Denosumab Treatment for a Residual Giant Cell Tumor of the Clivus: A Case Report and Review of the Literature

Huh, Andrew; Villelli, Nicolas W.; Martinez, Daniel; Ting, Jonathan Y.; Birhiray, Ruemu E.; Payner, Troy D.; Kulwin, Charles

doi:10.1016/j.wneu.2018.06.242

Cited by 13 publications

(13 citation statements)

References 17 publications

(34 reference statements)

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“…Neoadjuvant denosumab therapy for preoperative tumor downstaging has shown to decrease patient morbidity and frequency of surgical management [26,31]. Various case reports have identified regression of sellar lesions and a decrease in associated symptoms after initiating denosumab therapy [32][33][34]. In one of these reports, denosumab was given after tumor regrowth in combination with proton therapy [32].…”

Section: Discussionmentioning

confidence: 99%

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Sphenoid Sinus Giant Cell Tumor: A Case Report and Literature Review

Pousti

Andera

Haugen

2020

ORL

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We describe a 27-year-old female with a giant cell tumor of her sphenoid sinus, presenting with nasal obstruction and cranial neuropathies. Both the surgical and subsequent medical management are reviewed. Additionally, we review the overall presentation, pathophysiology, and management of giant cell tumors of the skull base. Current treatment recommendations are presented.A 27-year-old female presented to our institution with a 1-month history of retro-orbital headache, neck pain, nasal obstruction, and blurred vision. CT head identified a sphenoid mass with extension into the sella, clivus, and ethmoid sinuses ( Fig. 1). MRI outlined a clival mass extending into the sphenoid sinus and cavernous sinus with a mass effect on the contents of the sella turcica (Fig. 2). An endoscopic endonasal biopsy was performed with pathology consistent with GCTb (Fig. 3).The patient then presented to the emergency department 5 days later with new-onset diplopia of the right eye, nasal drainage, and worsening headache. She was found to have a right-sided cranial nerve VI palsy. MRI showed invasion into the cavernous sinus with encroachment on the optic chiasm and internal carotid arteries bilaterally. ConclusionGiant cell tumors of the skull base are rare, benign, and locally aggressive, with high recurrence rates. The age of presentation is usually between 20 and 40 years with a predominance in females. The presenting clinical symptoms vary widely depending on tumor location. Hearing loss, headache, tinnitus, and dysfunction of the cranial nerves are the usual modes of presentation in skull base involvement. Surgical excision remains the treatment of choice, yet due to the possibility of incomplete resection and high recurrence rates, adjuvant therapy with denosumab may be necessary to improve local control. Our report, in combination with previous reports, provides evidence to support this as a potential new standard of care.

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Section: Discussionmentioning

confidence: 99%

“…Various case reports have identified regression of sellar lesions and a decrease in associated symptoms after initiating denosumab therapy [32][33][34]. In one of these reports, denosumab was given after tumor regrowth in combination with proton therapy [32]. In another, it was administered after early tumor regrowth was identified [33].…”

Section: Discussionmentioning

confidence: 99%

Sphenoid Sinus Giant Cell Tumor: A Case Report and Literature Review

Pousti

Andera

Haugen

2020

ORL

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“…Гигантоклеточная опухоль кости (ГКО) выявляется в 4-9,5 % всех первичных костных опухолей и является наиболее часто встречаемой доброкачественной первичной костной опухолью [1]. Пик заболеваемости приходится на возрастную группу 20-40 лет, с примерно одинаковой частотой поражает лиц обоего пола.…”

Section: Introductionunclassified

“…Локализация ГКО является одним из значимых дифференциально-диагностических критериев, так как опухоль поражает определенные отделы скелета. Наиболее частая локализация -длинные трубчатые кости конечностей, при этом до 60-70 % опухолей локализуются в эпифизах и эпиметафизах бедренной и большеберцовой костей [1][2][3][4].…”

Section: Introductionunclassified

“…Различные варианты внутриочаговых, краевых и сегментарных резекций с замеще-нием дефекта ауто-и аллотрансплантатами и эндопротезами широко применялись и применяются в клинической практике. В ситуации невозможности проведения адекватного хирургического вмешательства проводят лучевую терапию, но при этом возрастает риск возникновения вторичной злокачественной ГКО, а также высока частота рецидивов (20-50 %) [1,5,7,9]. В последние годы, учитывая открытие нового механизма остеокластогенеза, представления о патогенезе, морфогенезе, клинико-прогностической оценке ГКО претерпели определенную эволюцию.…”

Section: Introductionunclassified

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Analysis of the Density Characteristics of Giant Cell Bone Tumors Treated with Denosumab According to CT Findings

Табакаев

Фролова

Anisenya

et al. 2021

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Background: Giant cell tumor of bone (GCTB) is a relatively common benign bone tumor, accounting for 4–9.5 % of all primary bone neoplasms. Localization of GCTB is one of the most important differential diagnostic criteria, since the tumor affects certain parts of the skeleton. Until now, surgical treatment was considered the method of choice in the treatment of GCTB. However, in recent years, denosumab, a genetically engineered drug, has been widely used to treat this tumor. Denosumab treatment of GCTB prevents further tumor progression and reduces tumor size. Histological examination of the surgical specimen is undoubtedly the most objective method for assessing the effectiveness of the treatment. However, it is sometimes necessary to get information regarding the effectiveness of conservative therapy.Purpose: To analyze the density characteristics of denosumab-treated GCTB using CT densitometry.Material and methods: The study included 15 patients aged 28–59 years with histologically verified giantcell tumor, who received denosumab treatment followed by surgery. Tumor structure was assessed before starting denosumab therapy, after 3 and 6 courses of denosumab therapy.Results: Changes in the density parameters (the mean tumor density, standard deviation of density, increase in the median tumor density and standard deviation of density, index of the relative density of the tumor) measured by CT images were analyzed. These changes were statistically significant in GCTB patients before initiating therapy with denosumab, and after 3 and 6 courses of denosumab therapy.Conclusion: Thus, CT densitometry is a useful tool for assessing the density characteristics of the tumor in GCS patients treated denosumab.

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