Tag Archive for: giant-cell tumor

Local Recurrences of Giant Cell Tumor of Bones after Extended Surgical Curettage – A Retrospective Cohort Study

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 9-12 | DOI: 10.13107/jbst.2020.v06i01.007

Author: Dominic K Puthur [1], Dijoe Davis [1], N Sanjay [1]

1. Department of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence
Dr. Dijoe Davis,
Department of Orthopaedics, Amala Institute of Medical Sciences,
Cloud Nine, Kollannur Villas, Jasmin Road, Near Water Tank Street
Nehrunagar, Kuriachira P.O, Thrissur – 680 006, Kerala, India.
E-mail: dr.dijoe@gmail.com

Abstract

Introduction: Giant cell tumor of bone (GCTB) is a locally aggressive tumor well known for recurrence after surgical treatment. Local recurrence rate ranged from 10 to 25%. The objectives of this study are to find out the incidence of recurrence in GCT after extended surgical curettage, factors affecting recurrence, and also to find the best modality of treatment available for the recurred GCT.
Materials and Methods: It was a retrospective cohort study of 225 patients diagnosed and treated by extended surgical curettage in the Orthopaedic Department of a Tertiary Care Hospital in South India, between January 2003 and December 2017. Patients were followed up clinically and radiologically for diagnosis of recurrence. Factors affecting the recurrence were analyzed. These recurrent cases were further followed up. IBM SPSS v23 was used for data analysis such as age, gender, site of lesion and side, and material used to fill the defect after curettage. Descriptive statistics was elaborated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Fisher’s exact test is used for comparison.
Results: Recurrence was found in 27 patients of 225 cases of GCTB treated by extended surgical curettage. These include 9 of 135 cases initially treated by extended curettage and bone cement and 18 of 88 cases initially treated by curettage and bone graft. Recurrence was found to be more common in males than females.
Conclusions: Local recurrence is significantly lower in patients treated by cementation following extended surgical curettage than bone graft which makes bone cement as a better filling material with regard to recurrence.
Keywords: Giant cell tumor, Curettage, Bone cement, Bone graft, South India.

References

1. Fletcher CD. Who Classification of Tumours of Soft Tissue and Bone. Geneva: World Health Organization; 2013.
2. Puri A, Agarwal M. Treatment of giant cell tumor of bone: Current concepts. Indian J Orthop 2007;41:101-8.
3. Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone-an overview. Arch Bone Jt Surg 2016;4:2-9.
4. Rao PT. Management of giant cell tumor of bone. Kini memorial oration. Indian J Orthop 1993;27:96-100.
5. Huvos AG. Bone Tumors: Diagnosis, Treatment and Prognosis. 2nd ed. Philadelphia, PA: WB Saunders Co.; 1991. p. 429.
6. Reddy CR, Rao PS, Rajakumari K. Giant cell tumour of bone in South India. J Bone Joint Surg 1974;56:617-9, 106-114.
7. Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res 2002;400:201-10.
8. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res 2004;424:221-6.
9. Cavanna L, Biasini C, Monfredo M, Maniscalco P, Mori M. Giant cell tumor of bone. Oncologist 2014;19:1207.
10. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.
11. Nelson DA, Barker ME, Hamlin BH. Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia 1997;13:287-306.
12. Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res 1998;347:250-60.
13. Quint U, Müller RT, Müller G. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg 1998;117:43-6.
14. Balke M, Ahrens H, Streitbuerger A, Koehler G, Winkelmann W, Gosheger G, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol 2009;135:149-58.
15. Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Recurrent giant cell tumor of long bones: Analysis of surgical management. Clin Orthop Relat Res 2011;469:1181-7.
16. Puthoor DK, Puthezhath K. Management of giant cell tumor of bone: Computerized tomography based selection strategy and approaching the lesion through the site of cortical break. Orthop Surg 2012;4:76-82.
17. Puthoor D, Iype W. Giant cell tumor: Curettage and bone grafting. Indian J Orthop 2007;41:121-3.
18. Dominic K, Dijoe D, Aravind R. Extended curettage and reconstruction with proximal fibula for treating giant cell tumor of lateral femoral condyle: A prospective study. Arch Clin Exp Surg 2017;6:1.
19. Puthoor DK, Davis D, Francis L. The incidence and distribution of pathological fractures in giant cell tumour of bone-a retrospective study. Kerala J Orthop 2018;31920:27-31.
20. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.
21. Lausten GS, Jensen PK, Schiødt T, Lund B. Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases. Int Orthop 1996;20:172-6.
22. Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jörgensen P, et al. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian sarcoma group
study. J Bone Joint Surg Br 2006;88:531-5.
23. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: A Canadian sarcoma group study. Clin Orthop Relat Res 2002;397:248-58.
24. Nahal A, Ajlan A, Alcindor T, Turcotte R. Dedifferentiated giant cell tumour of bone in the form of low-grade fibroblastic osteogenic sarcoma: Case report of a unique presentation with follow-up. Curr Oncol
2010;17:71-6.
25. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer 2003;97:2520-9.
26. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.
27. Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giantcell tumor of bone with pulmonary metastases: Clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol
1992;158:331-4.
28. Dahlin DC. Caldwell lecture. Giant cell tumor of bone: Highlights of 407 cases. AJR Am J Roentgenol 1985;144:955-60.

