Case Report: Unresectable pulmonary metastases of a giant cell tumor of bone treated with denosumab: a case report and review of literature

Abstract

Giant cell tumors of bone (GCTB) sometimes metastasize to distant organs. In this case report, we present pulmonary metastases of GCTB mimicking malignancies. A 49-year-old man underwent two surgical treatments for a GCTB of the right proximal radius. At the time of the second surgery, no lesions were observed on chest radiography. Three years after surgery, the patient presented with cough and dyspnea, and chest radiography and computed tomography (CT) revealed multiple lung nodules. Positron emission tomography/CT revealed a high accumulation of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) in multiple lesions. Based on the rapid growth and accumulation of 18F-FDG, a metastatic malignant tumor was suspected. CT-guided needle biopsy was performed, and the histology showed proliferation of spindle cells and multinuclear giant cells without malignant changes. Denosumab was administered because multiple lung lesions were unresectable. One month after denosumab treatment, CT showed marked shrinkage of the lesions, and the symptoms significantly improved. Eighteen months after the initial treatment with denosumab, the patient had no symptoms or tumor growth. Although its long-term efficacy and safety remain unclear, denosumab may be a treatment option for patients with unresectable pulmonary GCTB.

The Evaluation and Management of Lung Metastases in Patients with Giant Cell Tumors of Bone in the Denosumab Era

“…Our analysis suggests that lung metastases in GCTB are more prevalent than previously reported (2-4%) [15,20], occurring in approximately 7-10% of patients [16,22,23,[32][33][34]41] and up to 14% in spinal GCTB cases [16]. Our findings align with the literature [58], indicating that most metastases are multiple and bilateral, predominantly located in the lung periphery.…”

Multimodality imaging of ureteral desmoplastic small round cell tumor: a case description and literature analysis of 18F-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography findings

“…In the interpretation of PET/CT images, a differential diagnosis of DSRCT should be considered if increased FDG uptake in the ureter is encountered. A growing number of studies strongly support the use of PET/CT for staging ( 13 - 37 ), and we present a summary of the English literature on the clinical utility of this technique in patients with DSRCT in Table 1 ( 38 - 46 ).…”