Giant-cell tumor of bone with pulmonary metastases

We reviewed the cases of seven patients with histologically benign primary giant-cell tumor of bone and histologically proved metastases to the lung. All seven had a Stage-3, aggressive, benign lesion with interruption of the cortex and soft-tissue extension. The main histological features of the primary lesion were identical to those of the pulmonary metastases. In only one of the seven patients were the metastases detected simultaneously with the primary lesion. All seven patients were treated by surgical resection of the lung nodules and chemotherapy. Of the seven patients, four were alive and free of disease after an average follow-up of nine years; two were receiving chemotherapy; and one, who had had immunosuppression for an allograft transplant, died less than one year after the discovery of the pulmonary lesions. Based on this small series, we concluded that patients with a Stage-3 giant-cell tumor of bone may be at risk for pulmonary spread of the disease. This lesion, with its benign histological picture even in lung lesions, has a favorable prognosis when treated with pulmonary resection of the nodules. However, the role for chemotherapy after pulmonary surgery is still unclear.     

A giant testicular tumor detected with dyspnea due to lung metastases: a case report

A 19-year-old male presented with dyspnea. Clinical examination revealed the left infant-head-sized testicular tumor, multiple lung metastases and retroperitoneal bulky lymph node metastasis with marked elevation of serum lactic dehydrogenase (LDH) and alpha-fetoprotein. Left radical orchiectomy followed by the chemotherapy with etoposide and cisplatin (EP) for 4 cycles was performed. The tumor weighed 1,700 g, and was pathologically diagnosed as mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor. After the treatment, the tumor markers were normalized with partial response (PR) of lung metastases and complete response (CR) of retroperitoneal lymph node metastasis. Thereafter, biopsy of lung metastases through video-assisted thoracoscopic surgery (VATS) was performed, and pathologically no viable cells were detected. Five months after the treatment, he was seized with convulsion due to brain metastasis with hemorrhage. Therefore, a surgical resection of brain metastasis and 2nd line chemotherapy with etoposide, ifosfamide and cisplatin (VIP) chemotherapy for 3 cycles was performed. The patient has been free of recurrence for 21 months after the 2nd line chemotherapy.     

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 tumors of the patella

This study describes the clinical, radiographic, and histopathologic features, and discusses the management options of 11 cases of benign giant-cell tumors of the patella seen over 20 years. Fine needle aspiration cytology was a useful preoperative diagnostic tool. Ptellectomy and reconstruction of the extensor apparatus is the favored treatment option with curettage and bone grafting restricted to selected localized lesions.     

髌骨软骨母细胞瘤1例

患者,男,17岁。1年前无明显诱因出现右膝酸痛,右侧股四头肌萎缩,并伴有行走乏力,曾在当地医院就诊,行右下肢股四头肌肌电图检查,考虑为股神经损害,给予药物"弥可保"营养神经治疗,但症状改善不明显,为求进一步诊治于2011年3月4日就诊并入院。患者无明确外伤史。查体:双下肢等长,右侧股四头肌萎缩,右侧髌骨上10cm处周径较左侧短缩5cm,右膝关节无内、外翻畸形,未见明显肿胀,触之皮温略高,右膝关节浮髌试验阴性,髌骨摩擦试验阴性,髌骨压痛阳性,无半月板及韧带损伤体征。实验室检查结果未见明显异     

Giant-cell tumour in the cervical spine: a case report

A forty-six-year-old man presented with a two-month history of increasing neck pain of insidious onset. He received treatment from his familty doctor and chiropractor consisting of analgesics and manipulation respectively, both of which did not offer relief. The patient presented to University Hospital where plain radiographs and CT showed a pathological fracture of the C4 vertebral body. A neoplasm was suspected and surgical excision revealed a giant-cell tumour of bone. This type of neoplasm is rare in the spine and difficult to manage in this site. This case highlights some of the problems encountered in the treatment of giant-cell tumour of the spine.     

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.     

Superior dislocation of the patella: a case report

Background  

Superior dislocation of the patella is an uncommon condition that mainly occurs in knees with a high patella and medial femorotibial degenerative arthritis. There are no previous reports of this condition occurring in association with tibial valgus osteotomy. Case report: We report the case of a patient in whom vertical dislocation recurred twice at 4 months after tibial valgus osteotomy. To avert additional recurrence or new dislocations, the patient was treated surgically to remove the existing osteophytes. Conclusions: An arthroscopic approach was decided because of the lower associated morbidity and good results with this technique compared to open surgery.