 

How to Cite this article: Puthur D K, Davis D, Sanjay N | Local Recurrences of Giant Cell Tumor of Bones After Extended Surgical Curettage– A Retrospective Cohort Study | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2020; 6(1): 9-12.

[Full Text HTML]    [Full Text PDF] [XML]

Health-Related Quality of Life in Patients with Bone Tumor around the Knee after Resection Arthrodesis

Vol 5 | Issue 1 | Jan-April 2019 | page: 17-20 | Wilasinee Sirichativapee, Weerachai Kosuwon, Winai Sirichativapee.

Authors: Wilasinee Sirichativapee [1], Weerachai Kosuwon [1], Winai Sirichativapee [1].

[1] Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Address of Correspondence
Dr. Winai Sirichativapee,
Department of Orthopaedics, Srinagarind Hospital, 123 Khon Kaen University, Nai Mueang Sub-District, Mueang District, Khon Kaen Province – 40002, Thailand.
E-mail: winaisiri@yahoo.com

Abstract

Background: This study aimed to compare the health-related quality of life (HRQoL) of patient with bone tumor around the knee after resection arthrodesis.
Methods: Patients between 15 and 70 years of age who underwent resection arthrodesis in Srinagarind Hospital >1 year were recruited. Patients were interviewed using a short form-36 questionnaire (social functioning-36 [SF-36] Ver2.0 Thai version) regarding their daily life problems.
Results: Eighteen patients with the mean age of 36.6 years (15–63 years) were included (15 females) in the study. Histological diagnoses were giant cell tumor 10 cases, osteosarcoma seven cases, and low-grade chondrosarcoma one case. Site of lesions was distal femur 15 cases and proximal tibia 3 cases. According to HRQoL, patients have good quality of life (score SF-36 >70) in all domains: Mean score: Physical functioning 75.55 ± 21.88, role physical 71.18 ± 22.70, bodily pain 85.41 ± 22.51, vitality 77.43 ± 16.76, general health 74.44 ± 19.16, SF 83.05 ± 26.40, role emotional 80.09 ± 22.89, and mental health 77.77 ± 21.29. Complications post-operative are broken implants (3 cases, 16.7%) and infections (4 cases, 22.2%).
Conclusion: In patients with bone tumor around the knee after resection, arthrodesis has a good quality of life in all domains in SF-36 version 2.0 questionnaire including function, pain, and mentality.
Keywords: Limb salvage, Arthrodesis, Quality of life, social functioning-36 version 2.0, Osteosarcoma, Giant cell tumor.

