Giant cell tumor of bone: current review of morphological, clinical, radiological, and therapeutic characteristics

Abstract

ÖZETKemiğin dev hücreli tümörü erişkinlerdeki tüm primer kemik tümörlerinin %5'ini oluşturur ve kemik tümörlerinin en güç ve yoğun araştırılanıdır. Bu durum büyük ölçüde tekrarları öngörmeye izin veren tek tip klinik, radyografik, histolojik ve morfolojik özelliklerinin olmayışı nedeniyledir. Dünya Sağlık Örgütü tarafından agresif potansiyeli olan malign bir lezyon olarak sınıflandırılan kemiğin dev hücreli tümörü akciğere metastaz yapar ve malign dejenerasyon veya çok merkezli lokalizasyon gösterir. Tümör genellikle uzun kemiklerde oluşur, ancak alışılmadık lokalizasyonlarda da olabilir. Yaygın semptomu tümör bölgesindeki artan ağrıdır. Standart tedavi küretajdan geniş rezeksiyona kadar değişir ve değişik onkolojik ve fonksiyonel sonuçlar doğurur. Tümör evresine bakılmaksızın, cerrahiyi takip eden ilk 2-3 yılda tekrarlama riski yüksektir. Bu yazıda bu patolojik teşekkülün morfolojik, klinik, radyolojik ve tedavi özellikleri ile ayırıcı tanısı tartışılmıştır.Anahtar kelimeler: Kemiğin dev hücreli tümörü, tanı, tedavi, derleme ABSTRACTGiant cell tumor of bone accounts for about 5% of all primary bone tumors in adults and is still one of the most obscure and intensively examined tumors of bone. This largely results from the lack of uniform clinical, radiographic, histological or morphological aspects that allow prediction of recurrence. Classified by the World Health Organization as "an aggressive, potentially malignant lesion", the giant cell tumor of bone could give lung metastases, could undergo malignant degeneration or could have multicentric localization. It usually develops in long bones but can also occur in unusual locations. The common presenting symptom is increasing pain at the tumor site. Standard treatment ranges from curettage to wide resection, with reports of varying oncological and functional results. The recurrence rate is high during the first 2-3 years after surgery regardless of pre-operative tumor stage. Herein, we discuss the morphological, clinical, radiological, and therapeutic characteristics of this pathologic entity as well as its differential diagnosis. J Clin Exp Invest 2014; 5 (3): 475-485

RETRACTED: Denosumab versus zoledronic acid in cases of surgically unsalvageable giant cell tumor of bone: A randomized clinical trial

“…Giant cell tumor of bone (GCTB) is a locally aggressive osteolytic lesion [1]. It is a rare, generally benign cancer of limb bones [2] that can cause metastases, especially in the lung [1], [3] as well as significant bone destruction [2]. In most cases, GCTB occurs in the long bones of skeletally mature adolescents and young adults.…”

An Active Giant Cell Tumor of the Patella: A Case Report

“…CT is useful in the evaluation of the cortical bone and could clearly present thinning of the cortex, pathologic fracture, a periosteal reaction, and absence of matrix mineralization. In cases of cortical destruction, CT is surpassed by MRI’s ability to delineate the soft-tissue extension of the tumor where it appears with a heterogeneous signal that is low in T1-weighted images and high in T2-weighted images [ 1 ].…”

“…A giant cell tumor of the bone (GCTB) is considered to be histologically benign, but it tends to be locally invasive and to form pulmonary metastases. With a prevalence of 4-5% of all primary bone lesions, these tumors develop in the metaphysis and epiphysis of the long bones and are staged as latent, active, or aggressive depending on the containment of the tumor within the bone, thinning of the cortex, or breaching of the bone by the tumor [ 1 ]. Although GCTB is usually located around the knee joint, patellar involvement is unusual.…”

“…Its occurrence within this bone is under 1% of all GCTBs [ 2 ]. The most common symptoms are pain and/or swelling [ 1 ].…”

Neoadjuvant and Adjuvant Treatment with Denosumab in Aggressive Giant-cell Tumor of Bone in the Proximal Fibula: a Case Report

“…It has an unpredictable natural course with metastases in 2%-3%, mainly to the lungs. 3 Surgery is the mainstay of treatment, usually intralesional curettage being the method of choice, supplemented with local adjuvants, aiming to minimize the risk of recurrence. Advanced understanding of the biology of GCTB proved that signaling through the receptor activator of nuclear factor kappa B (RANK) expressed by the giant cells and its ligand (RANKL) expressed by the stromal cells is critical to tumor growth and osteolysis.…”