Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study / Resultados da curetagem estendida com e sem aloenxerto ósseo para tumores de células gigantes de grau II no joelho. Um estudo comparativo retrospectivo

Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.

Ankle arthrodesis with intramedullary retrograde nail for bone tumors. preliminary results and surgical technique / Artrodese do tornozelo com cavilha intramedular retrógrada para tumores ósseos. resultados preliminares e técnica cirúrgica

ABSTRACT Objective Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. Methods We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Results Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. Conclusion No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

RESUMO Objetivo Apresentar os resultados preliminares de uma série de casos utilizando a técnica cirúrgica de artrodese do tornozelo com haste intramedular retrógada para tumores ósseos. Métodos Apresentamos os dados preliminares de quatro pacientes, três homens e uma mulher, com idade média de 46,2 (variação de 32 a 58) anos, com histologia comprovada de tumor de células gigantes em três e osteossarcoma em um. O comprimento médio de ressecção da tíbia distal foi de 11,75 (variação de 9 a 16) cm, e todos os pacientes foram submetidos à reconstrução com uma artrodese tibiotalocalcaneana com um aloenxerto intercalar fixado por uma haste intramedular retrógrada. Resultados O acompanhamento oncológico evoluiu sem evidências de recidiva local ou progressão da doença, em todos os pacientes. Após um tempo médio de 69,5 (variação de 32 a 98 meses), os pacientes tiveram uma pontuação média funcional MSTS12 de 82,5% (variação de 75 a 90). Todos os locais de artrodese e osteotomia diafisária tibiais foram fundidos em 6 meses com retorno às atividades de vida diária sem complicações relacionadas à cobertura ou infecção. Conclusão Não foram registradas complicações; todos os locais de artrodese e osteotomia diafisária da tíbia fundiram-se em 6 meses, e o acompanhamento médio desses pacientes foi de 69,5 (variação de 32 a 988) meses, com uma pontuação média funcional MSTS de 82,5% (variação de 75-90). Nível de Evidência IV; Série de Casos Retrospectivos.

Treatment of Patients Diagnosed with Giant Cell Tumor of Bone: Experience of a Philanthropic Hospital in the State of Piauí, Brazil / Tratamento de pacientes com diagnóstico de tumor ósseo de células gigantes: Experiência de um hospital filantrópico no Piauí, Brasil

Abstract Objective To evaluate the treatment of patients with giant cell tumors of bone treated from 2009 to 2019 in a philanthropic hospital, as well as to try and determine the regional clinical and epidemiological profile, aiming to enrich the Brazilian data set and compare our findings with those of the literature. Methods An analytical, observational, and cross-sectional study with retrospective data collection and a quantitative approach, analyzing medical records of patients with giant cell tumors treated at a philanthropic hospital from 2009 to 2019. Results We evaluated 49 medical records; 55.1% of the patients were women, 53.1% were aged between 20 and 40 years, 69.4% of the cases were Campanacci grade III, and 30.6% affected the proximal end of the tibia. The rate of pathological fractures secondary to the tumor and pulmonary metastasis was low. More than 69% of the patients underwent intralesional surgery. Recurrence occurred in 16.3% of the cases. Conclusion The criteria used for the diagnosis, classification, and treatment at our service followed the standards established by the literature, and they can guide further research and improve local prognosis in the future.

Resumo Objetivo Avaliar o tratamento fornecido a pacientes com diagnóstico de tumor de células gigantes ósseo atendidos no período de 2009 a 2019 em um hospital filantrópico, bem como determinar o perfil clínico e epidemiológico regional, visando enriquecer os dados nacionais e comparar os achados com a literatura existente. Métodos Estudo analítico, observacional e transversal, com coleta retrospectiva e abordagem quantitativa, com análise de prontuários de pacientes diagnosticados com tumor de células gigantes atendidos em um hospital filantrópico no período de 2009 a 2019. Resultados Foram avaliados 49 prontuários, sendo que 55,1% eram de mulheres, com 53,1% dos casos na faixa etária de 20 a 40 anos, 69,4% de casos de grau III de Campanacci, e 30,6% acometendo a extremidade proximal da tíbia. Observou-se baixo índice de fratura patológica secundária ao tumor e de metástase pulmonar. A cirurgia intralesional foi realizada em 69,5% dos pacientes. Houve recidiva em 16,3% dos casos. Conclusão Os critérios usados para diagnóstico, classificação e tratamento em nosso serviço seguiram os padrões estabelecidos pela literatura, e podem orientar novas pesquisas e melhorar o prognóstico local futuramente.

