Malignancy in Giant Cell Tumor of Bone: A Review of the Literature

Abstract

Background: Primary and recurrent giant cell tumor of bone is typically benign; however, rarely giant cell tumor of bone can undergo malignant transformation. Malignancy in giant cell tumor of bone may be primary (adjacent to benign giant cell tumor of bone at first diagnosis) or secondary (at the site of previously treated giant cell tumor of bone). Malignant giant cell tumor of bone has a poor prognosis; it is important to distinguish malignant from benign lesions to facilitate appropriate management. The true incidence of malignant giant cell tumor of bone is not known, probably owing to inaccurate diagnosis and inconsistent nomenclature. We have analyzed current data to provide a robust estimate of the incidence of malignancy in giant cell tumor of bone. Methods: A literature search was performed to source published reports of primary and secondary cases of malignant giant cell tumor of bone. Studies that reported a denominator were used to estimate the incidence of malignancy. Results: We identified 4 large series of patients with malignant giant cell tumor of bone that provided data on 2315 patients with giant cell tumor of bone. Across these studies, the cumulative incidence of malignancy was 4.0%; the cumulative incidence of primary malignancy was 1.6% compared with 2.4% for secondary malignancy. Our analyses confirmed that most malignant giant cell tumor of bone is secondary and occurs following radiation. In addition, data from 8 small series showed that 4.8% of patients with giant cell tumor of bone who received radiation therapy developed secondary malignancy. Conclusions: Malignant giant cell tumor of bone is rare, and its identification is hindered by a lack of clear diagnostic criteria. For optimal care of patients with giant cell tumor of bone, we recommend: comprehensive histologic sampling to ensure accurate diagnoses; watchful follow-up, particularly for patients treated with radiation; and timely treatment of local recurrence.

Radiological findings of denosumab treatment for giant cell tumours of bone

“…Several cases of sarcomatous transformation in recurrent GCTB have been described, for example in the tibia with transformation into a high-grade pleomorphic sarcoma after 13 months on denosumab treatment [52] and transformation into a high-grade osteosarcoma in the ischium after 6 months on treatment [53]. Transformation into different types of sarcoma has been described, including undifferentiated pleomorphic sarcoma, fibrosarcoma and osteosarcoma [12,54].…”

Survival and Prognostic Factors Analyses in Malignant Giant Cell Tumor of Bone

“…Some tumours showed aggressive features, such as cortical and subchondral involvement, reactive bony zone in ltration, and soft tissue masses [6,7]. Recently, a study including four large series identi ed 92 cases of malignant GCTB in 2,315 patients; the incidence ranged from 1.1-11.3%, and the cumulative incidence was 4.0% [8]. It is important to perform survival prediction to determine individual treatments.…”

Survival and prognostic factors analyses in malignant giant cell tumor of bone

“…Some tumors showed aggressive features such as cortical and subchondral involvement, reactive bony zone infiltration, and soft tissue mass [6,7]. Recently, a study including four large series identified 92 cases with malignant GCTB in 2,315 patients, the incidence was from 1.1% to 11.3% and the cumulative incidence was 4.0% [8]. It's important to perform survival prediction for the arrangement of individual treatment.…”