References

1. Tarnawska-Pierścińska M, Hołody Ł, Braziewicz J, Królicki L. Bone metastases diagnosis possibilities in studies with the use of 18F-NaF and 18F-FDG. Nucl Med Rev Cent East Eur 2011;14:105-8.
2. Sampath SC, Sampath SC, Mosci C, Lutz AM, Willmann JK, Mittra ES, et al. Detection of osseous metastasis by 18F-NaF/18F-FDG PET/CT versus CT alone. Clin Nucl Med 2015;40:e173-7.
3. Harisankar CN, Agrawal K, Bhattacharya A, Mittal BR. F-18 fluoro-deoxy-glucose and F-18 sodium fluoride cocktail PET/CT scan in patients with breast cancer having equivocal bone SPECT/CT. Indian J Nucl Med 2014;29:81-6.
4. Roop MJ, Singh B, Singh H, Watts A, Kohli PS, Mittal BR, et al. Incremental value of cocktail 18F-FDG and 18F-NaF PET/CT over 18F-FDG PET/CT alone for characterization of skeletal metastasesin breast cancer. Clin Nucl Med 2017;42:335-40.
5. Chan HP, Hu C, Yu CC, Huang TC, Peng NJ. Added value of using a cocktail of F-18 sodium fluoride and F-18 fluorodeoxyglucose in positron emission tomography/computed tomography for detecting bony metastasis: A case report. Medicine (Baltimore) 2015;94:e687.
6. Iagaru A, Mittra E, Mosci C, Dick DW, Sathekge M, Prakash V, et al. Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: Results of an international multicenter trial. J Nucl Med 2013;54:176-83.
7. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN Clinical Practice Guidelines in Oncology Breast Cancer Version 2; 2016. Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. [Last accessed on 2016 Oct 19].
8. Yoon SH, Kim KS, Kang SY, Song HS, Jo KS, Choi BH, et al. Usefulness of (18)F-fluoride PET/CT in breast cancer patients with osteosclerotic bone metastases. Nucl Med Mol Imaging 2013;47:27-35.
9. Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging 2006;33:1280-4.
10. Lapa P, Saraiva T, Silva R, Marques M, Costa G, Lima JP. Superiority of 18F-Fna PET/CT for detecting bone metastases in comparison with other diagnostic ımaging modalities. Acta Med Port 2017;30:53-60.
11. Araz M, Aras G, Küçük ÖN. The role of 18F-NaF PET/CT in metastatic bone disease. J Bone Oncol 2015;4:92-7.
12. Schirrmeister H, Glatting G, Hetzel J, Nüssle K, Arslandemir C, Buck AK. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42:1800-4.
13. Piccardo A, Puntoni M, Morbelli S, Massollo M, Bongioanni F, Paparo F, et al. 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-naF PET/CT. Nuklearmedizin 2015;54:163-72.
14. Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med 2013;38:e290-6.
15. Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: Results from the national oncologic PET registry. J Nucl Med 2015;56:222-8.
16. Iagaru A, Mittra E, Dick DW, Gambhir SS. Prospective evaluation of (99m)Tc MDP scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CTfor detection of skeletal metastases. Mol Imaging Biol 2012;14:252-9.

How to Cite this article: Koç Z P, Kara P Ö, Sezer E, Erçolak V.Diagnostic Comparison of F-18 Sodium FluorideNaF, Bone Scintigraphy, and F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis. Journal of Bone and Soft Tissue Tumors Jan-Apr 2019;5(1): 17-20.

               

  (Abstract    Full Text HTML)   (Download PDF)

Resection and Arthrodesis of the Knee Joint by Different Modalities for Aggressive Giant Cell Tumors of Bone

Volume 3 | Issue 1 | May- Aug 2017 | Page 17-21 | Y. J. Mahale, Shubham Mishra, Sagar Chinchole

Authors: Y. J. Mahale [1], Shubham Mishra [1], Sagar Chinchole [1].

[1]Departmnet of Orthopedics, ACPM Medical College, Dhule, Maharashtra, India,

Address of Correspondence
Dr. Shubham Mishra,
ACPM medical college ,
Dept of orthopaedics, room no 604,
pg boys hostel ,saakri road dhule, 424001
Email : shaggyurfrnd28@gmail.com