Reconstruction with a Custom made Prosthetic Wrist Arthrodesis after Bone Tumor Resections of the Distal Radius. Single Centre Experience / Reconstrução com implante metálico personalizado de artrodese após ressecções de tumor ósseo do rádio distal. Experiência em um único centro

Abstract Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.

Resumo Objetivo O presente estudo teve como objetivo analisar os resultados clínicos, radiológicos e funcionais da reconstrução do rádio distal após a ressecção do tumor com implante metálico personalizado de artrodese e compará-los com outros tipos de reconstrução do rádio distal, conforme apresentado na literatura. Pelo que conhecemos, este é o primeiro artigo descrevendo esse tipo particular de implante e funcionalidade no paciente. Métodos Os desfechos funcionais de reconstrução do rádio distal foram avaliados em uma série de 4 pacientes. Três dos pacientes tiveram ressecção de tumores de células gigantes (TCGs), sendo um paciente com ressecção de osteossarcoma. Resultados Não houve complicações relacionadas ao implante, como infecção, não sindicalidade ou afrouxamento. Dois pacientes tiveram que passar por uma nova cirurgia para a protusão da prótese metálica. A função geral foi boa de acordo com as pontuações da Musculoskeletal Tumor Society (MSTS) e Disabilities of the Arm, Shoulder, and Hand (DASH). Conclusão O estudo mostra que o implante metálico personalizado de artrodese se beneficia do fato de que pode ser usado como opção de salvamento quando outros tratamentos falharam, ou pode ser usado como opção primária nos casos em que há estoque ósseo limitado após a ressecção do tumor do rádio distal.

Primary malignant giant cell tumor of the sternum

Primary malignant giant cell tumor (PMGCT) is a diagnosis based on the presence of a high-grade sarcomatous component along with a typical benign giant cell tumor (GCT). We report the first case of PMGCT of the sternum in a 28-year-old male with painless swelling over the manubrium sterni. The differential diagnoses of PMGCT and giant cell-rich osteosarcoma were considered. Surgical resection was performed, and the reconstruction was done with a neosternum using polymethyl methacrylate and prolene mesh. At 30 months follow-up, the patient is disease-free.

Inoperable Sacral Giant Cell Tumor: Therapeutic Options and Pain Control / Tumor de células gigantes do sacro inoperável: opções terapêuticas e controle da dor

Abstract Sacral giant cell tumor (GCT) is a rare condition. Its treatment is complex, since surgical removal is difficult and the response to other therapeutic options is low. The control of its growth and pain is an additional challenge. The present paper reports a case of inoperable sacral GCT, with embolization and radiotherapy for pain control as therapeutic options. The patient, a 39-year-old male, presented pain in the sacral region with lower limb irradiation due to an inoperable sacral giant cell tumor. The patient was submitted to embolization, radiotherapy, pain management with opioids and other drugs, and a rehabilitation program. Despite the difficulty in tumor growth and pain control during the follow-up, the outcome is stable after 9 years.

Resumo O tumor de células gigantes (TCG) do sacro é raro e seu tratamento é complexo, devido à dificuldade para a exerese cirúrgica e a baixa resposta às outras opções terapêuticas. Entre os desafios relacionados a este tumor está o controle do seu crescimento e da dor. No presente trabalho, relatamos um caso de tumor de células gigantes do sacro inoperável, apresentando as opções terapêuticas de embolização e de radioterapia para o controle da dor. Relato do caso: paciente do sexo masculino, admitido aos 39 anos de idade, apresentando dor na região sacral com irradiação para os membros inferiores (MMII), com diagnóstico de TCG do sacro inoperável. Realizou-se embolização, uso de interferon, radioterapia, tratamento da dor com opioides e medicamentos adjuvantes, associados a programa de reabilitação. Descreveu-se o difícil controle do crescimento tumoral e da dor ao longo do seguimento, com desfecho estável após 9 anos.

