Treatment and outcome of giant cell tumors of the pelvis

Background and purpose Giant cell tumors (GCTs) of bone rarely affect the pelvis. We report on 20 cases that have been treated at our institution during the last 20 years.

Methods 20 patients with histologically benign GCT of the pelvis were included in this study. 9 tumors were primarily located in the iliosacral area, 6 in the acetabular area, and 5 in the ischiopubic area. 8 patients were treated by intralesional curettage and 6 by intralesional resection with additional curettage of the margins. 3 patients with iliacal tumors were treated by wide resection. 2 patients were treated by a combination of external beam irradiation and surgery, and 1 patient solely by irradiation. In addition, 9 patients received selective arterial embolization one day before surgery. Of the 6 patients with acetabular tumors, 1 secondarily received an endoprosthesis and 1 was primarily treated by hip transposition. The patients were followed for a median time of 3 (1–11) years.

Results 1 patient with a pubic tumor developed a local recurrence 1 year after intralesional resection and additional curettage of the margins. The recurrence presented as a small soft tissue mass within the scar tissue of the gluteal muscles and was treated by resection. No secondary sarcoma was detected and none of the patients developed pulmonary metastases or multicentricity. No major complication occurred during surgery.

Interpretation We conclude that most GCTs of the pelvis can be treated by intralesional procedures. For tumors of the iliac wing, wide resection can be an alternative. Surgical treatment of tumors affecting the acetabular region often results in functional impairment. Pre-surgical selective arterial embolization appears to be a safe procedure that may reduce the risk of local recurrence.     

Giant Cell Tumor of the Pelvis: a Systematic Review

This is a systematic review of articles concerning the morbidity, recurrence rate, treatment and treatment complications of pelvic giant cell tumors (GCTs). The key words “giant cell tumor, pelvis” were used to identify articles which included data on patients with pelvic GCTs in English and Chinese databases of published reports from 1949–2012. The articles were filtered by title, abstract and full text. Thirty‐eight articles and 165 patients were identified for this review. Data on all identified patients were studies; data in different articles on the same patients was not used repeatedly. The following patient data were collected where possible and subjected to systematic analysis; age, location of GCT, treatment, follow‐up, complications, recurrence and whether alive or dead. The mean age of onset was 33.2 years (range, 14–73 years), the peak ages of onset being between 21 and 40 years. A pronounced sex difference was identified, the male : female ratio being 1:1.7. The acetabulum was the commonest area for pelvic GCTs. Forty‐eight tumors were primarily located in the iliac, 60 in the acetabular and 31 in the ischiopubic area. Twenty‐seven patients experienced complications of treatment. Patients who had been treated by wide resection had the most complications; these included incisional infection and delayed healing of incisions. Local recurrence was common, having occurred in 39/158 patients (24.6%), comprising 24/72 (33.3%) who had undergone intralesional surgery only; 9/20 (45.0%) who had undergone radiotherapy only; 1/51 (2.0%) who had undergone wide resection; and 5/14 patients (35.7%) who had undergone radiation therapy or cryotherapy plus intralesional surgery. Mortality was low (3.2%, 5/158). Pelvic GCT is not common, the acetabular area appears to the most frequent site and the peak age is the third and fourth decades. Although the recurrence rate is high for all pelvic GCTs, the mortality is low. Treatment has a critical influence on recurrence. In spite of the associated complications, the lower local recurrence rate makes wide resection a reasonable option for patients with extensive and/or aggressive GCTs.     

