Radiation therapy for giant cell tumors of bone

For giant cell tumors of bone, does radiotherapy provide a safe and effective treatment? This retrospective review includes 24 patients with 26 histologically diagnosed tumors treated with megavoltage radiotherapy between March 1972 and July 1996. Of the 10 recurrent tumors, five had an intralesional resection, two had a biopsy, and three had no biopsy before radiotherapy. Of the 16 previously untreated tumors, one was irradiated after a marginal resection, five after an intracapsular resection, and 10 after biopsy alone. The total doses ranged from 35 to 55 Gy (median, 43 Gy) in fractions of 1.67 to 2.33 Gy per day. Twenty of 26 tumors (77%) were controlled locally. All of the local recurrences occurred within the irradiated field. Five of six patients with local recurrence were treated successfully with additional surgery. Salvage surgery after local recurrence required amputation of an extremity in three patients and a total knee replacement in one patient. The ultimate local control rate was 96% with one patient alive with progressive disease. Lung metastases in one patient were treated successfully with surgery, chemotherapy, and radiotherapy. In one patient a radiation-induced sarcoma developed 22 years after treatment. The authors conclude that radiation therapy is a safe and effective treatment option for benign giant cell tumors of bone. A total dose greater than 40 Gy is the only variable found to significantly influence local control.     

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.     

Multinucleated giant cells in cultured giant cell tumor of bone

Further observations on multinucleated giant cells (MGCs) in 12 giant cell tumors of bone (GCT) were made, by means of tissue culture, electron microscopy and immunohistochemistry. In continuous in vitro culture, two distinct types of MGCs were found and herein termed preliminarily short-lived MGCs and long-lived MGCs respectively. The former type had limited life span of about 2-3 weeks, whereas the latter type of MGCs maintained growth or continual formation. They had entirely different appearance and characteristics. This fact reflects two types of MGCs exist in GCT in vivo. Besides, the origin of MGCs were also investigated and discussed in considerable depth.     

脊柱骨巨细胞瘤的综合治疗

脊柱骨巨细胞瘤是一种原发于脊柱的良性肿瘤,血运丰富,侵袭性生长,易复发,并可发生肺转移,因此治疗难度大.文中综述了各种治疗方法及其效果,包括外科治疗、放射治疗、动脉栓塞治疗及其发生肺转移时的治疗方法.结果显示:目前,对于脊柱骨巨细胞瘤,最有效的治疗方法是广泛或边界的整块切除,如果不能达到边界切除,则应辅助放射治疗,消灭可能残留的肿瘤细胞,巨大的骶骨骨巨细胞瘤可采用连续动脉内栓塞治疗.对于发生肺转移的脊柱骨巨细胞瘤,可以通过肺叶切除和(或)采用化疗来控制.     

骨巨细胞瘤临床分级与手术方法

目的探讨骨巨细胞瘤临床、病理、X线分级和各种术式的选择与疗效。方法对107例经手术病理证实的骨巨细胞瘤患者,根据临床、病理、X线分级程度采用刮除植骨、骨水泥填充、大块切除、人工关节置换等不同手术方式进行治疗。通过随访观察疗效。结果随访6～70个月（平均24个月）。刮除植骨14例,复发2例;刮除骨水泥填充术42例,复发4例;肿瘤骨大块切除,带血管腓骨髂骨重建25例,复发1例;瘤段切除26例,均无复发。结论骨巨细胞瘤的临床症状、病例、X线三结合综合分期,对确定其属性和程度,正确估计预后和选择适当的手术方案有重要的临床意义。     

骨巨细胞瘤辅助性化疗现代观点

作为骨巨细胞瘤的辅助治疗方法,化疗的必要性和适用范围一直存在争议.传统观点认为化疗不良反应大,可产生免疫抑制,影响骨质愈合;化疗药物一般只对增殖中的细胞有抑制作用,而骨巨细胞瘤细胞增殖比率不高,对化疗不敏感,疗效常不令人满意.进一步研究发现化疗药物对体外培养的骨巨细胞瘤细胞的克隆增殖有明显抑制作用,这为骨巨细胞瘤临床化疗提供了理论依据.临床治疗中对恶性程度高或手术彻底切除的骨巨细胞瘤多采用全身化疗或局部化疗.有学者证实瘤腔内化疗确实能杀灭残存的肿瘤细胞,全身或局部化疗能降低骨巨细胞瘤复发率和转移率.骨巨细胞瘤化疗的适应证、药物选择和应用方式,有待进一步研究.     

骨巨细胞瘤诊断与治疗现状

骨巨细胞瘤(GCT)是最常见的原发性骨肿瘤之一.早期研究表明,病灶简单刮除、植骨术后关节功能满意,但局部复发率很高.随着更为先进的影像技术和各种物理化学辅助措施如液氮冷冻、骨水泥等的应用,GCT复发率降低,预后改善.GCT瘤体整块切除适用于部分患者,使复发率更低,但需行复杂的重建手术.普遍认为,GCT病理学及影像学分期...     

