Primary malignant giant cell tumor of bone: a series of three rare cases

The purpose of this research was to study incidence; clinical, histological, and radiological features; and outcome of primary malignant giant cell tumor (PMGCT). The authors retrospectively reviewed all cases of giant cell tumor (GCT) in which a diagnosis of GCT was related to sarcoma treated in their department between 1997 and 2004. Three cases of PMGCT were found according to the criterion of Hutter and Dahlin. Histological and radiological records of all the three cases were reviewed. In these three cases of PMGCT, the initial clinical and radiological findings were the same as those for benign giant cell tumor. Wide excision of the tumor was performed in all three cases. In two cases, knee arthrodesis was performed, and in one case a custom-made total knee replacement was performed. PMGCT was diagnosed on initial biopsy in one patient, in the second patient it was diagnosed in the excised specimen, and in third case it was only diagnosed after local recurrence 6 months after initial treatment. All the patients died within 5 months of detection of recurrence and metastasis. PMGCT has a very poor prognosis. Histological examination is highly significant in such cases. Awareness about this entity, adequate biopsy, and sampling of specimen can aid in early diagnosis, which may improve the overall prognosis.     

Giant cell tumor of tendon sheath simulating giant cell tumor of bone: report of a case

A 24-year-old male patient presented with a painful eccentric lytic lesion of the proximal tibial epiphysis with a soft tissue component. Clinical and radiological assessment led to the tentative diagnosis of aggressive giant cell tumor of bone. The patient was treated with curettage, high-speed burr, and cementation after intraoperative pathology consultation. The final pathological report indicated that the tumor was giant cell tumor of the tendon sheath with bone invasion. Although uncommon, GCTTS should be considered in the differential diagnosis of such lesions when there is a prominent soft tissue component. Although the resection was intralesional, the thermal effect of the cementation of the involved cavity and complete removal of the tendon sheath may allow successful local control conjecture of lesions that otherwise present with clinical and radiographic findings suggesting giant cell tumor of the bone.     

Multicentric giant cell tumor of bone: Case series of 4 patients

Background

We aimed to retrospectively investigate patients with multicentric giant cell tumor (MCGCT) who were treated at our hospital and to clarify their clinical features, treatment policy, and follow-up method.

定制人工假体置换治疗近关节部位骨巨细胞瘤

目的评价定制人工假体置换治疗近关节部位骨巨细胞瘤的疗效。方法对近关节部位骨巨细胞瘤42例行瘤段切除、定制人工假体置换治疗。其中37例行旋转铰链型人工膝关节假体置换,3例行人工肱骨头置换,2例行加长柄双动性股骨头置换。结果 42例患者均获随访,时间12~96个月,无局部复发或远处转移。术后6个月MSTS评分为16~28(24.0±2.34)分,肢体功能优31例,良8例,中3例,优良率为92.8%。结论定制人工假体置换是治疗近关节部位骨巨细胞瘤的有效方法,能减少局部复发,提高临床效果。     

Multicentric giant cell tumor of bone: a case report and review of the literature

Multicentric giant cell tumor of bone is the rare variant of a lesion that is relatively common in a skeletally mature population. An otherwise healthy 13-year-old boy presenting with this entity was followed up for 6 years. During this period, the patient was diagnosed with and treated for six individual lesions. One recurrence required resection, Ilizarov bone lengthening, and subsequent ankle arthrodesis. He remains fully active and free of distant metastasis.     

骨巨细胞瘤术后复发的手术治疗

目的:探讨骨巨细胞瘤术后复发的手术方法及疗效。方法:1994年6月-2003年10月,收治四肢长骨复发性骨巨细胞瘤18例,男12例,女6例;年龄18~44岁,平均26岁。股骨下端5例,胫骨上端8例,股骨上端1例,桡骨远端4例。Enneking分期:Ⅰa期14例,Ⅰb期4例。放射影像学Cam-panicci分级:Ⅰ级7例,Ⅱ级7例,Ⅲ级4例。病理学Jaffe分级:Ⅰ级8例,Ⅱ级7例,Ⅲ级3例。采用肿瘤扩大切除,吻合血管的自体腓骨、髂骨联合移植术治疗9例;瘤段切除,吻合血管的腓骨头移植重建术4例;瘤段切除,人工假体置换术5例。结果:随访时间11~110个月,平均66个月。所有移植骨术后均愈合,一侧关节间隙轻度狭窄2例,术后再复发1例。术后功能评价:优13例,良3例,可1例,差1例。结论:肿瘤扩大切除,吻合血管的自体腓骨、髂骨联合移植术既能彻底切除病变,又能保持和重建关节功能,是一种较理想的方法,Campanicci分级Ⅲ级、病理学Jaffe分级Ⅱ~Ⅲ级的复发性骨巨细胞瘤原则上应施行更为广泛的瘤段切除术,桡骨远端复发性骨巨细胞瘤因其部位的特殊性,应用自体腓骨移植重建效果良好。     