骨盆骨巨细胞瘤临床治疗的系统文献综述

 目的 分析骨盆骨巨细胞瘤（giant cell tumor, GCT）的好发年龄、发病部位、不同治疗方式的复发率及并发症。方法 在医学常用外文数据库检索“giant cell tumor,pelvis”,在医学常用中文数据库检索“骨巨细胞瘤,骨盆”,时间选取1949至2012年,所有被检索的文献及参考文献均被用于分析,经文题、摘要、全文内容二次筛选,共筛选出38篇文献,将所涉及的骨盆GCT患者作为研究对象,删除重复报告的病例;收集每例入选患者的发病年龄、发病部位、手术方式、随访时间、并发症、复发率及死亡率等。采用系统分析的方法对数据进行分项研究。结果 筛选出的38篇文献中共165例骨盆GCT患者纳入研究进行系统分析,发病年龄14~73岁,平均33.2岁,高发年龄21~40岁;男、女比例为1∶1.7。发病部位：髂骨区（A区）48例,髋臼区（B区）60例,耻、坐骨区（C区）31例。随访时间1.5~35年,平均9.5年。27例（32.5%,27/83）患者出现治疗并发症,以病灶外整块切除方式进行治疗的患者（13/28）发生率最高;常见并发症为切口内感染、切口延迟愈合。9例（45.0%,9/20）接受单纯病灶放疗的患者术后复发,24例（33.3%,24/72）接受病灶内手术的患者术后复发,5例（35.7%,5/14）接受病灶内手术联合放疗或冷疗的患者术后复发,1例（2.0%,1/51）接受病灶外手术的患者术后复发,总复发率为24.6%（39/158）,死亡率为3.2%（5/158）。结论 骨盆GCT临床少见,常累及髋臼区（B区）,高发年龄为21~40岁,病灶外整块切除术后并发症最为常见,但术后复发率最低,骨盆GCT总体复发率较高,死亡率较低。     

The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton

BackgroundThe treatment for recurrent giant cell tumor (GCT) remains controversial. In this study, we evaluated the outcome of surgical intervention for recurrent GCT.MethodTwenty-seven patients (14 males and 13 females) with recurrent GCT were recruited. Their primary GCTs were all treated with intralesional surgery. Among these recurrent GCTs, 9 grade III and 1 grade II tumors were treated with en bloc resection and endoprosthetic replacement, whereas 16 grade II and 1 grade III tumors were treated with intralesional curettage and PMMA bone cement filling.ResultsThe mean interval between initial surgery and first recurrence was 28.8 months (range 7–97 months). About 70 % of first recurrences affected bones around the knee, 44 % in the proximal tibia and 26 % in the distal femur. Of 27 patients, 3 women treated with intralesional procedures suffered second recurrences in the proximal tibia. No second recurrence was found in patients with en bloc resection. Two grade III re-recurrence GCTs were treated with en bloc resection, and 1 grade II was treated with an intralesional procedure. One patient with en bloc resection developed tumor metastasis in both lungs. Compared to patients with intralesional treatment, the functional score was significantly decreased in patients with en bloc resection (p < 0.01).ConclusionThe re-recurrence risk of grade III GCTs can be significantly decreased by wide en bloc resection and endoprosthetic replacement. However, intralesional treatment is a good option for less aggressive (相似文献   

骨盆和骶骨骨巨细胞瘤的治疗策略

目的 探讨骨盆和骶骨骨巨细胞瘤(GCT)外科治疗的手术方法、局部复发率、并发症.方法 1997年12月至2005年12月我院共收治骶骨、骨盆GCT 46例,其中男性25例,女性21例.年龄17～64岁,平均32岁.骶骨GCT 24例、骨盆GCT 22例.骨盆Ⅰ区GCT(髂骨)8例,Ⅱ区(髋臼)10例,Ⅲ区(坐骨耻骨)4例.S1-5 GCT 2例,S1-4 4例,S1-3 12例,S1-2 5例,S3-5 1例.手术方法:行3次手术者2例,行2次手术者7例.骶骨GCT患者的治疗方式包括19例患者进行了病灶内边缘切除术,2例患者同时进行了病灶内边缘切除术和放疗,3例患者进行了广泛边缘切除术.骨盆22例GCT患者中,除2例坐骨及1例髂骨GCT患者采用刮除术外,其余19例均行大块切除术.结果 1例患者在外院手术后复发,肿瘤巨大、表面溃烂,再次手术后2周死于严重感染.余45例患者,随访时间12个月至8年,平均随访时间37个月.2例患者1年后死亡.1例骶骨GCT患者术后2年出现肺转移,化疗1周期,随访1年,肺部病灶无明显增大.1例髋臼部GCT患者刮除术后2年出现肺转移、局部复发,行肺部照射、髋臼部肿瘤广泛切除、人工半骨盆置换术,肺部病灶随访1年,控制良好.局部复发:骶骨:9/24(37.5%),其中复发2次的患者2例,复发1次的患者7例;骨盆:2/22(9.1%),2例坐骨GCT刮除后均局部复发;行大块切除的19例GCT均未复发.结论 对于骶骨GCT,由于刮除术后局部复发率高,治疗应该更具侵袭性.肿瘤广泛边缘切除术可能会引起骶神经损害,但由于局部复发率降低,所以仍为治疗的最佳选择.     

Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton

Background

Diagnosis and treatment of low-grade chondrosarcoma remain controversial. We performed a review of a single-center series with the aims of assessing the oncologic outcome of these patients, verifying if intralesional curettage can be adequate treatment, and defining clinical criteria to support the surgeon and the oncologist in decision-making for surgery and subsequent follow-up.

Materials and methods

A retrospective review of 85 patients was performed (61 females and 24 males, age range 20–76 years). The site of the lesion was the femur in 35 cases, humerus in 33, tibia in 15, and fibula in 2. Sixty-four patients were treated by intralesional curettage. Twenty-one patients with aggressive radiological patterns were treated with wide resection.

Results

Mean follow-up was 67 months (range 24–206 months). Two patients developed local recurrence, both after intralesional curettage. The difference in incidence of recurrence was not statistically significant between the two groups. No distant metastases were observed. Postsurgical complications were significantly higher in the resection group.

Conclusions

Low-grade chondrosarcoma of the appendicular skeleton without aggressive radiological patterns can be treated with intralesional surgery with good oncological outcome and very low rate of postsurgical complications. Wide resection, following surgical principles of malignant bone tumors, should be considered only when aggressive biologic behavior is evident on imaging.     

Long-term outcomes following en bloc resection for sacral tumor: a retrospective analysis of 93 cases

Sacral tumors are rare. Appropriate surgical resection is crucial to treat the disease while minimizing disease recurrence. We present the results of 93 patients with sacral tumors to analyze the long-term functional and oncological results of patients undergoing en bloc resection. The medical data between January 2003 and July 2010 was retrospectively reviewed. None of the 93 patients died intra- or postoperatively. Patients undergoing intralesional curettage (range, 6500-25,000 mL; mean, 13,500 mL) lost more blood than those patients with wide excision (range, 1000-8100 mL; mean, 3590 mL). Mean follow-up duration from the time of surgery until most recent clinic visit or death was 44.5 months (range, 6-105 months). This study is an educational tool regarding primary sacral tumors and provides evidence on the treatment. It presents results from a large group of patients with sacral tumor. After follow-up, we did not find that sacrificed nerve roots and surgical margins have an impact on the recurrence of the tumor. Patients undergoing intralesional curettage lost more blood than those patients with wide excision. Postoperative bladder/bowel dysfunction was more severe for patients with removal of S1 and S2.     

病灶内切除与整块切除治疗桡骨远端骨巨细胞瘤的Meta分析

目的 :用Meta分析的方法对国内外已发表较高质量的有关比较病灶内切除术和整块切除术对桡骨远端骨巨细胞瘤患者术后复发率、并发症发生率和功能康复结果的临床研究进行综合定量分析,为桡骨远端骨巨细胞瘤的外科治疗模式的选择提供参考依据。方法:计算机检索Cochrane图书馆(2014年8期)、Pub Med、Ovid、Elsevier、CNKI等数据库。检索从(1970-01-01/2013-01-01)年有关病灶内切除与整块切除治疗治疗桡骨远端骨巨细胞瘤的文献,筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane协作网提供的Rev Man 5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。计算病灶内切除术相对整块切除术其复发及并发症发生危险的优势比(OR),评价病灶内切除术与整块切除术对桡骨远端骨巨细胞瘤患者复发及并发症发生的影响。结果 :符合纳入标准的文献7篇,总样本量163例。其中病灶内切除术组92例(PMMA n=54,骨移植n=33,非PMMA或非骨移植n=5),整块切除术组71例。病灶内切除术组骨巨细胞瘤复发率比整块切除术组高[OR=3.87,95%CI(1.42,10.53)],而在Campanacci 3级GCTs中[OR=10.12,95%CI(1.57,65.27)],病灶内切除术组并发症发生率更少[OR=0.13,95%CI(0.04,0.40)],病灶内切除术组内用PMMA与骨移植物充填病灶的复发率没有明显差异[OR=0.96,95%CI(0.26,3.56)]。通过选择用MSTS系统评价、VAS系统评价和握力计系统评价时,病灶内切除术组在功能康复结果中优于整块切除组。结论:基于有限的资料,表明整块切除术更加适合治疗桡骨远端骨巨细胞瘤,而病灶内切除术在治疗桡骨远端骨巨细胞瘤的Campanacci 1、2级比3级更加适合,病灶内切除桡骨远端骨巨细胞瘤方面,PMMA并不优于骨移植物。病灶内切除桡骨远端骨巨细胞瘤在功能康复方面优于整块切除组。     