Retrospective Study of the Results of Surgical Treatment of 31 Giant Cell Tumors of the Tendon Sheath in the Hand / Estudo retrospectivo dos resultados do tratamento cirúrgico de 31 tumores de células gigantes da bainha do tendão da mão

Abstract Objective To evaluate the results of the treatment of 31 giant-cell tumors of the tendon sheath of the hand cared for between 2006 and 2015. Methods A group of patients for the present retrospective evaluation was defined, covering the period between February 2006 and November 2015, in which 31 records of patients who underwent surgery due to cell tumor of the tendon sheath of the fingers were studied and evaluated. The recommended treatment was complete excision of the tumor with preservation of the adjacent structures. The diagnosis was confirmed by pathological examination. The progress of the treatment after surgery was evaluated, especially regarding the rate of tumor recurrence. Results Taking all 31 patients into consideration, there was a predominance of the female gender and white ethnicity. Most of these patients were aged between 30 and 50 years. The most affected side was the left one, and most tumors were in the flexor face. There was a predominance of the radial fingers, along with their distal end. A total of 27 patients are being followed up at regular intervals at an outpatient clinic, and three cases of tumor recurrence have been identified. Conclusion An appropriate surgical technique is essential in order to prevent GCTTS recurrences. The results obtained in this research are in agreement with the literature.

Resumo Objetivo Avaliar os resultados do tratamento de 31 tumores de células gigantes da bainha do tendão da mão encontrados entre 2006 e 2015. Métodos Entre fevereiro de 2006 e novembro de 2015, um grupo de pacientes foi selecionado para avaliação retrospectiva, na qual foram estudados e avaliados 31 prontuários de pacientes submetidos a procedimento cirúrgico devido a tumor de células gigantes da bainha do tendão dos dedos da mão. O tratamento preconizado foi a excisão completa do tumor com a preservação das estruturas adjacentes. A confirmação diagnóstica foi feita pelo exame anatomopatológico. Foi avaliada a evolução do tratamento após a cirurgia, principalmente no tocante ao índice de recidivas dos tumores. Resultados Dos 31 pacientes da amostra, houve predomínio do sexo feminino e da etnia branca. O tumor acometeu principalmente indivíduos entre 30 e 50 anos. O lado mais acometido foi o esquerdo, e amaioria dos tumores estava na face flexora. Houve predominância dos dedos radiais, juntamente com sua extremidade distal. Esses pacientes têm sido acompanhados em intervalos regulares em ambulatório. Dos 27 pacientes reavaliados, foram identificados 3 casos de recidiva tumoral. Conclusão Uma técnica cirúrgica adequada é essencial para a prevenção de recidivas do TCGBT. Os resultados obtidos na pesquisa estão em concordância com a literatura atual.

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Giant cell tumor locally advanced around the knee: treatment and literature review / Tumor de células gigantes localmente avançado ao nível do joelho: tratamento e revisão da literatura

ABSTRACT Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics. They are more prevalent in the third decade of life and demonstrate a preference for locating in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. The risk of lung metastases is around 3%. Between October 2010 and August 2014, nine patients diagnosed with locally advanced GCT or with pathological fracture to the knee level underwent surgical treatment. The aim of this study was to evaluate the results of the treatment, particularly with regard to relapse, and to conduct a literature review. There was a predominance of males (77.7%). The most common location was the distal femur. Four patients (44%) developed local recurrence in the first year after surgery, three in distal femur and one in proximal tibia. Of the two patients with pathologic fracture at diagnosis, one of them presented recurrence after five months. The treatment of GCT is still a challenge. The authors believe that the best treatment method is wide resection and reconstruction of bone defects with non-conventional endoprostheses. Patients should be aware and well informed about the possible complications and functional losses that may occur as a result of the surgical treatment chosen and the need for further surgery in the medium and long term.

