Denosumab Therapy Related Changes in Giant cell Tumor (Osteoclastoma) of Bone : A New Osteosarcoma Mimicker

Vol 4 | Issue 2 | July-Dec 2018 | Page 4-6 | Pradnya Manglekar, Sujit Joshi, Yogesh Panchwagh.

Authors: Pradnya Manglekar [1], Sujit Joshi [1], Yogesh Panchwagh [1].

[1] Dept. of Pathology Deenanath Mangeshkar Hospital and Research Centre, Pune
[2] Orthopaedic Oncology Clinic, Pune, India.

Address of Correspondence
Dr. Sujit Joshi,
Dept. of Pathology Deenanath Mangeshkar Hospital and Research Centre, Pune


Objectives: Giant cell tumor (Osteoclastoma)of bone is locally aggressive osteolytic tumor. Denosumab–A monoclonal antibody against RANKL is recently being used to treat this tumor. We discuss histopathological changes occurring in giant cell tumor of bone after Denosumab treatment.
Method: A retrospective study of 12 cases from January 2014 to March 2018. All patients included were diagnosed as giant cell tumor (osteoclastoma) of bone on needle or open biopsy. Subsequently these patients received Denosumab therapy followed by surgical resection (extended curettage or wide excision). Histomorphological features after Denosumab therapy were evaluated in these specimens and compared with morphological features of prior biopsy samples.
Results: Needle or open biopsy samples studied prior to receiving Denosumab therapy showed typical morphological features of osteoclastoma i.e. presence of uniformly distributed osteoclastic cells and sheets of mononuclear stromal cells. No atypical mitoses or matrix production noted. Post Denosumab therapy resection specimens showed marked reduction in number of osteoclastic giant cells. There was predominance of mononuclear stromal cells along with abundant, irregular new bone (osteoid) formation with osteoid matrix deposition. Occasional mitotic activity was seen. Few foci of necrosis were noted.
Conclusion: Denosumab treatment causes significant giant cell depletion accompanied by abundant new bone formation separated by cellular stromal proliferation. These features bear very little resemblance to their pre-treatment counterparts and can mimic morphological features of osteosarcoma and other bone forming tumors. Hence, one should be aware of these changes so that a misdiagnosis of osteosarcoma can be avoided.
Keywords: Giant cell tumor (osteoclastoma), Denosumab, RANKL.


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How to Cite this article: Manglekar P, Joshi S, Panchwagh Y. Denosumab Therapy Related Changes in Giant cell Tumor (Osteoclastoma) of Bone : A New Osteosarcoma Mimicker. Journal of Bone and Soft Tissue TumorsJuly-Dec 2018;4(2):4-6.

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JBST- Special APMSTS 2018 Issue

Vol 4 | Issue 2 | July-Dec 2018 | page:1 | Dr. Yogesh Panchwagh, Dr. Ashish Gulia,  Dr. Ashok Shyam.

Author: Yogesh Panchwagh [1], Ashish Gulia [2], Ashok Shyam [1,3].

[1] Orthopaedic Oncology Clinic, Pune, India.
[2] Orthopedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai.
[3] Indian Orthopaedic Research Group, Thane, India,
[4] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Yogesh Panchwagh.
Orthopaedic Oncology Clinic, 101, Vasant plot 29, Bharat Kunj Society -2, Erandwana, Pune – 38, India.

JBST- Special APMSTS 2018 Issue

It gives us immense pleasure in presenting the special IMSOS (Indian Musculoskeletal Oncology Society) issue of Journal of bone and soft tissue tumors on the occasion of the 12th Asia Pacific Musculoskeletal Tumor Society meeting, Jaipur, India. It’s only the second time, the first being in 2002, that APMSTS conference is being held in India. It is being co-hosted by the IMSOS, a relatively new body comprising of mostly the young but enthusiastic clinicians and paramedical staff involved in sarcoma care in India. Under the able presidentship of Dr Ajay Puri, a veteran in the field, the 12th APMSTS is all set to give the delegates a memorable experience. It’s but natural that Dr Ajay Puri, President – APMSTS 2018 and IMSOS has penned the guest editorial for this issue.

JBST (Journal of bone and soft tissue tumors) is proud to be associated with IMSOS as its official journal. All the members of IMSOS have contributed wholeheartedly to this issue echoing the theme of APMSTS 2018: “Education – Collaboration – Innovation”. The issue comprises of original articles on the data from institutes located across India on varied topics ranging from demographics of sarcoma in eastern India to osteosarcoma of facial bones from South India to recent topics like post denosumab changes in the histopathology of Giant cell tumors from western India. Even the case reports, which are rare clinical presentations of pathologies like osseous hydatid cyst, chordoma, clear cell chondrosarcoma, sacral inclusion cyst, hold a high educational value.

We also take this opportunity to invite all delegates to submit to Journal of Bone and Soft tissue tumors, which is one of the few journals that publish bone tumor research. We have a great editorial board and an online submission and review system. JBST has completed four years now and we are committed to make JBST the best resource for publishing bone tumor research in the world. This can be only achieved by co-operation and collaboration from all of you

We are happy to present this issue at the 12th APMSTS at Jaipur. Hope you will enjoy it as much as the vibrant, colourful and warm Indian hospitality.

Dr. Yogesh Panchwagh
Dr. Ashish Gulia
Dr. Ashok Shyam

How to Cite this article: Panchwagh Y, Gulia A, Shyam AK. JBST – Special APMSTS 2018 Issue. Journal of Bone and Soft Tissue Tumors July-Dec 2018; 4(2):1.

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