Abstract

Purpose: The aim is to evaluate the functional outcomes inCampanacci Grade 3 giant cell tumor (GCT)of distal femur and proximal tibia treated with wide resection and arthrodesis with different implants used such as long intramedullary interlocking nail(n=11),long Kuntscher nail(n=2), and DCP plate(n=3) andto compare the outcomes and functional results of arthrodesis with arthroplasty which were done elsewere.GCTis a aggressive benign bone tumor[1]seen in young patients with a normal life expectancy. Campanacci Grade 3 tumors and recurrent tumors require wide resection[1,2].Arthrodesis is an alternativeoptions for reconstruction in Campanacci Grade 3,though Arthroplasty is ideal option for campannci Grade 3 tumors.
Methods: Criteria included 16 patients of Campanacci Grade 3 GCT in which 14 male and 2 female around aged between 20and 60 years with a mean age of 30 years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur(n=7) or proximal tibia(n= 9).After wide resection,2 struts were fashioned from the harvested fibula of thesame side and inserted into medullary canal at the resected ends of the tibia and femur.Cancellous bone grafts were taken from thesame side of theiliac crest.Hemicylindrical graft was taken from anteriorpart of either distal femur or proximal tibia. A long intramedullary interlocking nail was inserted inretrograde fashion through piriformis fossa to distal tibia.Cancellous bone grafts[2,3]were placed transversely along the struts and circumferentially over the host-graft junctions.For other patients, long Kuntscher nail and DCP plate with K-wirewere used.Results of arthrodesis were evaluated those in which long intramedullary interlocking nail(n=11), long Kuntscher nail(n=2),and DCP (n=3).Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere.
Results: Patients were followed up for a mean of 12 years. All patients were ofCampanacciGrade 3.The mean size of tumors was 12-10-7cm.All patients achieved arthrodesis with intramedullary interlocking nail, Kuntscher nail,and plating.A total number of patient (n=16).The mean bone union time was 12-14 weeks. There was no loss of alignment,loosening, and no implant breakage. The mean musculoskeletal tumor society[5] score was 27(87%of full score). The complications were evaluated in which patients were having skin necrosis(n=3),skin infection (n=2),and peroneal nerve injury(n=1).
Conclusions: In aggressiveCampanacciGrade 3 GCT around theknee joint,arthrodesis [6,7]withlong intramedullary interlocking nail provides good results. Longintramedullary interlocking nailing in arthrodesisprovides high fusion rates, minimal shortening,and rotational stability as compared to plate fixation. Arthrodesis is acost-effective method as compared to arthroplasty in economically constrained population of developing nations and shows good functional outcomes with acceptable morbidity.
Keywords: Giant cell tumor, arthrodesis, intramedullary interlocking nail, hemicylindrical graft, fibula transposition, bone transplantation.

References

1. Dahlin DC, Cupps RE, Johnson EW. Giant-cell tumor: A study of 195 cases. Cancer 1970;25(5):1061-1070.
2. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant-cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am 1982;64(5):755-761.
3. Yip KM, Leung PC, Kumta SM. Giant cell tumor of bone. ClinOrthopRelat Res 1996;323:60-64.
4. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J ClinOncol 2006;29(1):96-99.
5. Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am 1999;81(6):811-820.
6. Lim YW, Tan MH. Treatment of benign giant cell tumours of bone in Singapore. Ann Acad Med Singapore 2005;34(3):235-237.
7. Wang HC, Chien SH, Lin GT. Management of grade III giant cell tumors of bones. J SurgOncol 2005;92(1):46-51.
8. Malawer M. Proximal tibia resection with endoprosthetic reconstruction. In: Makawer MM, Sugarbaker PH, editors. Musculoskeletal Cancer Surgery. Dordrecht: Kluwer Academic Publishers; 2001. p. 485-505.
9. Turcotte RE. Giant cell tumor of bone. OrthopClin North Am 2006;37(1):35-51.
10. Khalil el SA, Younis A, Aziz SA, El Shahawy M. Surgical management for giant cell tumor of bones. J Egypt NatlCancInst 2004;16(3):145-152.
11. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: Long-term results. J Bone Joint Surg Br 2007;89(4):521-526.
12. Maruthainar K, Dunstan ER, Hamilton PD, Unwin P, Cannon SR, Briggs TW. Massive endoprostheses for giant cell tumours of the distal femur: A 12-year follow-up. Knee 2006;13(5):378-381.
13. Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ. Early distal femoral endoprosthetic survival: Cemented stems versus the Compress implant. IntOrthop 2006;30(6):465-472.
14. Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am 2006;88(6):1285-1293.
15. Sharma S, Turcotte RE, Isler MH, Wong C. Cemented rotating hinge endoprosthesis for limb salvage of distal femur tumors. ClinOrthopRelat Res 2006;450:28-32.
16. Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 2006;88(6):790-795.
17. Langlais F, Belot N, Ropars M, Lambotte JC, Thomazeau H. The long-term results of press-fit cemented stems in total knee prostheses. J Bone Joint Surg Br 2006;88(8):1022-1026.
18. Morgan HD, Cizik AM, Leopold SS, Hawkins DS, Conrad EU. Survival of tumormegaprostheses replacements about the knee. ClinOrthopRelat Res 2006;450:39-45.
19. D’Aubigne RM, Dejouany JP. Diaphyseo-epiphyseal resection for bone tumour at the knee. J Bone Joint Surg Br 1959;40:385-395.
20. Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 1980;62(7):1039-1058.
21. Enneking WF, Shirley PD. Resection-arthrodesis for malignant and potentially malignant lesions about the knee using an intramedullary rod and local bone grafts. J Bone Joint Surg Am 1977;59(2):223-236.
22. Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 1980;62(7):1039-1058.
23. Enneking WF, Shirley PD. Resection-arthrodesis for malignant and potentially malignant lesions about the knee using an intramedullary rod and local bone grafts. J Bone Joint Surg Am 1977;59(2):223-236.
24. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. ClinOrthopRelat Res 1993;286:241-246.
25. Vidyadhara S, Rao SK. A novel approach to juxta-articular aggressive and recurrent giant cell tumours: Resection arthrodesis using bone transport over an intramedullary nail. IntOrthop 2007;31(2):179-184.
26. Wada T, Usui M, Nagoya S, Isu K, Yamawaki S, Ishii S. Resection arthrodesis of the knee with a vascularised fibular graft. Medium-to long-term results. J Bone Joint Surg Br 2000;82(4):489-493.