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

Background  

Because of the anatomic complexity of the pelvis, there is no standard surgical treatment for giant cell tumors (GCTs) of the pelvic bones, especially in the periacetabular region. Treatment options include intralesional curettage with or without adjunctive techniques and wide resection. The best surgical treatment of a pelvic GCT remains controversial.     

Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management

Background  

Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs.     

Surgical strategy for the management of sacral giant cell tumors: a 32-case series

Background contextSurgical treatment of sacral giant cell tumors (GCTs) is associated with a high rate of complications, and there is controversy over which type of surgical treatment is optimal.PurposeTo develop an optimal treatment strategy for sacral GCTs.Study design/settingRetrospective/academic medical center.Patient sampleA total of 32 patients (18 women and 14 men) with sacral GCT who underwent surgery between August 1996 and August 2008.Outcome measuresLocal recurrence rate, surgical margins, blood loss, sacral nerve root preservation, and complications.MethodsThe medical charts of 32 patients were reviewed.ResultsPatients underwent either wide resection (n=2), marginal resection (n=11), marginal resection plus curettage (n=12), or curettage alone (n=7). The curettage group and the wide resection group had the highest and lowest amounts of blood loss (4,500 vs. 1,300 mL, respectively). During follow-up (median, 42 months), 12 patients (37.5%) had local recurrence, including five of seven in the curettage group. The recurrence rate was significantly lower in the marginal excision group compared with that in the curettage group (18.2% vs. 71.4%, respectively; p=.049). Five patients had bladder dysfunction, and two patients had bowel dysfunction. Four patients who underwent marginal resection had lower limb dysfunction. Overall survival was 93.6%, and 2-year recurrence-free survival was 84.4%.ConclusionsChoosing an optimal surgical margin in the treatment of sacral GCTs is of great importance for local recurrence control and sacral nerve root preservation. Curettage alone should not be used to treat sacral GCT.     

Aneurysmal bone cyst of the mobile spine: report on 41 cases

STUDY DESIGN: Forty-one cases of aneurysmal bone cyst of the mobile spine were retrospectively reviewed. OBJECTIVES: To evaluate the role of surgical and nonsurgical treatment of aneurysmal bone cyst of the spine. SUMMARY OF BACKGROUND DATA: Ten to 30% of aneurysmal bone cysts arise from the mobile spine, frequently occurring in pediatric patients. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. Intralesional surgery seems to be an effective treatment, as well as radiotherapy and embolization. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Thirty-two patients underwent curettage (14 of them followed by radiotherapy), four were submitted to selective arterial embolization, three received radiotherapy alone, and two underwent en bloc-excision. RESULTS: All patients were found alive and disease free at final follow-up evaluation. Two recurrences followed one incomplete curettage and one embolization. The combination of curettage and radiotherapy, although effective, showed the greatest incidence of late axial deformity. Selective arterial embolization was curative in three of four cases and did not affect the possibility of surgery in case of local recurrence. CONCLUSIONS: If confirmed on larger series, selective arterial embolization seems to be the first treatment option for spine aneurysmal bone cyst, because of the low cost-to-benefit ratio. Diagnosis must be certain, based on pathognomonic radiographic pattern or on histologic study.- In case of neurologic involvement, pathologic fracture, technical impossibility of performing embolization, or local recurrence after at least two embolization procedures, complete intralesional excision would be the therapy of choice.     

