Histologically verified lung metastases in benign giant cell tumours—14 cases from a single institution

Abstract

From 1975 to 1997, 649 cases of benign giant cell tumours of the bone were treated at the Istituto Rizzoli. Fourteen patients (2.1%) experienced lung metastases after a mean of 35.2 months. The time interval between the diagnosis and the appearance of the lung metastases ranged from 3 months to 11.9 years. Metastasectomy was performed in all patients. Histologically, the metastases were identical to the primary bone lesions. Two patients with unresectable multiple metastases received additional chemotherapy. After a follow-up of 70 months (range: 8.2 to 185 months), all patients are alive. Ten patients showed no evidence of disease, one of these after a second resection of metastases, and four patients presented stable disease with multiple lung metastases. Local recurrence of the bone lesion occurred in seven patients before or simultaneously to the metastases. In contrast to previous reports, we could not detect a predominance of the distal radius, but all of the patients had a stage III tumour according to the Enneking criteria of benign lesions. We conclude that even metastatic benign giant cell tumours have an excellent prognosis after adequate resection. No prognostic factors despite highgrade lesions were detectable.

Metastatic Giant Cell Tumor of Bone: Are There Associated Factors and Best Treatment Modalities?

“…A second limitation is that although stringent radiographic criteria have been used to identify metastases, not all lesions were histologically verified. However, this series includes all radiographically detected operable and inoperable metastatic lesions in contrast to other reported series of the same subject [7,9,17,19,20]. Many of the inoperable patients were treated symptomatically and therefore were followed up over the natural course of these presumed metastatic lesions.…”

“…GCTs of bone are regarded as aggressive and the most unpredictable neoplasms of the skeletal system, which can metastasize despite their innocent appearance [7,9,17,19,20]. There currently is no definitive method of predicting distant metastasis in GCT based on histology or flow cytometry [12].…”

“…There currently is no definitive method of predicting distant metastasis in GCT based on histology or flow cytometry [12]. We therefore explored the association, if any, between variably reported factors with metastasis in GCT [7,9,17,19,20], such as site of primary tumor, duration and number of local recurrences, and treatment of primary tumor, assessed their outcome after a long followup, and evaluated the optimum therapeutic modality for management.…”

“…Their growth rate (as measured by doubling time) is extremely low, supporting the concept that these probably were present at the time of initial resection and took years to become radiographically recognizable [10]. Reported potential risk factors for metastasis in GCT [7,17,19,20] include the primary site, local recurrences, and modality of treatment of the primary tumor. The literature contains only reports of surgically resected cases and none seeking to explore the best treatment for metastatic GCT.…”

“…Metastasis in giant cell tumor (GCT) of bone occurs most commonly in the lung, variously reported from 1% to 9% [7,9,17,19,20]. There have been isolated case reports of its occurrence at different sites, such as the lymph nodes (mediastinum, paraaortic), bone, skin, and breast [1,6,9,13,14,21].…”