RESUMO O tumor de células gigantes (TCG) é um tumor ósseo benigno com características agressivas. São mais prevalentes na terceira e quarta décadas de vida e localizam-se preferencialmente na região epifisária dos ossos longos. Apresentam altas taxas de recorrência local, a qual depende do tipo de tratamento e da apresentação inicial do tumor. O risco de disseminação sistêmica (metástases pulmonares) gira em torno de 3%. Entre outubro de 2010 e agosto de 2014, nove pacientes com diagnóstico de TCG localmente avançados ou com fratura patológica ao nível do joelho foram submetidos a tratamento cirúrgico. O objetivo deste estudo foi avaliar os resultados decorrentes do tratamento, especialmente com relação à recidiva, e fazer uma revisão da literatura. Houve predominância do sexo masculino (77,7%). A localização mais comum foi o fêmur distal. Quatro pacientes (44%) apresentaram recidiva local no primeiro ano de pós-operatório, três do fêmur distal e um na tíbia proximal. Dos três pacientes que apresentaram fratura patológica no momento do diagnóstico, um deles apresentou recidiva cinco meses após a cirurgia. O tratamento ainda é um grande desafio. Acreditamos que o melhor método de tratamento é a ressecção ampla com reconstrução da falha óssea com endoprótese não convencional. Os pacientes devem estar cientes e bem orientados quanto às possíveis complicações e prejuízos funcionais que podem ocorrer em decorrência do tratamento escolhido e quanto à necessidade de novas intervenções cirúrgicas em médio e longo prazo.

Total knee replacement in patients with diffuse villonodular synovitis / Artroplastia total do joelho em paciente com sinovite vilonodular pigmentada forma difusa

ABSTRACT This paper reports a case of diffuse pigmented villonodular synovitis (DPVNS), associated with advanced gonarthrosis, submitted to total knee replacement. The patient had progressive pain and swelling. She had two previous surgeries, firstly arthroscopic , synovectomy and subsequently open synovectomy associated with radiotherapy, with recurrence of the disease. Magnetic resonance imaging revealed diffuse synovitis, advanced arthrosis, and bone cysts. The patient was submitted to a total knee replacement and synovectomy. There was a good postoperative clinical course, with improvement of pain, function, and joint edema on examination. The patient will be followed regarding the possibility of disease recurrence and implant survival.,

RESUMO Este trabalho relata um caso de sinovite vilonodular pigmentada forma difusa (SVNPD), associada a genoartrose avançada, que foi submetida a artroplastia total do joelho. A paciente apresentava dor e edema em joelho de caráter progressivo, já submetida previamente a duas sinovectomias, uma por via artroscópica e outra por via aberta, além de radioterapia, com recidiva da doença. As radiografias demonstravam obliteração dos espaços articulares, além de erosões e cistos intraósseos na tíbia e no fêmur. Ressonância magnética evidenciou sinovite difusa extensa, além de artrose avançada e cistos ósseos. A paciente foi submetida a artroplastia total do joelho combinada com sinovectomia ampla. Ela apresentou boa evolução clinica pós-operatória, com melhoria da dor, da função e do edema. A paciente será acompanhada quanto à possibilidade de recorrência da doença e sobrevida do implante.

Giant cell tumor of temporomandibular joint masquerading as temporomandibular joint pain dysfunction syndrome: a rare case report

Giant cell tumor (GCT) of the craniofacial bones has been reported but they are not common. This tumor occurs more often in women than in men and predominantly affects patients around the third to fifth decade of life. GCTs are generally benign but can be locally aggressive as well. We report a case of GCT involving the temporomandibular joint (TMJ), which was initially thought to be temporomandibular disorder (TMD). A 22-year-old female presented with swelling and pain over the right temporal region for 18 months associated with jaw locking and clicking sounds. On examination, her jaw deviated to the right during opening and there was a 2×2 cm swelling over the right temporal region. Despite routine treatment for TMD, the swelling increased in size. Computed tomography and magnetic resonance imaging of the brain and TMJ revealed an erosive tumor of the temporal bone involving the TMJ which was displacing the temporal lobe. Surgical excision was done and the tumor removed completely. Histopathological examination was consistent with a GCT. No clinical or radiological recurrence was detected 10 months post-surgery.