Decision making in primary sacral tumors

Background contextPrimary tumors of the sacrum are extremely rare lesions. Their management is governed by an interplay of complex factors. Appropriate decision making is crucial to obtain the best possible outcome in terms of maximizing disease control while attempting to minimize neurological dysfunction.PurposeOur study presents the results of a group of patients with primary tumors of the sacrum who were surgically treated by the same multidisciplinary team at a specialist oncology center over a relatively short period of time (5 years).Study design/settingPatients were identified by a retrospective review from a prospectively maintained database.Patient sampleBetween January 2000 and December 2005, 17 primary sacral tumors were surgically treated at our institution, a referral center for oncology.Outcome measuresWe evaluated the outcome in terms of local disease control, residual neurological dysfunction, and complications as a result of surgical intervention.MethodsThere were 12 males and 5 females. The diagnosis included chordoma in six patients, giant cell tumor in seven patients, aneurysmal bone cyst in two patients, and a chondrosarcoma and an osteoblastoma in one patient each. Sixteen of these patients were analyzed. Four lesions had their upper extent at S1, six lesions had their upper extent at S2, four lesions had their upper extent at S3, and two lesions were below S3. Ten cases were treated with wide excision and underwent partial sacral amputations. Five cases had a midline sacral amputation through S1, three through S2, and two through S3. Six benign lesions were treated with curettage. None of the patients received chemotherapy. Four cases received postoperative radiation. The follow-up duration ranged from 18 to 44 months with a mean of 31 months.ResultsNone of the six patients who presented with loss of bladder and bowel control regained it after surgery. Of the 10 patients who had intact bladder and bowel control preoperatively only 4 retained bladder and bowel control postoperatively. Of the six patients who lost bladder and bowel control postoperatively, four patients had a wide excision where bilateral S2 roots were sacrificed. The other two cases in whom the disease extended up to S1 had curettage. Local recurrence occurred in 4 of the 10 lesions treated with wide excision. All the patients who had inadequate margins recurred. Local recurrence occurred in two of the six lesions treated with curettage. Three of the four cases who received postoperative irradiation developed recurrence. Our wound complication rate was 13%.ConclusionWide resection with adequate margins gives the best chance of local control and should be the surgery of choice for all malignant primary sacral tumors and in benign lesions involving lower segments when preservation of both S3 roots is possible. Intralesional curettage has a higher risk of local recurrence without providing the certainty of retaining neurological function. To retain bladder and bowel control and minimize neurological dysfunction, it may be worthwhile managing benign sacral tumors that extend above S3 with serial embolization. The administration of parentral bisphosphonates may prove beneficial in cases of giant cell tumor managed with serial embolization.     

Treatment of aneurysmal bone cysts of the pelvis and sacrum.

BACKGROUND: Aneurysmal bone cysts are benign, non-neoplastic, highly vascular bone lesions. The purpose of this study was to describe the prevalence, the clinical presentation, and the recurrence rate of aneurysmal bone cysts of the pelvis and sacrum and to examine the diagnostic and therapeutic options and prognosis for patients with this condition. METHODS: Forty consecutive patients with an aneurysmal bone cyst of the pelvis and/or sacrum were treated from 1921 to 1996. Their medical records and radiographic and imaging studies were reviewed, and histological sections from the cysts were examined. Seventeen lesions were iliosacral, sixteen were acetabular, and seven were ischiopubic. Seven involved the hip joint, and two involved the sacroiliac joint. All twelve sacral lesions extended to more than one sacral segment and were associated with neurological signs and symptoms. Destructive acetabular lesions were associated with pathological fracture in five patients and with medial migration of the femoral head, hip subluxation, and hip dislocation in one patient each. The mean duration of follow-up was thirteen years (range, three to fifty-three years). RESULTS: Thirty-five patients who were initially treated for a primary lesion had surgical treatment (twenty-one had excision-curettage and fourteen had intralesional excision); two patients also had adjuvant radiation therapy. Of the thirty-five patients, five (14%) had a local recurrence noted less than eighteen months after the operation. Of five patients initially treated for a recurrent lesion, one had a local recurrence. At the latest follow-up examination, all forty patients were disease-free and twenty-eight (70%) were asymptomatic. There were two deep infections. CONCLUSION: Aneurysmal bone cysts of the pelvis and sacrum are usually aggressive lesions associated with substantial bone destruction, pathological fractures, and local recurrence. Current management recommendations include preoperative selective arterial embolization, excision-curettage, and bone-grafting.     