How to Cite this article:  Mahale Y. J, Mishra S, Sagar Chinchole S. Resection and Arthrodesis of the Knee Joint by Different Modalities for Aggressive Giant Cell Tumors of Bone. Journal of Bone and Soft Tissue Tumors Jan-Apr 2016;2(1): 17-21.

 

  (Abstract    Full Text HTML)      (Download PDF)

Current Concepts in Imaging of Giant Cell Tumor of Bone

Volume 3 | Issue 1 | May – Aug 2017 | Page 3-7 | Khushboo Pilania, Bhavin Jankharia

Authors: Khushboo Pilania [1], Bhavin Jankharia [1].

[1]Consultant Radiologists, Picture This by Jankharia, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Bhavin Jankharia,
Bhaveshwar Vihar, 383 S V P Rd,
Mumbai – 400004, Maharashtra, India.
E-mail: bhavin@jankharia.com

Abstract

Giant cell tumor(GCT) of bone is a tumor of giant cell proliferation that usually affects men and women in the thirdand fourthdecades. Typical cases have straight-forward imaging appearances. Atypical cases may resemble many other benign and sometimes malignant lesions. Plain radiographs and magnetic resonance imaging (MRI) are the mainstay of diagnosis, followed by biopsy and histology.Positron emission tomography/computed tomography (CT) has a limited role to play.Aneurysmal bone cyst transformation within GCTs is known. This may change the imaging appearance. GCTs may be multifocal, locally aggressive, and may metastasize to nodes and lungs.Treatment with drugs like denosumab also changes the appearance on radiographs and MRI. Post-operative imaging can be a challenge, and picking up recurrence also requires high-quality radiographs, MRIs, and CT scans.
Keywords: Giant cell tumor, giant cell tumor, bone neoplasm, computed tomography scan, magnetic resonance  imaging, plain radiograph.

