Unresectable Clival Giant Cell Tumor, Tumor Control With Denosumab After Relapse: A Case Report and Systematic Review of the Literature

Pionelli, Maria Grazia; Asaftei, Sebastian Dorin; Tirtei, Elisa; Campello, Anna; Rosa, Gianpaolo Di

doi:10.1097/mph.0000000000002477

Cited by 3 publications

(4 citation statements)

References 33 publications

(118 reference statements)

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“…In more extensive lesions, bony erosion of the mass can also increase the incidence of cerebrospinal fluid leak due to its proximity to the prepontine cistern, hence leading to higher postoperative complications. Recurrence could occur within the first two years following treatment, making long-term surveillance necessary [ 6 ]. Because of their rarity and lack of available literature, the definitive treatment of clival GCTs has not been standardized.…”

Section: Discussionmentioning

confidence: 99%

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Giant Cell Tumor of the Clivus in a 19-Year-Old Male Presenting With Doubling of Vision: A Case Report

Matabang,

Opinaldo

2024

Cureus

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Giant cell tumor (GCT) of the skull is an extremely rare condition, accounting for less than one percent of all bone GCTs. Clival GCT is even rarer, with only 25 cases documented to date. It generally follows a benign course; however, due to its location and vascularity, it can be locally aggressive. Complete resection of GCT in this location may be challenging, resulting in residual tumors. In this paper, we report a case of a 19-year-old male who presented with a chronic headache later accompanied by diplopia and was noted to have a mass spanning the sella and the clivus on cranial imaging. The histopathology report of the excised mass revealed findings compatible with GCT of the bone. Most GCTs remain stable in the first two years after initial treatment. However, four months after its partial excision, the clival GCT continued to progress. The patient underwent adjuvant radiation therapy, yet symptoms persisted. This profile highlights the crucial role of long-term surveillance and prompt adjuvant radiation therapy and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

“…In most cases, the mainstay of therapy is function-preserving surgery combined with adjuvant chemoradiation. In a case of residual clival GCT reported by Huh et al in 2018, the patient was treated with a combination of adjuvant denosumab therapy, a monoclonal antibody that targets RANK-L, and proton therapy at 45-60 Gy doses [ 3 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Giant Cell Tumor of the Clivus in a 19-Year-Old Male Presenting With Doubling of Vision: A Case Report

Matabang,

Opinaldo

2024

Cureus

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“…However, multinucleated osteoclast-like giant cells can be found in several malignant and nonmalignant bone lesions (i.e., osteosarcomas, chondroblastomas, giant cell granulomas, giant cell reparative granulomas, and brown tumors of hyperparathyroidism); therefore, postoperative histopathology can be ambiguous, and clival GCTs can be easily misdiagnosed [ 16 17 18 ]. Among patients with clival GCTs, four patients, including ours, underwent H3F3A (histone 3.3) G34W IHC, all of which showed positive mutations [ 19 20 ]. This finding supports the argument of Scotto di Carlo et al [ 20 ] that the recurrent somatic H3F3A mutation present in 92% of typical GCTs in long bones can also be found in clival GCTs.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Clival Giant Cell Tumor: A Case Report and Literature Review

Yang,

Kang,

Kim

2024

Brain Tumor Res Treat

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Giant cell tumors (GCTs) are locally aggressive primary bone tumors of osteoclast-like cells. Most GCTs occur within the long bones, and primary GCTs involving the clivus are extremely rare. We present the case of an 18-year-old boy with binocular horizontal diplopia with an insidious onset who was found to have a hypointense enhancing mass involving the clivus and left side dorsum sellae on magnetic resonance images. The tumor was completely resected via an endoscopic endonasal transclival approach, and histopathologic examination via immunohistochemistry indicated a GCT. The patient’s left abducens nerve palsy improved slightly after surgery. Because of the rarity of GCTs, there is no consensus about the definitive treatment protocol. However, we suggest that gross total resection is the treatment of choice, and denosumab plays a critical role in patients with subtotal resection.

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“…In the retrospective study of Deveci et al [ 26 ], none of the eight patients with recurrent GCTB treated with adjunctive subcutaneous denosumab had another recurrence or experienced any complication associated with its use. According to the current evidence, denosumab not only can reduce the extent of surgical resection but can also be used as monotherapy for unresectable and recurrent lesions, particularly in medically compromised patients [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Recurrent Giant Cell Tumor of Bones: A Systematic Review

Pitsilos

Givissis

Papadopoulos

et al. 2023

Cancers

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The giant cell tumor of bones (GCTB) is a benign bone tumor with high postoperative recurrence potential. No specific treatment protocol has been developed to date in case of tumor recurrence, and the kind of re-operative surgery depends upon the surgeon’s preferences. The aim of this systematic review is to determine the second recurrence rate and the respective functional results of the available treatment options applied to recurrent GCTB. Medline/PubMed and Scopus were searched to identify articles published until March 2023. Twelve studies fulfilled the inclusion criteria, comprising 458 patients suffering from recurrent GCTB. The overall incidence of second recurrence was 20.5%, at a mean interval of 28.8 months after the first surgery, and it was more evident after intralesional curettage (IC) surgery than en-bloc resection (EBR) (p = 0.012). In the IC group of patients, the second recurrence rate was lower and the functional outcome was greater when polymethylmethacrylate cement (PMMAc) was used as an adjuvant instead of bone grafting (p < 0.001 for both parameters). Reconstruction of the created bone defect after EBR with a structural allograft provided a better outcome than prosthesis (p = 0.028). According to this systematic review, EBR (first choice) and IC with PMMAc (second choice) are the best treatment options for recurrent GCTB.

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Unresectable Clival Giant Cell Tumor, Tumor Control With Denosumab After Relapse: A Case Report and Systematic Review of the Literature

Cited by 3 publications

References 33 publications

Giant Cell Tumor of the Clivus in a 19-Year-Old Male Presenting With Doubling of Vision: A Case Report

Giant Cell Tumor of the Clivus in a 19-Year-Old Male Presenting With Doubling of Vision: A Case Report

Treatment of Clival Giant Cell Tumor: A Case Report and Literature Review

Treatment of Recurrent Giant Cell Tumor of Bones: A Systematic Review

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