Nonepiphyseal giant cell tumor of the long bones. Clinical, radiologic, and pathologic study

Faïn, J; Unni, K. Krishnan; Beabout, John W.; Rock, Michael G.

doi:10.1002/1097-0142(19930601)71:11<3514::aid-cncr2820711109>3.0.co;2-a

Cited by 42 publications

(38 citation statements)

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“…Of 1,682 cases of GCTB reported by the authors, only 14 (0.8%) were located in exclusively metaphyseal or diaphyseal regions. A notable finding of that study was the fact that the majority of patients with non-epiphyseal GCTB were <15 year-old (15). These unusual cases raised debate as to whether GCTB is capable of developing in the epiphysis (6,9) or in the metaphysis, with subsequent extension to the epiphysis following growth plate closure (16-18).…”

Section: Discussionmentioning

confidence: 99%

“…Murphey et al (14) reported that in skeletally immature patients, GCTBs were located in metaphyseal rather than meta-epiphyseal bone, with an open epiphyseal plate acting as a barrier to tumor growth. Fain et al (15) reported non-epiphyseal GCTB of long bones. Of 1,682 cases of GCTB reported by the authors, only 14 (0.8%) were located in exclusively metaphyseal or diaphyseal regions.…”

Section: Discussionmentioning

confidence: 99%

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Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

et al. 2016

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Abstract. Giant cell tumor of bone (GCTB) is a primary benign bone tumor with a locally aggressive character. Definitive descriptions of the site of origin for this type of tumor are not available. The aim of the present study was to evaluate the site of origin of GCTB of long bones with regards to epiphyseal lines by means of radiographic examination. For that purpose, plain X-ray scans of 71 GCTBs arising in long bones were retrospectively reviewed. The tumor locations were the distal femur in 31 cases, proximal femur in 11 cases, proximal tibia in 13 cases, distal radius in 6 cases, proximal humerus in 5 cases and proximal fibula in 5 cases. The vertical center (VC) of the tumor was determined with X-ray anteroposterior view, and the correlation between the VC and the epiphyseal line, and between the distance from the epiphyseal line to the VC and tumor area or volume were analyzed using a regression model equation based on scatter plot diagrams. The VC of the tumor was located in the metaphyseal region in 57 cases, in the epiphyseal line in 11 cases and in the epiphyseal region in 3 cases. In cases of GCTB located in the distal femur or proximal tibia, significant correlations between the distance from the VC to the epiphyseal line and tumor area or volume were identified. The site of origin of GCTB was estimated to be located in the metaphyseal region. GCTB often occurs in mature patients, which renders it challenging to estimate the true site of origin of this lesion, since the metaphyseal line has disappeared in mature patients. The results of the present study suggest that GCTB possibly originates in the metaphyseal region. IntroductionGiant cell tumor of bone (GCTB) is a relatively uncommon primary bone tumor that exhibits an aggressive character and a high risk of local recurrence following surgery. GCTB accounts for 4-5% of all primary bone tumors and 13-20% of all benign bone tumors (1,2). These tumors frequently occur in skeletally mature persons, with a peak incidence in the third to fourth decade of life, while rarely arise in patients with an open growth plate. In addition, GCTBs display a slight female preponderance (3). The majority of GCTBs follow a benign course. However, GCTBs often exhibit local recurrence following surgery (3), and a previous study reported that pulmonary metastases develop despite the presence of benign histological features in 3% of patients with GCTB (4). GCTBs may undergo malignant transformation (3). Rock et al (5) reported that this may occur as a result of dedifferentiation of the primary tumor, or secondary to prior radiation therapy.The majority of GCTBs are located at the end of long bones, and ~50~60% of them are located around the knee, distal femur and proximal tibia, being the distal femur the bone most frequently involved (6-8).A previous study described that GCTB arises in the epiphyseal region of long tubular bones (9). The recent literature states that the majority of GCTBs exhibit a typical metaphyseal/epiphyseal location (10), whereas GCTBs may be cente...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

et al. 2016

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“…It is important to distinguish GCTs of the hand from other giant cell-rich lesions more common in those sites, including TB (7)(8)(9)(10)(17)(18)(19). The correct diagnosis depends on a high index of clinical suspicion, referral to mycobacterial laboratory tests, careful histologic examination of tissue samples and especially radiomorphologic findings.…”

