Giant cell tumor of bone: Unusual features of a rare tumor

Abstract

Giant cell tumor of bone is a benign tumor with an aggressive behavior. Its typical subarticular location and high recurrence risk can be associated with significant morbidity. Although benign, it can rarely metastasize especially to the lungs. Also, it can be multicentric in less than 1% of patients. Late malignant transformation, although rare, can occur with a very poor prognosis. This series reports on these unusual and challenging features and management considerations of giant cell tumor of bone. This retrospective study included review of the medical records of patients with a confirmed histopathological diagnosis of giant cell tumor of bone. A total of 25 patients (16 females and 9 males) with a mean age of 34.5 years were included; 22 had primary tumors, while 3 were referred with recurrent tumors. Pain was the most common presenting symptom. Most patients had grade III tumors. Tumors around the knee were the most common. Multicentric tumors were detected in three patients. Twenty-three patients (20 primary giant cell tumor of bone and 3 with recurrence) received treatment. Most patients (15/23) were treated with intralesional curettage with or without adjuvants. Seven patients had wide excision. Recurrence was seen in 45% (9/20) of primary giant cell tumor of bone especially with difficult anatomical locations. Most recurrences occurred more than 4 years after treatment. Pulmonary nodules were detected in four patients; two of them showed resolution during follow-up. One patient developed secondary sarcoma transformation with a fatal outcome. Giant cell tumor of bone was more common in females. Long bones were more affected, especially around the knee. Intralesional curettage was the most frequently used treatment. Recurrence was associated with inadequate tumor resection (especially in difficult anatomical location), younger age, male gender, and advanced local tumor grade. Denosumab can be used in the treatment of pulmonary metastasis, multicentric and recurrent giant cell tumor of bone. Due to late recurrence and malignant transformation, a prolonged follow-up is warranted.

Giant Cell Tumor of Bone: Histopathological Analysis and a Few Cases With Unusual Presentation.

“…8.9 In the spine, the sacrum has been found as the most common location. 3 However, in this series, one tumor involves the spine but at the C7 location. Less than 1% of GCTs are found in the cranial bones.…”

Visualization of hidden soft-tissue recurrence of giant cell tumor of bone enabled by preoperative denosumab treatment: a case description

“…The eggshell-like mineralization following preoperative denosumab treatment made the marginal resection easier, too. Although local recurrence of GCTB after three years from initial treatment is reported to be rare, late recurrence more than four years and malignant transformation more than ten years after treatment were reported (11). Therefore, a long-term, meticulous follow-up is essential.…”

Secondary Malignancy in Giant Cell Tumor: A Single-Center Study

“…Pulmonary implants were observed in 2% of the patients with GCTB at a mean duration of three to four years after the initial diagnosis 30 . In general, such lung metastasis developed in benign GCTB of unusual sites and rarely occurred at the initial presentation 31 . As local recurrence is a known risk factor for pulmonary implants 1 , the biologic activity of GCTB may be related to lung metastasis.…”