References

1. Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr, et al. Giant cell tumor of bone: Review, mimics, and new developments in treatment. Radiographics 2013;33:197-211.
2. Dorfman HD, Czerniak B. Giant-cell lesions. In: Dorfman HD, Czerniak B, editors. Bone Tumors. St Louis, Mo: Mosby; 1998. p. 559-606.
3. Stacy GS, Peabody TD, Dixon LB. Mimics on radiography of giant cell tumor of bone. AJR Am J Roentgenol 2003;181:1583-9.
4. Cooper AS, Travers B. Surgical Essays. London, England: Cox Longman & Co.; 1818.
5. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ, et al. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: Radiologic-pathologic correlation. Radiographics 2001;21:1283-309.
6. Manaster BJ, Doyle AJ. Giant cell tumors of bone. Radiol Clin North Am 1993;31:299-323.
7. Moser RP Jr., Kransdorf MJ, Gilkey FW, Manaster BJ. From the archives of the AFIP. Giant cell tumor of the upper extremity. Radiographics 1990;10:83-102.
8. Puri A, Agarwal MG, Shah M, Jambhekar NA, Anchan C, Behle S, et al. Giant cell tumor of bone in children and adolescents. J Pediatr Orthop 2007;27:635-9.
9. Joyner CJ, Quinn JM, Triffitt JT, Owen ME, Athanasou NA. Phenotypic characterization of mononuclear and multinucleated cells of giant cell tumor of bone. Bone Miner 1992;16:37-48.
10. Frassica FJ, Sanjay BK, Unni KK, McLeod RA, Sim FH. Benign giant cell tumor. Orthopedics 1993;16:1179-83.
11. Kafchitsas K, Habermann B, Proschek D, Kurth A, Eberhardt C. Functional results after giant cell tumor operation near knee joint and the cement radiolucent zone as indicator of recurrence. Anticancer Res 2010;30:3795-9.
12. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.
13. Arnold RT, van Holsbeeck MT, Mayer TG, Mott MP, Koch SR. Best cases from the AFIP: Necrotic giant cell tumor of bone manifesting with pathologic fracture. Radiographics 2011;31:93-8.
14. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: A Canadian sarcoma group study. Clin Orthop Relat Res 2002;397:248-58.
15. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.
16. Dahlin DC. Caldwell lecture. Giant cell tumor of bone: Highlights of 407 cases. AJR Am J Roentgenol 1985;144:955-60.
17. Bandyopadhyay R, Biswas S, Bandyopadhyay SK, Ray MM. Synchronous multicentric giant cell tumor. J Cancer Res Ther 2010;6:106-8.
18. Dhillon MS, Prabhudev Prasad A, Virk MS, Aggarwal S. Multicentric giant cell tumor involving the same foot: A case report and review of literature. Indian J Orthop 2007;41:154-7.
19. Varshney A, Rao H, Sadh R. Multicentric GCT of tarsal bones in an immature skeleton: A case report with review of literature. J Foot Ankle Surg 2010;49:399.
20. Novais EN, Shin AY, Bishop AT, Shives TC. Multicentric giant cell tumor of the upper extremities: 16 years of ongoing disease. J Hand Surg Am 2011;36:1610-3.
21. Okamoto Y, Mathew S, Daw NC, Neel MD, McCarville MB, Dome JS, et al. Giant cell tumor of bone with pulmonary metastases. Med Pediatr Oncol 2003;41:454-9.
22. Diel J, Ortiz O, Losada RA, Price DB, Hayt MW, Katz DS, et al.The sacrum: Pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics 2001;21:83-104.
23. Smith J, Wixon D, Watson RC. Giant-cell tumor of the sacrum. Clinical and radiologic features in 13 patients. J Can Assoc Radiol 1979;30:34-9.
24. Kwon JW, Chung HW, Cho EY, Hong SH, Choi SH, Yoon YC, et al. MRI findings of giant cell tumors of the spine. AJR Am J Roentgenol 2007;189:246-50.
25. Anchan C. Giant cell tumor of bone with secondary aneurysmal bone cyst. Int J Shoulder Surg 2008;2:68.
26. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: Concept, controversy, clinical presentation, and imaging. AJR Am J Roentgenol 1995;164:573-80.
27. Murphey MD, Flemming DJ, Torop AH, Smith SE, Sonin AH, Temple HT. Imaging differentiation of primary and secondary aneurysmal bone cyst with pathologic correlation (abstr). Radiology 1998;209:311.
28. Libicher M, Bernd L, Schenk JP, Mädler U, Grenacher L, Kauffmann GW, et al. Characteristic perfusion pattern of osseous giant cell tumor in dynamic contrast-enhanced MRI. Radiologe 2001;41:577-82.
29. O’Connor W, Quintana M, Smith S, Willis M, Renner J. The hypermetabolic giant: 18F-FDG avid giant cell tumor identified on PET-CT. J Radiol Case Rep 2014;8:27-38.
30. Costelloe CM, Chuang HH, Madewell JE. FDG PET/CT of primary bone tumors. AJR Am J Roentgenol 2014;202:W521-31.
31. Tian R, Su M, Tian Y, Li F, Li L, Kuang A, et al.Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions. Skeletal Radiol 2009;38:451-8.
32. Salzer-Kuntschik M. Differential diagnosis of giant cell tumor of bone. Verh Dtsch Ges Pathol 1998;82:154-9.
33. Nedopil A, Raab P, Rudert M. Desmoplastic fibroma: A case report with three years of clinical and radiographic observation and review of the literature. Open Orthop J 2013;8:40-6.
34. Gong YB, Qu LM, Qi X, Liu JG. Desmoplastic fibroma in the proximal femur: A case report with long-term follow-up. Oncol Lett 2015;10:2465-7.
35. Pavlovic S, Valyi-Nagy T, Profirovic J, David O. Fine-needle aspiration of brown tumor of bone: Cytologic features with radiologic and histologic correlation. Diagn Cytopathol 2009;37:136-9.
36. Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: Implications for limb-sparing surgery. Radiographics 2007;27:189-205.
37. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ, et al. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 1994;76:1827-33.
38. Lee FY, Montgomery M, Hazan EJ, Keel SB, Mankin HJ, Kattapuram S, et al. Recurrent giant-cell tumor presenting as a soft-tissue mass. A report of four cases. J Bone Joint Surg Am 1999;81:703-7.
39. Remedios D, Saifuddin A, Pringle J. Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br 1997;79:26-30.
40. Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, et al. Denosumab in patients with giant-cell tumour of bone: An open-label, phase 2 study. Lancet Oncol 2010;11:275-80.
41. Hakozaki M, Tajino T, Yamada H, Hasegawa O, Tasaki K, Watanabe K, et al.Radiological and pathological characteristics of giant cell tumor of bone treated with denosumab. Diagn Pathol 2014;9:111.
42. Unni KK. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996.

