Clinical and Immunohistochemical Characteristics of Benign Giant Cell Tumour of Bone with Pulmonary Metastases: Case Series

Osaka, Shunzo; Sugita, Hideyuki; Osaka, Eiji; Yoshida, Yukihiro; Ryu, Junnosuke; Hemmi, Akihiro; Suzuki, Ko

doi:10.1177/230949900401200111

Cited by 28 publications

(29 citation statements)

References 17 publications

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“…11 Benign GCT of bone with pulmonary metastasis occurs most frequently in recurrent cases; these recurrent tumours have the potential to develop malignant biological behavior. [8][9][10] Study by Viswanathan S shows that, out of 24 tumors metastasized, 13 developed recurrence prior.…”

Section: Discussionmentioning

confidence: 99%

“…Although distant metastasis from GCT is known to be rare, cases were reported in locations like bone, muscle, lymph node, breast, penis, skin, brain, adrenal, GIT, kidney with lung being the common site having an incidence between 1-9%. [2][3][4][5][6][7][8][9][10][11][12]15 Clinical data from literature shows that age of the patients ranges between 15-61 with mean age being 31.8 with a male predominance. 16 Risk factors for pulmonary metastasis include primary site, locally aggressive tumors, multiple recurrences and modality of treatment of primary tumor.…”

Section: Discussionmentioning

confidence: 99%

“…ie why some suggested surgical procedure accelerate development of pulmonary metastasis. 8,10,11,19 Report by Viswanathan et al, shows that there is no association between metastasis and risk factors such as locally aggressive disease and multiple recurrences.…”

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Benign giant cell tumor of bone with pulmonary metastasis- report of two cases and review of literature

et al. 2017

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Tumors that are metastasizing generally considered as malignant. But there are exceptions. Giant cell tumor of bone is well known for its potential to metastasize without sarcomatous transformation. Potential of benign GCT to metastasize was first reported by Jaffe et al in 1940. Prevalence of pulmonary metastasis in benign GCT is between 1-9%. Factors favoring metastasis include recurrence of tumor, surgical manipulation of initial bone tumor, location of femur etc. Peripheral or basilar portion of pulmonary parenchyma is involved commonly. Eventhough death reported in 16-25% of cases, overall it has a favorable prognosis. Surgical resection is preferred treatment for pulmonary metastasis. In the present study 2 case studies were done. In 1st study 18 year old female, known case of GCT Lt tibia, with history of curetting and cementing presented with pain and swelling at same site and pulmonary metastasis 1 year later. Biopsy from initial as well as recurrent tumor confirmed benign GCT without any features of atypia, mitosis or necrosis. Aspirate from pulmonary lesion showed osteoclastic giant cells. No treatment given to metastatic deposits and is asymptomatic even though size of pulmonary lesions is increasing. And in second study a 22 year old female, with past history of GCT referred to our institution for evaluation of lung lesion detected in X-ray. Patient underwent metastatectomy here and histopathology was similar to that of bone lesion. There was no evidence of sarcomatous transformation both in initial and recurrent lesion. Patient is asymptomatic other wise and doing well.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Benign giant cell tumor of bone with pulmonary metastasis- report of two cases and review of literature

et al. 2017

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“…Patients who experienced at least one local recurrence were reported to be more likely to develop lung metastases than those who had no local recurrence. Patients with positive cells for Ki-67 in immunohistochemistry in stage III giant cell tumours seemed to have a higher prevalence of lung metastases [16].…”

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confidence: 99%

Histologically verified lung metastases in benign giant cell tumours—14 cases from a single institution

Dominkus

Ruggieri²,

Bertoni³

et al. 2006

International Orthopaedics (SICOT)

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From 1975 to 1997, 649 cases of benign giant cell tumours of the bone were treated at the Istituto Rizzoli. Fourteen patients (2.1%) experienced lung metastases after a mean of 35.2 months. The time interval between the diagnosis and the appearance of the lung metastases ranged from 3 months to 11.9 years. Metastasectomy was performed in all patients. Histologically, the metastases were identical to the primary bone lesions. Two patients with unresectable multiple metastases received additional chemotherapy. After a follow-up of 70 months (range: 8.2 to 185 months), all patients are alive. Ten patients showed no evidence of disease, one of these after a second resection of metastases, and four patients presented stable disease with multiple lung metastases. Local recurrence of the bone lesion occurred in seven patients before or simultaneously to the metastases. In contrast to previous reports, we could not detect a predominance of the distal radius, but all of the patients had a stage III tumour according to the Enneking criteria of benign lesions. We conclude that even metastatic benign giant cell tumours have an excellent prognosis after adequate resection. No prognostic factors despite highgrade lesions were detectable.

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“…7,8 Previous studies have not found any significant difference in the proliferation of neoplastic cells between primary and recurrent GCT. 4,9,10 The present study was undertaken to evaluate whether delineation of reactive and neoplastic component of GCT using immunohistochemistry can help in deriving histopathological performance indicators which differ in primary and recurrent GCT. Nuclear morphometry of immunostained slides by image analysis was used for more accurate measurement and to assess the utility of this approach.…”

Section: Introductionmentioning

confidence: 99%

Histopathological, immunohistochemical, and image analytic parameters characterizing the stromal component in primary and recurrent giant cell tumor of bone

Saxena

Safaya

Madan

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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Immunohistochemistry Primary Recurrent a b s t r a c tGiant cell tumor (GCT) of bone is a benign locally aggressive tumor whose biological behavior is unpredictable. Currently, there are no definitive clinical, histological, biochemical, or immunological parameters that can predict its behavior. This study was undertaken to examine whether delineation of reactive and neoplastic stromal component of GCT can help in this regard. 55 cases of GCT (30 primary, 25 recurrent) were subjected to histopathological grading, immunohistochemistry, and image analysis. Spindling of stroma was more frequent in recurrent GCT with 64% cases having more than 50% spindled stroma (p < 0.001).Number of mitosis/10 HPF and higher grade were more in recurrent GCT. Mean percentage positivity for CD68 (38.36%) and a1-ACT (70.86%) was higher in primary than recurrent GCT.PCNA and MiB-1 labeling indices were higher in recurrent (42.62% and 9.18%, respectively) than in primary group (24.75% and 7.7%, respectively). A single numerical parameter encompassing stromal cell population and its proliferation was derived as ratio of PCNA/ CD68 and PCNA/a1-ACT. Both ratios were higher in recurrent (0.81 AE 0.38; 1.58 AE 1.50) than in primary GCT (0.58 AE 0.62; 0.34 AE 0.29) ( p = 0.002; 0.01). On image analysis, parameters significantly different between the two groups were nuclear area and nuclear integrated optical density. It was thus concluded that recurrent GCT shows higher grade, increased mitosis, more spindling, fewer reactive components, and higher proliferation than primary GCT.Delineation of reactive component (a1-ACT positive) and proliferating component (PCNA positive cells) using immunohistochemistry with calculation of the PCNA/ACT ratio delivers more information than image analysis.

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Clinical and Immunohistochemical Characteristics of Benign Giant Cell Tumour of Bone with Pulmonary Metastases: Case Series

Cited by 28 publications

References 17 publications

Benign giant cell tumor of bone with pulmonary metastasis- report of two cases and review of literature

Benign giant cell tumor of bone with pulmonary metastasis- report of two cases and review of literature

Histologically verified lung metastases in benign giant cell tumours—14 cases from a single institution

Histopathological, immunohistochemical, and image analytic parameters characterizing the stromal component in primary and recurrent giant cell tumor of bone

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