Imaging of giant cell tumors of the skull:a report of 16 cases and literature review / 实用放射学杂志

Objective To investigate the imaging features of giant cell tumors (GCTs) of the skull and review of the literatures.Methods CT and MR features of 16 histologically proven GCTs of the skull were analyzed retrospectively.The imaging features of GCTs of the skull were summarized based on literature.Results 16 patients (male=9,female=7) with GCTs of the skull were enrolled in the study.Most of the lesions were originated from sphenoid and temporal bone.On CT scan,the lesions showed slightly hyperdense with cystic formation.Those of the sphenoid bone in sellar region usually showed osteolytic bone destruction;those of the temporal bone usually showed expansive bone destruction,foci calcification in the lesion and discontinuous "bony shell" sign could be seen at the edge.On MR images,the lesion showed isointense on T1 WI and iso-or hypointense on T2 WI with cystic formation.After contrast medium injection,the lesions demonstrated heterogeneous and apparent enhancement,and the enhancement of the adjacent meninges could be detected in some cases.Conclusion GCTs of the skull mainly originate from sphenoid and temporal bone,and the bone changes are different between the two sites on CT scan.The imaging features of GCTs are various on MR images and mainly show isointense or hypointense on T2 WI.

Giant cell tumor of the femoral neck: case report / Tumor de células gigantes do colo do fêmur: relato de caso

ABSTRACT The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

RESUMO Os autores apresentam um caso de uma paciente portadora de tumor de células gigantes do colo do fêmur esquerdo com invasão progressiva de tecido ósseo adjacente. Foi tratado inicialmente com esvaziamento por meio de curetagem local e enxertia autóloga com tabiques da fíbula, eletrofulguração e preenchimento com metilmetacrilato. A paciente evoluiu com recidiva da lesão tumoral local após um ano, foi necessária uma nova intervenção cirúrgica, com ressecção em bloco da parte proximal do fêmur e fixação de endoprótese não convencional. São discutidos os aspectos clínicos e a abordagem terapêutica. O relato tem por função demonstrar a necessidade de abordar o tumor de células gigantes do colo do fêmur, em obediência aos princípios oncológicos de ressecção óssea, com prioridade para a total exérese do tumor e sua extensão local, preservação da integridade do membro e demonstração da total falha de tentativas preservadoras no caso de acometimento do colo femoral.

Giant-cell tumor: analysis on the importance of early diagnosis and the epidemiological profile / Tumor de células gigantes: análise sobre importância do diagnóstico precoce e perfil epidemiológico

This study aimed to ascertain the relationship between early diagnosis of giant-cell tumors (GCT) and their prognosis, by correlating the time of symptom onset with the staging of the injury (through the Campanacci classification at the time of diagnosis), and with the type of treatment. The secondary objective of the study was to outline the epidemiological profile of patients with GCT in the region where the data were gathered, and to compare them with data in the literature. METHODS: The authors present an evaluation on 61 patients diagnosed with bone GCT, with regard to the site of involvement, age, initial symptoms, time of symptom onset, classification and type of treatment, among patients attended between May 1994 and August 2009. RESULTS: The threshold indicated as the limit for Campanacci stage I tumors to be the commonest diagnosis, with a 98.2% chance that the treatment would be non-aggressive, was 2 months after symptom onset. This finding was statistically significant (p = 0.017). Every additional month increased the chance that a patient would be diagnosed with an advanced-stage tumor by 10.94%, in relation to the chances of having the other two stages of the tumor. CONCLUSION: The study result not only suggests that the alternative hypothesis that the earlier the diagnosis of GCT is, the less severe the lesion will be, has been confirmed; but also especially predicts the relationship between the time of symptom appearance and the severity of the tumor.