How to Cite this article:  Pilania K, Jankharia B. Current Concepts in Imaging of Giant Cell Tumor of Bone. Journal of Bone and Soft Tissue Tumors May-Aug 2017;3(1): 2-6.

 

 (Abstract    Full Text HTML)      (Download PDF)

Intralesional Curettage technique for Giant cell tumor of bone – current concepts and evidence

Volume 3 | Issue 1 | May- Aug 2017 | Page 7-12 | Manish Agarwal

Authors: Manish Agarwal [1]

[1]Department of Surgical Oncology, P.D Hinduja Hospital & Medical Research Centre, Veer SavarkarMarg, Mahim, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Manish Agarwal,
P.D Hinduja Hospital & Medical Research Centre,
Veer SavarkarMarg, Mahim, Mumbai – 400 016, Maharashtra, India.
E-mail: mgagarwal@gmail.com

Abstract

Intralesionalsurgery is the most favored kind of surgery for giant-cell tumors of the bone. A good surgical technique helps minimize the risk of local recurrence. A good exposure followed by meticulous curetting aided by a high-speed burr is the backbone of this surgery. The role of chemical and thermal adjuvants is discussed with the evidence. The best way to reconstruct the cavity after curettage has been hotly debated. This article discusses the role of bone, cement, as well as a combination “sandwich” technique.
Keywords: Intralesional surgery, curettage, giant-cell tumor, adjuvant, “sandwich” reconstruction.