骨巨细胞瘤术后复发的手术治疗

目的:探讨骨巨细胞瘤术后复发的手术方法及疗效。方法:1994年6月-2003年10月,收治四肢长骨复发性骨巨细胞瘤18例,男12例,女6例;年龄18⁴4岁,平均26岁。股骨下端5例,胫骨上端8例,股骨上端1例,桡骨远端4例。Enneking分期:Ⅰa期14例,Ⅰb期4例。放射影像学Cam-panicci分级:Ⅰ级7例,Ⅱ级7例,Ⅲ级4例。病理学Jaffe分级:Ⅰ级8例,Ⅱ级7例,Ⅲ级3例。采用肿瘤扩大切除,吻合血管的自体腓骨、髂骨联合移植术治疗9例;瘤段切除,吻合血管的腓骨头移植重建术4例;瘤段切除,人工假体置换术5例。结果:随访时间11¹10个月,平均66个月。所有移植骨术后均愈合,一侧关节间隙轻度狭窄2例,术后再复发1例。术后功能评价:优13例,良3例,可1例,差1例。结论:肿瘤扩大切除,吻合血管的自体腓骨、髂骨联合移植术既能彻底切除病变,又能保持和重建关节功能,是一种较理想的方法,Campanicci分级Ⅲ级、病理学Jaffe分级Ⅱ^Ⅲ级的复发性骨巨细胞瘤原则上应施行更为广泛的瘤段切除术,桡骨远端复发性骨巨细胞瘤因其部位的特殊性,应用自体腓骨移植重建效果良好。     

Cementation in the treatment of giant cell tumor of bone

Summary This study was designed to review the clinical experience of cementation in the treatment of giant cell tumor of bone and to clarify its biologic basis. Eleven patients treated by this technique had results rated excellent. No recurrences of the tumor were found. Serious complications, including infection, late fracture, or secondary osteoarthrosis, did not occur. The possibility of immediate fixation and stabilization of large defects is the most valuable point of this method. Local recurrence seems to be easily detectable by magnetic resonance imaging. A cell line of mononuclear cells from giant cell tumor of bone was examined for its response to hyperthermic exposure. Hyperthermic treatment was carried out at temperature of 60° for 10 min and in other conditions. The numbers of cells surviving after heat treatment were counted, and flow cytometry was used to analyze the positive rate of surface antigens of the cells and the pattern of DNA distribution at the different temperatures. The heat treatment caused a fair number of the cells to fall into S-phase, and the tetraploid value was very low. The higher the temperature and the longer the time, the fewer cells survived and the less the expression of the monocytic phenotype. No cells survived after heating at 60° for 10 min. Cementation seemed to have a hyperthermic effect to the cells of giant cell tumor of bone.     

膝关节周围骨巨细胞瘤的手术治疗

目的:回顾性分析膝关节周围骨巨细胞瘤行手术治疗的病例,探讨骨巨细胞瘤手术病灶刮除与功能重建的方法与疗效。方法:膝关节周围骨巨细胞瘤21例,男15例,女6例;年龄6～72岁,平均43岁。股骨下端骨巨细胞瘤14例,胫骨上端骨巨细胞瘤7例。无症状偶然发现者2例,膝关节周围疼痛肿胀伴活动障碍者19例。除1例采用截肢术外,对8例儿童及青少年采用瘤体扩大刮除、灭活、植骨治疗;对12例18岁以上成年人采用肿瘤扩大刮除、灭活、植骨及骨水泥充填,钢板内固定治疗。结果:20例获随访,随访时间6～48个月,平均42个月。术后肿瘤复发3例,切口液化坏死1例。膝关节功能按李强一等标准评价:优11例,良6例,差3例。结论:对膝关节周围骨巨细胞瘤采用肿瘤扩大刮除、灭活、植骨或骨水泥充填重建功能,降低了肿瘤的复发率,并最大程度地保留了肢体功能。     

Large pelvic giant cell tumor: a case report and a review of current treatment modalities

Giant cell tumors (GCTs) of bone typically present in adults between the ages of 20 and 50 with the symptoms of progressive pain and local swelling. Females are slightly more often affected than males. GCTs tend to arise in epiphyses of long tubular bones. The typical radiographic appearances are of geographical radiolucency and cortical thinning, without internal mineralization. GCTs represent 5% of all primary bone tumours. Although benign, GCTs are locally aggressive entities producing expansive and lytic lesions. We present the case of a young man with a GCT of his pelvis who could not be treated by previously described methods because of the size of the lesion, its location, and the effects it had on surrounding bony structures.     

骨巨细胞瘤手术治疗的临床观察

目的：观察骨巨细胞瘤患者手术治疗的疗效。方法：23例均手术治疗,其中肿瘤切除 碘酊、酒精局部灭活 骨水泥填塞术14例,肿瘤瘤段切除 人工金属假体置换术4例,截肢术2例,肿瘤切除 病灶清除术2例,肿瘤刮除 植骨术1例。结果：治愈20例,死亡3例。术后随访2年～7年5个月,平均3年6个月。结论：我们提倡GCT采用临床、X线和病理三结合方法,临床疗效满意。对提高诊断和治疗有很大的价值。     

A giant cell tumor of the thumb: a case report

Giant cell tumors of the flexor sheath are the second most common tumors of the hand. We present a case that is unusual in the extent of the tumor and the pronounced bony invasion, which is rare. Preoperative diagnosis was complicated by a history of gout in our patient.     

