Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature

Giant-cell tumor of bone rarely metastasizes to the lung. In three of six cases, lesions in lung tissue were histologically benign. In 39 such cases reported in the literature, the treatments were surgical extirpation, chemotherapy, and radiation therapy. Resection was indicated to definitely diagnose the pulmonary lesions as benign giant-cell tumors. Radiation therapy and/or chemotherapy may be beneficial as adjuvant treatment, especially where the lesions are anatomically inaccessible. Some pulmonary lesions spontaneously regress even in the absence of definitive treatment.     

Giant-cell tumor of bone

Of 327 patients who had a giant-cell tumor of bone and were seen at the Istituto Rizzoli, 293 were treated at the Institute, and 280 of these were followed for two to forty-four years. The distribution according to sex and age of the patient and site of the tumor was similar to the distributions in major reports of large series. The tumor usually involved the metaphysis and the epiphysis, but was occasionally limited to the metaphysis, and in only 2 per cent of the patients was it adjacent to an open growth plate. The tumor on occasion invaded the articular space, also involving the ligaments and the synovial membrane. Extension to an adjacent bone through the joint occurred in 5 per cent of the tumors. Our radiographic grading, which is roughly comparable with the staging system of Enneking et al., was Grade I in 4 per cent, II in 74 per cent, and III in 22 per cent of 266 patients before treatment. A pathological fracture was apparent on the first radiograph in 9 per cent of the patients. In the 280 patients with adequate follow-up, 331 surgical procedures were performed. The rate of local recurrence was 27 per cent in the 151 intralesional procedures, 8 per cent in the 122 marginal excisions, and zero in the fifty-eight wide or radical procedures. These results did not correlate with the radiographic grade of the lesion. Of the fifty-one local recurrences that were seen after treatment at our institution, 90 per cent appeared in the first three years after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Giant-cell tumor of the patella with lung metastases: a case report

Giant-cell tumors are an infrequent clinical, radiological, and pathological entity observed in 5% of primary bone tumors. They generally occur at the epiphysis of long bones, particularly in the knee area but patellar localization seems very rare. Despite their perfectly benign histological aspect, giant-cell tumors may be aggressive, leading to local recurrence or even distant metastasis to the lung. We report a case of benign giant-cell tumor of the patella with lung metastasis observed in a 23-year-old woman. The aggressive radiological image was suggestive of chondrosarcoma. Histologically the differential diagnosis with chondroblastoma was difficult. The tumor and lung metastasis were treated by surgical resection. Four years later there has been no recurrence. We present the anatomic and clinical aspects of giant-cell tumor of the bone together with the diagnostic approach and the clinical course.     

Giant-cell tumour of bone

Summary Thirty-nine patients with giant-cell tumours of bone were reviewed. Twelve of these were unusually large. Fungation of the tumours did not occur spontaneously but only after incision or trauma. Fungation of the tumour or local infiltration of soft tissues was not always associated with histological signs or a clinical course of malignancy. Radical resection in the lower limbs lead to frequent complications with fracture through the bone graft and thorough but more conservative local curretage is recommended particularly in the weight bearing bones.

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Résumé Révision de 39 cas de tumeurs osseuses à cellules géantes, dont 12 de volume inhabituel. Ces tumeurs ne s'ulcèrent pas de façon spontanée, mais à la suite d'une incision chirurgicale ou d'un traumatisme. L'ulcération de la tumeur ou l'infiltration locale des parties molles ne s'accompagne pas toujours de signes histologiques de malignité ni d'une évolution clinique défavorable.Au niveau des membres inférieurs la résection complète entraîne souvent des complications avec fracture de la zone greffée. Un traitement plus conservateur par curettage local minutieux est donc plus particulièrement recommandé au niveau des os qui supportent le poids du corps.

     

Giant cell tumor of bone with pulmonary and lymph node metastases. A case report

A giant cell tumor of bone appeared in a lymph node of a 21-year-old man at the time of local recurrence in its original location in the distal femur, prior to metastasizing the lung. Following a wide resection, the lesion did not recur, but asymptomatic pulmonary metastases were discovered. DNA analysis by flow cytometry demonstrated identical patterns in the primary and initial recurring lesions, as well as in the pulmonary metastases, which suggests that this technique may be a valuable diagnostic tool for assessing the potential aggressiveness of giant cell tumor of bone. Giant cell tumor of bone is rarely associated with metastases of any kind. Rare instances of pulmonary spread have been reported in the literature. Lymph node involvement is even more unusual. Only two such cases have been previously reported.     

