Giant cell tumor of the clavicle: report of a case in a rare location with consideration of surgical method

Abstract

BackgroundMost bone tumors that occur in the clavicle are malignant. A few giant cell tumors (GCTs) of the clavicle have been reported; however, the most appropriate operative method for this tumor has never been discussed.Case presentationA 54-year-old man noticed enlargement of the proximal aspect of the right clavicle. A plain X-ray revealed lytic change and ballooning of the proximal end of the right clavicle. The tumor was isointense on T1-weighted magnetic resonance images and showed a mixture of low- and high-intensity areas on T2-weighted images without extension to the surrounding soft tissues. Bone scintigraphy showed strong accumulation (normal/tumor ratio, 2.31), and positron emission tomography revealed strong uptake of fluorine-18-2-fluoro-2-deoxy-d-glucose (SUVmax, 6.0) in the proximal part of the right clavicle. Because we could not completely exclude malignancy, an open biopsy was performed. Pathologically, the tumor comprised mononuclear stromal cells and multinuclear giant cells, resulting in a diagnosis of a GCT of the bone. Although curettage may be considered for such lesions (Campanacci grade II), we chose resection to minimize the chance of recurrence. The tumor was resected en-bloc with the proximal half of the clavicle. No postoperative shoulder disproportion was observed, and full range of motion of the right shoulder was maintained. The patient was satisfied with the surgical outcome (Musculoskeletal Tumor Society score of 96 %). He returned to his original job as a land and house investigator without any signs of recurrence for 1 year after surgery.ConclusionsAlthough GCT of the bone rarely occurs in the clavicle, the typical X-ray findings demonstrated in the present case are helpful for a correct diagnosis. Although en-bloc resection without reconstruction is appropriate for GCTs in expendable bones, there has been much discussion about shoulder function after total claviculectomy. Considering the importance of the function of the clavicle, which is to support the scapula through the acromioclavicular joint, we preserved the muscle attachments of the deltoid, trapezius, and pectoralis major. Because both the oncological and functional outcomes were satisfactory, we recommend preservation of as much of the clavicle as possible in patients with clavicular bone tumors.

Giant Cell Tumor: A Rare Condition in the Immature Skeleton—A Retrospective Study of Symptoms, Treatment, and Outcome in 16 Children

“…The 3 clavicular lesions and 1 in scapula are interesting as the flat bones are hardly ever affected. Puri et al [10] found one clavicular lesion among the children in their material, and there are some existing case reports [15, 16]. Most of the larger materials contain none [1–3, 5].…”

Giant cell tumor of clavicle in an elderly: Rare presentation of a common tumor with review of literature; 1980–2020

“…GCT of the clavicle is rare with only 15 cases reported in literature in the last 40 years[ 3 4 6 7 8 9 10 11 12 13 14 15 ] [ Table 1 ]. Out of these, 7/15 were male and 8/15 were female.…”

Bone tumours of the clavicle: Histopathological, anatomical and epidemiological analysis of 113 cases

“…Bone tumours of the clavicle are exceedingly rare with a reported frequency of less than 1% of all bone tumours [1], [2]. There is a paucity of literature focusing on these lesions with most of the published articles being case reports or small case series [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Hence, the majority of physicians have limited experience in the diagnosis and treatment of these lesions.…”