膝关节周围骨巨细胞瘤治疗的多中心回顾性研究

 目的 回顾性分析多中心膝关节周围骨巨细胞瘤的治疗现状,探讨影响手术方案选择、肿瘤复发以及肢体功能的相关危险因素。方法 收集5个骨肿瘤治疗中心2000年3月至2012年5月病理学确诊并经手术治疗的222例膝关节周围骨巨细胞瘤患者,男120例,女102例;年龄(35.5±12.3)岁。肿瘤行囊内刮除术、切刮除术或边缘切除术。分析流行病学、形态学、影像学因素和临床特征,探索术后肿瘤复发、手术方式、术后肢体功能的相关影响因素。结果 行囊内刮除128例(57.6%),切刮除术13例(5.8%),边缘切除术79例(35.5%)。159例患者获得随访,随访率为71.6%。 术后23例复发,复发率14.5%(23/159),术后至复发的时间(23.9±22.3)个月。囊内刮除术后复发率为19.0％,切刮除术为0,边缘切除术为8.9％,手术方式是影响术后复发的唯一因素。复发肿瘤的手术方式与首诊原发肿瘤的差异有统计学意义,复发患者更倾向于边缘切除。病理性骨折、Campanacci分级、Enneking骨肿瘤分期以及有无软组织肿块可明显影响手术方式的选择。囊内刮除术后患者的国际骨肿瘤协会(Musculoskeletal Tumor Society, MSTS)评分明显优于边缘切除,Enneking分期、有无软组织肿块、首诊原复发亦可明显影响患者术后肢体功能。结论 手术切除方式是同时影响术后复发与肢体功能的唯一因素。     

Imaging of giant cell tumor of bone

Giant cell tumor (GCT) of bone is a benign but locally aggressive and destructive lesion generally occurring in skeletally mature individuals. Typically involving the epiphysiometaphyseal region of long bones, the most common sites include the distal femur, proximal tibia and distal radius. On radiographs, GCT demonstrates a lytic lesion centered in the epiphysis but involving the metaphysis and extending at least in part to the adjacent articular cortex. Most are eccentric, but become symmetric and centrally located with growth. Most cases show circumscribed borders or so-called geographical destruction with no periosteal reaction unless a pathological fracture is present. There is no mineralized tumor matrix. Giant cell tumor can produce wide-ranging appearances depending on site, complications such as hemorrhage or pathological fracture and after surgical intervention. This review demonstrates a spectrum of these features and describes the imaging characteristics of GCT in conventional radiographs, computerized tomography scans, magnetic resonance imaging, bone scans, positron emission tomography scans and angiography.     

唑来膦酸辅助治疗膝关节周围骨巨细胞瘤

[目的]探讨唑来膦酸(ZOL)对膝关节周围骨巨细胞瘤术后关节功能、疼痛、局部复发率及远处转移率的影响。[方法]回顾性分析2005年1月～2013年1月本院骨科收治的膝关节周围骨巨细胞瘤43例患者。其中,男性29例,女性14例,平均年龄32岁(14～43岁)。按术后是否接受静脉ZOL治疗,患者被分为ZOL组26例和非ZOL组17例。应用VAS视觉模拟评分、Lysholm膝关节评分评估临床效果。记录应用ZOL是否出现不良反应并分析其应用安全性。[结果]术前两组间VAS评分和Lysholm评分差异均无统计学意义(t=0.629,P0.05;t=-1.596,P=0.118)。术后1周时两组间VAS评分差异无统计学意义(t=0.855,P=0.397),但ZOL组的Lysholm评分明显高于非ZOL组,两组间差异具有统计学意义(t=2.251,P=0.024)。术后3个月时ZOL组的VAS评分明显低于非ZOL组,而Lysholm评分明显高于非ZOL组,差异均有统计学意义(t=-5.248,P0.001;t=2.729,P=0.005)。至末次随访时两组间VAS评分及Lysholm评分的差异均无统计学意义(t=0.974,P=0.163;t=1.370,P=0.088),ZOL组中局部复发率3.85%(1/26),非ZOL组中局部复发率17.65%(3/17),两组差异无统计学意义(P=0.284)。ZOL组中远处转移率0%,非ZOL组中远处转移率为5.88%(1/17),为肺转移,两组间差异无统计学意义(P=0.395)。ZOL组部分患者出现流感样症状等不良反应,但所有患者均未出现肝肾功能损害、下颌骨坏死等严重不良反应。[结论]静脉应用ZOL可改善术后早期患者疼痛及关节功能,可作为术后膝关节周围骨巨细胞瘤辅助治疗手段,但未降低骨巨细胞瘤局部复发率及远处转移率。