Presumir a relação entre o diagnóstico precoce do tumor de células gigantes (TCG) e o seu prognóstico, relacionar o tempo de surgimento dos sintomas com o estadiamento da lesão, por meio da classificação de Campanacci no momento do diagnóstico, e com tipo de tratamento. O objetivo secundário do estudo é traçar o perfil epidemiológico dos pacientes com TCG da região onde foram colhidos os dados e compará-lo com dados da literatura. MÉTODOS: Avaliação de 61 pacientes diagnosticados com tumor de células gigantes ósseo quanto ao local de acometimento, idade, sintomatologia inicial, tempo do surgimento dos sintomas, classificação e tipo de tratamento em pacientes atendidos entre maio de 1994 e agosto de 2009. RESULTADO: Aponta o marco de dois meses após o início da sintomatologia como data limite, quando seria mais comum o diagnóstico de tumor estágio I de Campanacci e com 98,2% de chance de ser tratado de modo não agressivo, dados com relevância estatística (p = 0,017). A cada aumento de um mês a chance de um paciente ser diagnosticado com tumor em estágio avançado é 10,94% maior do que em relação aos outros dois estágios do tumor. CONCLUSÃO: O resultado do estudo sugere não somente a confirmação da hipótese opcional de que quanto mais precoce o diagnóstico de TCG, menos grave é a lesão, mas, principalmente, prediz a relação do tempo de surgimento do sintoma com a gravidade do tumor.

The Clinical Characteristics, Treatments and Oncologic Outcomes of Chondroblastoma: Comparison with Giant Cell Tumor / 대한정형외과학회잡지

PURPOSE: The purpose of the study was to compare clinical, oncological outcomes between chondroblastoma and giant cell tumor. MATERIALS AND METHODS: This retrospective study reviewed 25 patients with histologically confirmed chondroblastoma of bone between 1998 and 2012. During the same period, 42 patients diagnosed as a giant cell tumor were also reviewed. We then analyzed clinical and oncological results of chondroblastoma compared with giant cell tumor. In chondroblastoma, 17 cases were male, and 8 cases were female, with a mean age of 20.6 years (range from 11 to 38 years). In giant cell tumor, 20 cases were male, and 22 cases were female, with a mean age of 39.26 years (from 17 to 75 years). All patients underwent surgical treatment that extended curettage with electrocauterization. After curettage, bony cavity was filled with autogenous bone, allogenic bone chip, bone cement, tricalcium phosphate, and so on. The results were compared in recurrence and metastatic rate. The minimum follow-up period was 1 year. RESULTS: In chondroblastoma, mean size was 2.18 cm (0.3 to 9.5 cm). Local recurrence and metastasis were absent. In giant cell tumors, mean size was 3.71 cm (0.3 to 11 cm). Local recurrence rate was 9.5% (4 of 42 cases) and there was one lung metastasis. CONCLUSION: Chondroblastoma is less invasive with better prognosis than giant cell tumor. Treatment of chondroblastoma and giant cell tumor is surgery. Electrocauterization as an adjuvant therapy showed good results.

The Clinical Characteristics of Giant Cell Tumor of Bone with Aneurysmal Bone Cyst / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the difference in clinical features, process, and prognosis depending on the presence of secondary aneurysmal bone cysts (ABCs) in patients with giant cell tumors. MATERIALS AND METHODS: A total of 33 patients who underwent surgery for giant cell bone tumors between March 2009 and April 2013 were selected. Data on clinical features were obtained from medical records and pathological and radiological review, including age, sex, location, and size of the tumor, and Campanacci grade, as well as whether there was any pathological fracture, local recurrence, distant metastasis, or malignant transformation. The Student t-test and Fisher exact test were used for comparison of the differences in clinical features by the presence or absence of ABCs. RESULTS: Local recurrence occurred in 6 of the 33 cases, 3 each were in the groups with and without ABCs; however, the difference was not statistically significant. In total, nine cases had pathological fractures, seven were in the group with ABC and two were in the group without ABC (p=0.013). No statistically significant differences in age, sex, location and size of the tumor, or Campanacci grade were observed between the groups with and without ABCs. CONCLUSION: There was no difference in the frequency of local recurrence between the groups with and without ABCs. However, pathological fracture occurred more frequently in the group with ABCs compared to the group without ABCs.