原发动脉瘤样骨囊肿117例临床回顾分析

背景：刮除植骨是原发动脉瘤样骨囊肿的主要治疗方式,其他治疗方式如切除、激素注射、栓塞也见诸报道,均可获得较为满意的治愈率。目的：回顾性分析117例原发动脉瘤样骨囊肿的流行病学特点及影响其复发的相关因素,探讨原发动脉瘤样骨囊肿的治疗方案。方法：1993年2月至2011年5月共收治原发动脉瘤样骨囊肿117例,男68例,女49例;年龄7～60岁,平均23.1岁,中位年龄21岁;病变主要位于股骨、胫骨、脊柱、骨盆及肱骨。治疗手段主要为病灶刮除,还包括局部切除、激素注射、栓塞、放疗、单纯内固定。结果：1年以上随访期77例,随访时间为12～176个月,平均36个月。7例复发,术后复发时间为6～102个月,中位术后复发时间为20个月,复发率为9.1%。复发病例均为病灶刮除患者,其中骨盆3例,股骨4例。初始行非手术治疗8例,其中6例可见病变修复。结论：病灶刮除仍是原发动脉瘤样骨囊肿的主要治疗手段,骨盆病变及复发病变接受治疗后的复发风险较大,对病变部位手术难度大或术后肢体功能影响较大的病变可试行非手术治疗,合理的治疗方案选择有助于控制复发率并保留肢体功能。     

成软骨细胞瘤65例临床分析

目的分析成软骨细胞瘤的特点、治疗方法和疗效。方法收集我院自1994年-2011年经手术病理确诊并有完整随访资料的成软骨细胞瘤共65例。其中男45例,女20例,男女比例为2.25︰1;年龄3~45岁,平均(18.42±7.94)岁。病变部位为胫骨近端8例(12%),股骨远端11例(17%),股骨近端23例(35%),肱骨近端和距骨各4例(6%),髌骨3例,跟骨和骨盆各2例,足舟骨、桡骨近端、桡骨远端、肋骨、肩胛骨、腓骨、股骨干、C7附件各1例。行单纯病灶内刮除5例,刮除植骨40例,刮除骨水泥填充11例。行瘤段切除9例(人工关节置换4例,单纯瘤段切除5例)。结果平均随访65.3个月(15~200个月)。3例局部复发,经再次手术治疗无复发。复发率为4.6%。未发现转移者。结论成软骨细胞瘤影像学诊断易与骨巨细胞瘤等混淆,病灶内刮除术可以达到较好的疗效,在保证患者肢体功能的前提下适度扩大病灶的切除范围可降低其复发率。     

Treatment of giant cell tumor of the distal radius

The results of surgical treatment of giant cell tumors of the distal radius were reviewed in 12 patients between 1982 and 1995. All 12 patients had Grade III lesions. Six of the 12 patients were treated using intralesional curettage with local excision, and the other six patients underwent en bloc resection with total condyle (four of the six by osteoarticular allograft, and the other two by fibular autograft) reconstruction with the aim of preserving the functional joint. There were no early or late complications such as infection, graft fracture, implant failure, or nonunion. No local tumor recurrence was seen in either group during the average followup of 6 years (range, 3-16 years). The best functional result was seen in the patients treated with intralesional curettage. The functional result of the resection group was good, achieving an average of 69% (range, 56%-83%) of their range of motion and 70% (range, 63%-77%) of their grip strength on the contralateral side. Intralesional excision should not be excluded as a possible treatment of Grade III lesions, although en bloc resection was used more commonly for these lesions because of tumor surgery reasons. Grade III lesions were treated with curettage when the tumor did not invade the wrist, destroy more than 50% of the cortex, or break through the cortex with an extraosseous mass in more than one plane. Reconstruction with osteoarticular allograft after en bloc resection is recommended in this non-weightbearing joint when there is contraindication for curettage of the lesion.     

