Giant cell tumor locally advanced around the knee: treatment and literature review

Abstract

Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics. They are more prevalent in the third decade of life and demonstrate a preference for locating in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. The risk of lung metastases is around 3%.Between October 2010 and August 2014, nine patients diagnosed with locally advanced GCT or with pathological fracture to the knee level underwent surgical treatment. The aim of this study was to evaluate the results of the treatment, particularly with regard to relapse, and to conduct a literature review.There was a predominance of males (77.7%). The most common location was the distal femur. Four patients (44%) developed local recurrence in the first year after surgery, three in distal femur and one in proximal tibia. Of the two patients with pathologic fracture at diagnosis, one of them presented recurrence after five months.The treatment of GCT is still a challenge. The authors believe that the best treatment method is wide resection and reconstruction of bone defects with non-conventional endoprostheses. Patients should be aware and well informed about the possible complications and functional losses that may occur as a result of the surgical treatment chosen and the need for further surgery in the medium and long term.

Joint salvage and biological repair of massive-cavity bone defects after extensive curettage of giant cell tumor around the knee with vascularized fibular autograft and cancellous allograft

“…The principal of GCTs treatment should be based on completely removing the tumor, reducing recurrence, and preserving or recovering limb function [3,4,18]. In this study, clinical examination revealed no cases of lung metastasis or local GCT recurrence at the last follow-up.…”

“…Currently, there are several methods that are used for the treatment of GCT around the knee, such as curettage or en-bloc resection with some reconstructive surgeries, arthrodesis by using a structural bone graft, a sandwich technique based on bone graft and polymethylmethacrylate (PMMA), and knee arthroplasty with structural bone allograft or knee prosthesis [3,4]. However, each of these methods has its advantages and disadvantages, respectively.…”

“…Intralesional curettage with PMMA or bone-graft llings, which can preserve the knee joint function, is an effective primary treatment for GCT around the knee [5]. Yet, GCT has a relatively high recurrent rate after intralesional curettage [3,4,6]. Furthermore, GCT is usually associated with cortical invasion, extracompartmental extension, and pathologic fracture in the metaphyseoepiphyseal region of the knee.…”

Role of cancer stem cells in the development of giant cell tumor of bone

“…The giant cells play a main role in the expression of calcitonin receptors which has been reported recently, giant cells mainly consist of osteoclasts in chronic giant cell granulomas (CGCGs). This fact was confirmed with the help of immune-histochemical study in which osteoclast specific monoclonal antibodies were used [60]. GCTBs undergo secondary modifications including aneurysmal bone cyst (ABC) modification, foamy histiocytic combinations and responsive bone or osteoid production [61].…”

Retrospective Analysis of Articular Surface Defect Cases Caused by Pathological Fracture of Giant Cell Tumor of Distal Femur Treated With Three-Dimension-Printed Custom-Made Prostheses Versus Conventional Endoprosthesis Replacement: Three-Dimension-Printed Custom-Made Prostheses Have Better Function Outcome

“…Pathological fracture of distal femur giant cell tumor (GCT) frequently leads to joint surface defect, which is challenging to be repaired. Due to the eccentric growth of GCT [3], such joint destruction is often con ned in one condyle, but conventional methods needs to remove the both condyles together followed endoprosthesis replacement which will face lower prosthesis survival rate and multiple joint replacement [4][5][6], especially in relatively young patients. So, considering these lesions destroy a part of the articular surface, it makes sense to discuss partial repair of the articular surface.…”