Misdiagnosed Handlebar Palsy: Giant Cell Tumor of the Tendon Sheath in Guyon's Canal / 대한스포츠의학회지

Ulnar tunnel syndrome (UTS) is a compressive neuropathy of the upper extremity that shows various clinical symptoms according to the anatomic region of the compression site. Numerous factors may cause UTS, and most publications are case reports describing various etiologies; thus, obtaining a correct diagnosis is often challenging. Giant cell tumor of the tendon sheath (GCTTS) is well described to be a common benign soft tissue tumor of the hand; however, it is rarely reported to cause UTS. We report a case of GCTTS in Guyon's canal causing UTS that was misdiagnosed as handlebar palsy.

Giant Cell-Rich Osteosarcoma: A Tumor Simulating Borderline Lesion / 대한정형외과학회잡지

PURPOSE: Giantcell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma. We reviewed; 1) radiological finding of GCRO and clinical impression-related diagnostic workup at referral center, 2) diagnostic delay until a proper diagnosis is made, 3) impact of diagnostic delay on the oncologic outcome. MATERIALS AND METHODS: We reviewed 17 patients with GCRO. We investigated the plain radiographic finding, tumor size and location, presence of pathologic fracture, clinical impression and pathological diagnosis at referral center, diagnostic delay, definitive treatment, local recurrence, metastasis, and survival rate. RESULTS: Eleven cases (64.7%) showed a plain radiographically, purely osteolytic pattern while 6 cases (35.3%) showed mixed osteolytic and sclerotic lesion. Diagnosis at primary center was osteosarcoma in 7 (41.2%), giant cell tumor in 7 (41.2%), and benign bone tumor in 3 (17.6%). Six patients (35.3%) experienced diagnostic delay. Mean diagnostic delay was 3.1 months (1 to 8). At final follow-up 5-year actuarial survival rate of 17 patients was 65%+/-25%. Although 11 patients without diagnostic delay showed a tendency of high survival over 6 patients with diagnostic problem, there was no statistical significance (p=0.14). CONCLUSION: GCRO is a rare subtype of osteosarcoma simulating giant cell tumor both pathologically and radiologically. Careful diagnostic approach is required in order not to misdiagnose this malignant tumor.

Research on the added value of CT values mean the critical value of sensitivity analysis in the clinical diagnosis of giant cell tumor of bone / 中国医学装备

Objective:To investigate the CT value added value of the mean of critical value in the diagnosis of giant cell tumor clinical sensitivity.Methods: Aretrospective analysis, selected from March 2013 to November 2014, the clinical data of 120 patients with bone tumors treated, they can be divided into two groups at random, control group and the observer, 60 cases in each group, observer for patients with giant cell tumor of bone, the control for the patients with giant cell tumor of bone. Each patient chose three ROI, the added value of the mean values of enhanced CT and CT values mean as observed values, under the experience of observation analysis of patients with giant cell tumor of the added value of CT values mean critical value and its sensitivity in the clinical diagnosis of giant cell tumor of bone.Results: The observation group of patients after CT enhanced scan display area average CT value of HU(108±39)HU was significantly higher than the control group(82±78)HU CT value(t=3.348, P<0.05), statistically significant difference; Through the ROC curve analysis, found that when the added value of CT values mean acuity 96.5 as critical, sensitivity and specificity of diagnosis of giant cell tumors of bone are 90.9% and 90.9% respectively; When the CT value added value of the mean acuity 41.5 HU as the critical point, the sensitivity and specificity of diagnosis of giant cell tumor bone were 98.9%, 48.1% respectively.Conclusion: The bone giant cell average CT value added value of diagnosis of critical value of 96.5HU 41.5HU, and high sensitivity, but the specificity is low, the added value of CT values help determine the existence of the giant cell tumors of bone.