im. M. Sklodowskiej-Curie, Instytut Oddział w Gliwicach.
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Abstract
OBJECTIVE To discuss the concept of pseudoanaplastic tumors of bone, which pathologically show hyperchromatism and marked pleomorphism with quite enlarged, pleomorphic nuclei, but with no to extremely rare, typical mitoses, and to propose guidelines for their diagnosis. DESIGN AND PATIENTS From a database of 4,262 bone tumors covering from 1971 to 2001, 15 cases of pseudoanaplastic bone tumors (0.35% of total) were retrieved for clinical, radiographic and pathologic review. Postoperative follow-up after surgical treatment was at least 3 years and a maximum of 7 years. RESULTS There were eight male and seven female patients. Their ages ranged from 10 to 64 years with average of 29.7 years. Pathologic diagnoses of pseudoanaplastic variants of benign bone tumors included: osteoblastoma (4 cases), giant cell tumor (4 cases), chondromyxoid fibroma (3 cases), fibrous dysplasia (2 cases), fibrous cortical defect (1 case) and aneurysmal bone cyst (1 case). Radiography of all cases showed features of a benign bone lesion. Six cases, one case each of osteoblastoma, fibrous dysplasia, aneurysmal bone cyst, chondromyxoid fibroma, giant cell tumor and osteoblastoma, were initially misdiagnosed as osteosarcoma. The remaining cases were referred for a second opinion to rule out sarcoma. CONCLUSIONS Despite the presence of significant cytologic aberrations, none of our cases showed malignant behavior following simple curettage or removal of bony lesions. Our observation justifies the concept of pseudoanaplasia in some benign bone tumors as in benign soft tissue tumors, especially in their late evolutionary stage when bizarre cytologic alterations strongly mimic a sarcoma.
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Affiliation(s)
- Won-Jong Bahk
- Department of Orthopaedic Surgery, Uijongbu St. Mary Hospital, The Catholic University of Korea, 65-1 Geumohdong, Uijongbu, Gyunggido, 480-821, Korea.
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Cappuccio M, Bandiera S, Gasbarrini A, De Iure F, Barbanti Bròdano G, Scimeca GB, Presutti L, Cocchi R, Boriani S. Giant cell tumor of the upper cervical spine: transmandibular-translingual access. Clinical case. Chir Organi Mov 2004; 89:305-12. [PMID: 16048052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The authors describe the clinical case of a patient aged 18 years affected with giant cell tumor (GCT) at C3 who came to the surgical unit of Orthopaedics and Traumatology at the Ospedale Maggiore in Bologna after being treated by surgery elsewhere. Particular attention is paid to surgical access by means of median transmandibuloglossotomy used in order to obtain a sufficiently wide surgical field that can adequately expose the vertebral segment affected by neoplastic disease. In particular, possible complications that may be observed postsurgery can be compared to other surgical approaches to the upper cervical spine and above all that there are no permanent clinical sequelae.
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Affiliation(s)
- M Cappuccio
- Divisione di Ortopedia e Traumatologia-Ospedale Maggiore, Bologna
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Strauss LG, Dimitrakopoulou-Strauss A, Koczan D, Bernd L, Haberkorn U, Ewerbeck V, Thiesen HJ. 18F-FDG kinetics and gene expression in giant cell tumors. J Nucl Med 2004; 45:1528-35. [PMID: 15347720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
UNLABELLED 18F-FDG kinetics were evaluated by use of compartment and noncompartment models of giant cell tumors. The kinetic data were compared with the gene expression data for a subgroup of patients. METHODS Nineteen patients with giant cell tumors were examined with PET and 18F-FDG, and tracer kinetics were assessed quantitatively. A 2-compartment model, including the transport constants k1-k4 as well as the vascular fraction (VB) for 18F-FDG, was used for evaluation of the data. A noncompartment model was used to calculate the fractal dimension of the 18F-FDG time-activity curve to assess the heterogeneity of the tracer kinetics. Furthermore, tumor specimens obtained from 5 patients were assessed with gene chip technology (U95A), and these data were compared with the quantitative 18F-FDG data. RESULTS The giant cell tumors showed generally enhanced 18F-FDG uptake 1 h after tracer application, with a mean 18F-FDG standardized uptake value (SUV) of 4.8 (range, 1.8-9.4). Quantitative evaluation of tracer kinetics showed a preferential increase for 18F-FDG transport, with a mean k1 of 0.340. The vascular fraction accounted for 35% of the tumor volume and was high compared with those for other tumors, such as soft-tissue sarcomas. 18F-FDG kinetics were heterogeneous, with a fractal dimension of 1.3. Gene chip analysis showed that the expression of 137 genes (1.1%) exceeded the median expression value of the reference gene, beta2-microglobulin. The highest expression was observed for the gene for the small, leucine-rich proteoglycan I (biglycan), which is important for bone cell differentiation and proliferative activity. Correlation analysis revealed an association of 18F-FDG data with the expression of several genes. Mainly genes related to angiogenesis were associated with the compartment parameters. The SUV at 56-60 min was correlated with the expression of vascular endothelial growth factor A (angiogenesis) and cell division cycle 2 protein (proliferation). CONCLUSION Despite their classification as benign tumors, giant cell tumors have generally enhanced 18F-FDG uptake, mainly attributable to an enhanced vascular fraction and increased 18F-FDG transport. A comparison of gene chip data and 18F-FDG kinetic data showed a close association of quantitative 18F-FDG results and the expression of genes related to angiogenesis.
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Affiliation(s)
- Ludwig G Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany.
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Icihikawa K, Tanino R. Soft tissue giant cell tumor of low malignant potential. Tokai J Exp Clin Med 2004; 29:91-5. [PMID: 15595466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Giant cell tumor of soft tissue (GCT-ST) is a rare tumor first described in 1972 by Salm and Sissons, followed shortly by Guccion and Enzinger. This tumor has been considered to be synonymous with the giant cell variant of malignant sarcoma with frequent local recurrence and metastasis. Recently GCT-ST has been described as a distinct entity of relatively benign prognosis, yet lacking marked atypia and pleomorphism, even in the presence of mitotic activity and vascular invasion. Now some authors think that GCT-ST represents the soft tissue analog of giant cell tumor of bone because of their histological and immunohistochemical similarity. Some reports documented these pathological new findings, but clinical case reports with description of imagings and surgery on the basis of these knowledge are very few. The authors describe the clinical, radiological, morphologic and histopathologial features of a case of GCT-ST occurring primarily in the subcutaneous tissue of the thigh with a review of the literature.
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Affiliation(s)
- Kota Icihikawa
- Department of Plastic Surgery, Tokai University School of Medicine, Japan.
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Abstract
OBJECTIVE The purpose of this study was to analyze the sonographic characteristics of giant cell tumors of the tendon sheath. CONCLUSION Giant cell tumors of the hand typically appear as solid, homogeneous hypoechoic masses with detectable internal vascularity that are associated with the flexor tendons of the fingers.
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Affiliation(s)
- William D Middleton
- The Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway, St. Louis, MO 63110, USA
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