References

1. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res. 1995 Dec (321):245–50.
2. Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop Relat Res [Internet]. 1991 Jan ;(262):42–57.
3. Blackley HR, Wunder JS, Davis a M, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am. 1999;81(6):811–20.
4. Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am [Internet]. 1970 Jun [cited 2016 Apr 10];52(4):619–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/5479455
5. Ward WG, Li G. Customized Treatment Algorithm for Giant Cell Tumor of Bone : 2002;(397):259–70.
6. Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res. 1998;1998(347):250–60.
7. Salai M, Rahamimov N. Prevention of recurrent giant-cell tumors of long bones a new surgical technique. J Surg Oncol. 1999;72(1):37–8.
8. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri B a, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002;(397):248–58.
9. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, And MD~, Huvos AG. Cryosurgery in the treatment of giant cell tumors of bone. A Report of 52 Consecutive Cases. Cancer 41:957-969, 1978
10. Bickels J, Kollender Y, Merimsky O, Isaakov J, Petyan-Brand R, Meller I. Closed argon-based cryoablation of bone tumours. J Bone Jt Surg [Internet]. 2004;86(5):714–8. Available from: http://www.bjj.boneandjoint.org.uk/cgi/doi/10.1302/0301-620X.86B5.14416
11. Meller I, Weinbroum A, Bickels J, Dadia S, Nirkin A, Merimsky O, et al. Fifteen years of bone tumor cryosurgery: A single-center experience of 440 procedures and long-term follow-up. Eur J Surg Oncol. 2008;34(8):921–7.
12. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res. 1999;1999(359):176–88.
13. Veth R, Schreuder B, van Beem H, Pruszczynski M, de Rooy J. Cryosurgery in aggressive, benign, and low-grade malignant bone tumours. Lancet Oncol. 2005;6(1):25–34.
14. Quint U, Vanhöfer U, Harstrick a, Müller RT. Cytotoxicity of phenol to musculoskeletal tumours. J Bone Joint Surg Br. 1996;78(6):984–5.
15. Quint U, Müller RT, G M. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg. 1998;117(1–2):43–6.
16. Toy PC, Heck RK.. General Principles of tumors. In: Campbells operative orthopaedics. 2012. Ch. 24. Canale ST, Beaty JH, editors. St. Louis: Elsevier Health Sciences; 2012.
17. Nithyananth M, Priscilla AJ, Boopalan P, Titus V, Lee VN. Time required for effective action of phenol against giant cell tumour cells. J Orthop Surg. 2014;22(1):104–7.
18. Schiller C, Ritschl P, Windhager R, Kropej D, Kotz R. [The incidence of recurrence in phenol treated and non-phenol treated bone cavities following intralesional resection of non-malignant bone tumors]. Z Orthop Ihre Grenzgeb [Internet]. [cited 2016 Aug 1];127(4):398–401. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2815940
19. Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res. 2005;438(438):123–7.
20. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Phenol (Update). 2008.
21. Teixeira LEM, Miranda RH, Druda OL, Azevedo Neto JG, Rajão GDS. Isolated cauterization as an adjuvant in the treatment of benign bone tumors. Acta Ortop Bras. [online]. 2011; 19(4):198-201. Available from URL: http://www.scielo.br/aob.
22. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res. 2004;(424):221–6.
23. Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res [Internet]. 2006;453(453):328–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16936591
24. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: Treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008;134(9):969–78.
25. Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon M a. Argon beam coagulation as an adjuvant for local control of giant cell tumor. Clin Orthop Relat Res. 2007;454(454):192–7.
26. Ofluoglu O. Aggressive treatment of giant cell tumour with multiple local adjuvants. Acta Orthop Belg. 2008;74:831–6.
27. Benevenia J, Patterson FR, Beebe KS, Abdelshahed MM, Uglialoro AD. Comparison of phenol and argon beam coagulation as adjuvant therapies in the treatment of stage 2 and 3 benign-aggressive bone tumors. Orthopedics [Internet]. 2012;35(3):e371-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22385449
28. Algawahmed H, Turcotte R, Farrokhyar F, Ghert M. High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. Hindawi Publishing Corporation Sarcoma; 2010;586090(5).
29. Frassica FJ, Gorski JP, Pritchard DJ, Sim FH, Chao EY. A comparative analysis of subchondral replacement with polymethylmethacrylate or autogenous bone grafts in dogs [Internet]. Clin Orthop Relat Res. 1993. p. 378–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8339507
30. Von Steyern F V., Kristiansson I, Jonsson K, Mannfolk P, Heinegard D, Rydholm A. Giant-cell tumour of the knee: The condition of the cartilage after treatment by curettage and cementing. J Bone Jt Surg – Br Vol . 2007;89–B(3):361–5.
31. Tejwani SG, Hame SL, Eckardt JJ. Subchondral giant-cell tumor of the proximal tibia: Arthroscopic treatment for accelerated articular cartilage and meniscal degeneration in two patients. Arthrosc – J Arthrosc Relat Surg. 2004;20(6):644–9.
32. Chen TH, Su YP, Chen WM. Giant cell tumors of the knee: Subchondral bone integrity affects the outcome. Int Orthop. 2005;29(1):30–4.
33. Buecker PJ, Gebhardt MC. Are Fibula Strut Allografts a Reliable Alternative for Periarticular Reconstruction after Curettage for Bone Tumors? Clin Orthop Relat Res [Internet]. 2007;461(Aug):170–4.

How to Cite this article:  Agarwal M. Intralesional Curettage Technique for Giant-cell Tumor of Bone – Current Concepts and Evidence. Journal of Bone and Soft Tissue Tumors May-Aug 2017;3(1): 7-12.

  (Abstract    Full Text HTML)      (Download PDF)