Neue Therapieansätze beim Riesenzelltumor

Background

Giant cell bone tumors (GCT) are benign but partially locally aggressive osteolytic tumors which typically occur around the knee joint in the epiphysis and metaphysis of long bones after maturation of the skeleton is completed. Due to the locally aggressive growth behavior with destruction of the bone structure, the rare possibility of pulmonary metastases in recurrent cases and a very rare possibility of malignancy, GCTs were previously also described as semimalignant bone tumors.

Therapy

The established therapy of these tumors at the typical locations consists of intralesional curettage, extension of resection margins using a high speed trephine and defect reconstruction with bone cement. The local recurrence rate is high (10–40?%) and lowest after using thermal extension of resection margins with a high speed trephine and defect reconstruction with bone cement. For uncommon localizations, such as the spinal column and the sacrum as well as in cases of recurrence, surgical treatment is more complicated.

Histology

Histologically, GCTs consist of osteoclastic giant and oval-shaped stromal cells which show a high expression of receptor activator of nuclear factor-κB ligand (RANKL) and decisively contribute to the osteolytic activity of the tumor. Novel pharmaceutical therapy approaches with human monoclonal RANKL antibodies interfere in this osteodestructive process in an inhibitory manner and can represent alternative treatment options just as the osteosupportive therapy with bisphosphonates.

Conclusion

After unsatisfactory attempts at surgical treatment of GCT patients, the new treatment option with denosumab is a promising alternative due to its effect as a monoclonal RANKL inhibitor. Nach unbefriedigenden chirurgischen Therapieversuchen bei RZT-Patienten ist Denosumab durch seine Wirkung als monoklonaler RANKL-Inhibitor als neue Behandlungsoption eine vielversprechende Alternative.     

Chondroblastoma of the Foot: 40 Cases From a Single Institution

Chondroblastoma (CB) of the foot is a rare lesion. The purpose of this report was to report a large series from a single institution to analyze clinical, radiographic, and histologic characteristics; treatment; and local recurrence.We present 40 patients (30 males, 10 females; mean age 25 years) diagnosed and treated for CB of the foot from 1975 to 2012. The mean follow-up visit was 55 months (range 7 months to 11 years). Clinical presentation, histology, imaging, surgical treatment, and local recurrence were evaluated. Males were more affected than females. The main symptom was pain (100%) accompanied by swelling (35%), with median duration of 12 months. The talus (50%) and calcaneus (37.5%) were the most affected bones. All patients underwent surgery: curettage (10 cases), curettage and bone graft (15 cases), curettage and cement (13 cases), wide resection (1 case), and Chopart amputation (1 case). Ten patients (25%) had secondary aneurysmal bone cyst. One patient had local recurrence after surgery.In conclusion, patients with CB of the foot are usually older than 20 years, and males are most affected. The hindfoot is the most affected area. Surgical treatment is required, and intralesional curettage and packing with cement or graft is curative in most cases. Local recurrence in foot is lower than in other locations.     

Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the literature

The optimal treatment of giant cell tumors of the pelvis and sacrum is controversial. Our current patient series was combined with cases identified in a review of the literature published in the past 50 years, yielding a combined group of 239 lesions for study. Recurrence rates were 49% for patients who had radiation therapy alone, 47% for patients who had surgery with intralesional margins, 46% for patients who had surgery with intralesional margins and radiation therapy, and 0% for patients who had surgery with wide margins. Six percent of patients had benign lung metastases develop, 2% of patients had secondary malignancies, 2% of patients died in the perioperative period, and less than 1% of patients had multicentricity. Radiation-induced sarcoma developed in 11% of patients who received radiation for primary or recurrent lesions. Larger doses of radiation therapy did not decrease the rate of local recurrence. Recurrence after surgery and radiation was not lower than after either treatment alone. Local recurrence was more likely in the patients with sacral tumors (48%) than in the patients with pelvic tumors (34%). Disease status was worse in the patients with sacral lesions (23% died of disease) than in the patients with pelvic lesions (6% died of disease).