关于多中心骨巨细胞瘤的系统回顾

骨巨细胞瘤是一种具有侵袭性的良性骨肿瘤,常为单发病灶,多中心发病者罕见,报道以个案为主。为进一步分析多中心骨巨细胞瘤的基本特点,总结其治疗方法和预后情况,作者搜集了国内外数据库中关于多中心骨巨细胞瘤的病例研究,对其做出了系统的分析和归纳,旨在为临床医生提供更多参考。多中心骨巨细胞瘤的发病年龄相对年轻,好发于骨骼未成熟的患者,女性多于男性,干骺端及手足骨的发病率高于单发者。病理组织学检查是明确诊断的最终手段,对患者进行系统的影像和核医学检查可以避免漏诊,在治疗时要求坚持对各个病灶独立评估其特点,确定治疗方案。多中心骨巨细胞瘤患者及高危患者应坚持长期随访。     

骨巨细胞瘤细胞生物学研究进展

骨巨细胞瘤(GCT)血管生成、局部浸润、细胞生物学方面的研究,近年有了新的进展.研究表明促血管内皮生长因子不仅可促进肿瘤血管生成,还可直接调节肿瘤细胞增殖;对基质金属蛋白酶在肿瘤细胞局部侵袭中的作用提出了怀疑;增殖调节基因p21、p27及细胞周期素D1之间的相互作用调节了肿瘤细胞增殖和巨细胞形成等;GCT可能来自成骨细胞谱系.这些新认识对GCT治疗、预后判断提供了帮助.     

Virus-like intranuclear inclusions in giant cell tumor of bone

An ultrastructural study of 13 cases of typical giant cell tumor of bone (GCT) revealed the presence of virus-like intranuclear inclusions (INI), morphologically identical to those reported in Paget's disease of bone. In two giant cells of two different patients, INI were found only after careful survey of a great number of cells. This finding, coupled with the scarcity of GCT with similar inclusions reported in the literature, reveals the extreme rarity of this finding and leaves open to discussion the specificity of these INI even in Paget's disease, as well as the possible etiological significance in giant cell tumor of bone.     

Clonality studies in giant cell tumor of bone.

Genetic studies including chromosome analysis, telomere reduction and telomere activity, DNA microsatellites and loss of heterozygosity (LOH) studies have been performed on giant cell tumor (GCT) of bone however whether this primary skeletal neoplasm represents a monoclonal or polyclonal proliferation is unknown. Utilizing a new assay to study the polymorphic human androgen receptor locus (HUMARA), the ratio of maternal inactive X-chromosome to the paternal inactive X (Lyon hypothesis) is determined via a methylation--specific polymerase chain reaction (PCR) technique to detect X-chromosome polymorphisms. Characterization of the genetic tumorigenesis of this unpredictable neoplasm may lend insight into its biological behavior and offer improvements in therapeutic intervention, as new information emerges regarding osteoclastic bone resorption. Seventeen female patients with giant cell tumor of bone had their DNA harvested and their X-chromosome inactivation pattern and polymorphisms determined and compared to control. A polyclonal proliferation pattern was identified in all informative samples studied.     

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。     

Iatrogenic giant cell tumor at bone graft harvesting site

30 year old female patient with giant cell tumor of the distal tibia initially treated at a peripheral nononcological center by curettage and autologous bone grafting from the ipsilateral iliac crest reported to us with local recurrence and an implantation giant cell tumor at the graft harvesting site which required extensive surgeries at both sites. The risk of iatrogenic direct implantation of tumor, often attributable to inadequate surgical planning or poor surgical techniques, and the steps to prevent such complication is reported here.     

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。     

骨巨细胞瘤复发合并感染的治疗个案报道

骨巨细胞瘤（giant cell tumor of bone,GCT）是一种具侵袭性、潜在恶性的骨肿瘤,在我国发病率为105％～155％,较欧美国家为多。膝关节是骨巨细胞瘤的好发部位,占全身各部位骨巨细胞瘤的50％以上。由于膝关节功能的负重性,此处患病直接影响患者的生活质量。骨巨细胞瘤的复发率较高,但是合并局部感染的患者并不多见。笔者于2006年收治1例骨巨细胞瘤复发合并感染的患者,现将治疗经过报道如下。     

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。     

肩胛骨骨巨细胞瘤1例

骨巨细胞瘤是常见的原发性骨肿瘤之一,起始于骨髓内间叶组织,原发部位几乎都发生在长管状骨干骺端,原发于肩胛骨极为少见。1病例资料患者,男,33岁。因右肩肩胛骨肿块7个月入院。无明显诱因及症状,无家族病史。查体:一般情况良好,发育正常,营养中等,无明显消瘦,双上肢前屈、后伸