Section: Discussionmentioning

confidence: 99%

“…One reported patient had a lesion located in her second metatarsus, which, although not purely diaphyseal but rather metadiaphyseal, was very close to the epiphysis [18]. With two exceptions, all the cases reported by Uppin S. occurred in the expected location for a GCT, i.e., the epiphysis or metaepiphysis [17] Only one patient had a lesion in the diaphysis of her second metacarpus [17], a location that is considered as being very unusual for a GCT [10,18,19].…”

Section: Unusual Coexistence Of Giant Cell Tumor and Small Bone Tubermentioning

confidence: 99%

“…It is important to distinguish that subset of GCTs from other giant cell-rich lesions that are more common in those sites, including aneurysmal bone cyst, osteosarcoma, and non-ossifying fibroma [19]. In one series of Indian patients with GCTs, 46.0% were caused by infections, the majority of which were TB [17].…”

Section: Unusual Coexistence Of Giant Cell Tumor and Small Bone Tubermentioning

confidence: 99%

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Unusual Coexistence of Giant Cell Tumor and Small Bone Tuberculosis of the Hand - A Case Report

Charach¹,

Grosskopf²,

Shteinvil³

et al. 2016

Global J Med Clin Case Reports

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Background: The coexistence of giant cell tumor (GCT) and metacarpal bone tuberculosis (TB) of the hand has never been described before in the English written literature. We report here a first observation. Case presentation:We report the case of a 49-year-old male who presented with severe pain in his left hand following a blunt trauma. A plain X-ray of the metacarpal bones showed a pathological fracture of the 4 th metacarpal bone (diaphysis), and computerized tomography and magnetic resonance imaging studies confirmed the diagnosis of destructive (lytic) lesions. biopsy of the metacarpal lesion revealed a GCT, and tissue cultures were positive for mycobacterium tuberculosis (TB). He was treated by a standard 4-drug protocol of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months and an additional 6 months of isoniazid and rifampicin. He then underwent excision of the metacarpal lesion, and the pathological examination showed a GCT with cultures negative for TB. Conclusions:The correct diagnosis of this unique combination of pathologies (GCT and metacarpal bone TB) depended on a high index of clinical suspicion, referral to mycobacterial laboratory tests, careful histologic examination of tissue samples and especially radiomorphologic findings.AIDS) [15]. When it spreads to the bones, it is also known as "osseous tuberculosis", a form of osteomyelitis [15,16]. We report here a first observation of the coexistence of GCT and metacarpal bone TB of the hand which has never been reported. Case PresentationAn Ukraine-born 49-year-old male presented to the emergency room with severe pain in his left hand, deformation and swelling of the 3,4,5 metacarpal area, following a blunt trauma. A plain X-ray for suspected fracture of the metacarpal bones showed a pathological fracture of the 4 th metacarpal bone (diaphysis) (Figures 1,2). Computerized tomography (CT) and magnetic resonance imaging studies confirmed the diagnosis of destructive (lytic) lesions. A bone scan for determining possible spread of the tumor showed a "hot spot" in the metacarpal bone where the tumor was located. An open biopsy of the metacarpal lesion revealed a GCT, and tissue cultures were positive for mycobacterium tuberculosis (TB).Extensive investigation for the port of entry for mycobacterium included purified protein derivative which was 10 mm. Sputum, urine and gastric lavage cultures were negative. A CT of the chest and abdomen and pelvis were negative both for tumor spread and TB lesions.The patient was asymptomatic except for the pain in his left hand . He was treated for TB by a standard 4-drug protocol of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months and an additional 6 months of isoniazid and rifampicin. After a full course of therapy for TB, the patient underwent excision (curettage) of the metacarpal lesion, and the pathological examination showed a GCT with cultures negative for TB.

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Giant cell tumor of the bones of the hand and foot

Biscaglia

Bacchini

Bertoni

2000

Cancer

130

112

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Nonepiphyseal giant cell tumor of the long bones. Clinical, radiologic, and pathologic study

Cited by 42 publications

References 10 publications

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

Unusual Coexistence of Giant Cell Tumor and Small Bone Tuberculosis of the Hand - A Case Report

Giant cell tumor of the bones of the hand and foot

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