Intrarenal neuroblastoma with pulmonary metastases mimicking a Wilms tumor

Primary intrarenal neuroblastoma is extremely rare and is a mimic of Wilms tumor. We present a case of a renal mass in a 14 month old male with lung metastases at the initial presentation. This was thought to represent a Wilms tumor. Histology of a biopsied lung nodule revealed neuroblastoma.     

Primary carcinoid tumor of prostate presenting with bone marrow metastases

Primary carcinoid tumor of the prostate is a rare tumor derived from the amine precursor uptake and decarboxylation cells of the prostate. We report a case of a 71-year-old man who presented with progressive anemia due to bone marrow metastases from primary carcinoid tumor of the prostate. No other metastasis was found clinically. This pattern of metastasis is very unusual and illustrates that carcinoid tumor of the prostate may metastasize distantly without locoregional lymph node involvement. This unique case highlights the need for a multidisciplinary approach to the evaluation of a metastatic carcinoid tumor of an unknown primary and that it should include the prostate.     

The case. Giant-cell tumor

Giant-cell tumor is a benign but locally aggressive primary bone tumor that requires surgical management. Most giant-cell tumors initially are demonstrated on radiographs as distal, subarticular, geographic osteolytic lesions. Abundant giant cells on histology are reactive secondary to a neoplastic fibroblast-like stromal cell. Giant cells are present in many neoplastic and non-neoplastic bone lesions; therefore the diagnosis of giant-cell tumors requires correlation of clinical, imaging, and pathologic data to exclude other lesions that demonstrate a similar histologic pattern. A small number of giant-cell tumors result in lung lesions, many of which have benign histology, can be treated by wedge resection, and do not affect long-term outcome. After adequate surgical curettage and the use of intraoperative surgical adjuvants, recurrence rates of approximately 10% are reported.     

Giant-cell tumor of the distal forearm

PURPOSE: Many authorities express concern that giant-cell tumors of the distal forearm are more frequently recurrent and difficult to treat chiefly because of the proximity to the carpus and the resultant diminished range of motion in the hand and forearm. We have studied the results from our institution for 49 patients with giant-cell tumors of the distal forearm treated from 2 to 28 years (mean, 14 +/- 7 years) and compared the results for different methods of treatment. METHODS: Through the computer database 49 patients with giant-cell tumors of the distal forearm (46 of the radius, 3 of the ulna) were identified. By using material from patient visits, chart review, and when necessary telephone interviews it was possible to gather demographic and outcome data for the 49 patients. For the radial lesions, 15 of the patients had a marginal resection of the distal radius along with the periosteum and ligamentous structures and implantation of cadaveric allografts. Twenty-six patients had intralesional curettage and insertion of polymethylmethacrylate (PMMA) and 5 had curettage and autograft insertion. The 3 patients with ulnar lesions were treated with Darrach resections. RESULTS: There were no deaths, infections, metastases, or amputations. In addition to the 49 original surgeries, the patients required 41 additional surgical procedures, 17 of which were for recurrent disease. The greatest numbers of recurrences were in the patients who underwent curettage with autograft or PMMA implantation. Only 2 recurrences were in patients who had a marginal resection and implantation of cadaveric allografts. The overall results for the patients showed that many had mostly minor complaints referable to function or pain and that only 18 of the 49 patients were asymptomatic. CONCLUSIONS: Although the patients with distal forearm giant-cell tumors have had a difficult course in terms of local recurrence and subsequent surgeries required for treatment failures, the ultimate outcomes for both allograft transplantation and curettage and insertion of PMMA are satisfactory. The patients with complete distal radial allografts had a better record for prevention of recurrence than the patients treated with curettage and PMMA insertion but the percentages of currently asymptomatic patients are approximately the same for both series (40% [6/15], 35% [9/26]). These data support the concept that marginal resection and complete distal radial allograft implantation should be used for patients with tumors that have destroyed much of the bone and have extensive soft tissue components and that curettage and PMMA insertion should be reserved for patients where the structural alteration of the bone is minimal.