Tumor de células gigantes (osteoclastoma) multicentrico, diagnóstico incidental de adenoma paratiroideo reporte de caso / Multicenter giant cell tumor (osteoclastoma), incidental diagnosis of parathyroid adenoma case report

Los tumores de células gigantes (TDG) llamados también osteoclastomas o tumores pardos cuando se hallan dentro la esfera endocrinológica, son uno de los tumores menos frecuentes, más controversial y menos predecible en su comportamiento. Se producen como consecuencia del exceso de la actividad osteoclastica, como ocurre en el caso del hiperparatiroidismo, mismo que es un desorden endocrino común, por lo general asintomático y diagnosticado por el hallazgo fortuito de hipercalcemia. El diagnóstico de los osteoclastomas suele ser un reto, el alto índice de sospecha es esencial y la biopsia es el estándar de oro para el diagnóstico. Presentamos el caso de un hombre de 42 años quien presentó fracturas patológicas de radio derecho y tibia izquierda, gammagrama óseo con Tc ­ 99m con múltiples lesiones óseas , hormona paratiroidea (PTH) elevada, hipercalcemia, gammagrama de paratiroides con MIBI con presencia de adenoma paratiroideo, la biopsia de las lesiones óseas con presencia de células gigantes multinucleadas correspondientes a osteoclastomas; se llevó a cabo paratiroidectomia y el examen histopatológico confirmó la presencia de un adenoma paratiroideo.

Giant cell tumors (TDG), also called osteoclastomas or brown tumors when they are within the endocrinological sphere, are one of the least frequent, most controversial and least predictable tumors in their behavior. They occur as a consequence of excess osteoclastic activity, as occurs in the case of hyperparathyroidism, which is a common endocrine disorder, generally asymptomatic and diagnosed by the fortuitous finding of hypercalcemia. Diagnosing osteoclastomas is usually challenging, the high index of suspicion is essential, and biopsy is the gold standard for diagnosis. We present the case of a 42-year-old man who presented pathological fractures of the right radius and left tibia, a bone scan with Tc-99m with multiple bone lesions, elevated parathyroid hormone (PTH), hypercalcemia, parathyroid scan with MIBI with the presence of parathyroid adenoma, the biopsy of the bone lesions with the presence of multinucleated giant cells corresponding to osteoclastomas; parathyroidectomy was performed and histopathological examination confirmed the presence of a parathyroid adenoma.

Gaint cell tumour of phalynx: have you seen it?

Giant cell tumors are rarely seen in the foot. Only 1-2% cases of GCT occur in the foot. They can cause a significant amount of pain and deformity due to their aggressive and recurrent nature whenever it occurs in foot. We present an unusual case of a giant cell tumor of proximal phalynx of middle toe of left foot. 26 year old male came with complaints of pain and swelling over the middle toe of left foot since 6 months. Clinical and radiological features showed features consistent with GCT. Foot Function Index revealed a) Pain scale: 29 / 50 = 58%, b) Disability scale: 56 / 90 = 62%, c) Activity limitation scale: 8 / 30 = 27%. Authors performed enbloc resection with ray amputation of 3rd toe. Histopathological examination of excised specimen revealed classic findings of mononuclear cells with interspersed fibro-collagenous strands and numerous multinucleated osteoclast-like giant cells which confirmed our diagnosis. Patient was serially followed up and at 6 months followup, there were no signs of recurrence with markedly improved foot function index.

An Assessment of Fate of CHA Blocks Used in the Cystic Lesions of Bone.

Background: The calcium phosphate system and in particular hydroxyapatite (CHA), has been the subject of intensive investigation. Although coralline hydroxyapatite is not inherently as strong as trabecular bone and does not exhibit plastic properties owing to the absence of a collagen matrix, with subsequent growth of native bone, it has been shown to become stronger but less stiff than autogenous graft material. Method: Thirty six cases of cystic lesions of long bones were curretted and filled with CHA blocks with or without autogenous cancellous bone chips between 2013 to 2014 with follow up duration ranging from 12 to 24 months. Filling by CHA blocks, mixing with autogenous bone grafts was done in osteoclastoma and fibrous dysplasia cases, while only CHA block filling was done in solitary bone cyst, aneurysmal bone cyst and fibroma cases. In all the cases, the diagnosis was made on the basis of clinical, radiological and histopathological examination. Both with and without pathological fractures cystic lesions were taken. Results: In the present study, 11 cases had pathological fracture. In our series, maximum cases were of osteoclastoma. Most of the cases were associated with pathological fracture. The pathological fractures united from 20-30 weeks time, Radiologically, the density of CHA blocks increased with the lapse of time. In our series, the longest follow up period was about 24 months and the shortest was of 12 months duration. 20 patients had excellent results with full functional, anatomical restoration without any pain and radiograph shows no recurrence, with healing of pathological fracture. While 2 patients had poor results they were not able to do activities of daily living, had pain and delayed healing. Conclusion: The CHA has favourable clinical result because of less adverse effects, biocompatibility to the tissue of the body, ease of manufacture, production and shape adjustment. Therefore, it is strongly suggested as a useful bone substitute.In our limited experience with coralline hydroxyapatite bone graft substitutes, we have encountered no significant complications related to implant themselves.

Adenocarcinoma pleomórfico de células gigantes de vías biliares (osteoclastoma like) / Pleomorphic adenocarcinoma of biliary ducts cells (osteoclastoma like)

Las células gigantes tipo osteoclásticas (CGTO) del páncreas son una entidad poco frecuente descritas originalmente por Rosaien 1968, ca-racterizado por osteoclastos, que son células gigantes mononucleares idénticas a las célu-las del estroma observadas en tumores óseos. Desde entonces, hay pocos informes de los tumores que contienen células gigantes en otras localizaciones anatómicas. Las CGTO se pueden distinguir de las células gigantes tipo pleomórficas (CGTP), debido a la falta de un marcado pleomorfismo nuclear asociado. A menudo, un carcinoma de páncreas histológi-camente reconocible acompaña CGTO, dan-do lugar a un mal resultado. Formas puras de CGTO presentan un mejor pronóstico porque se necesita mucho tiempo para desarrollar metástasis, pero esta forma es muy rara, con pocos casos reportados en la literatura Inglé-sa. La mayoría de veces se discute el diagnós-tico de benignidad de estos tumores basados en la evaluación de inmunohistoquímica.El presente caso se trata de una paciente de sexo femenino de 56 años de edad con cua-dro caracterizado por dolor tipo cólico que mejora con antiespasmódicos, de varios me-ses de evolución, con periodos de remisión y exacerbación. En el examen físico presenta: en piel y mucosas ligero tinte subictérico, a nivel abdominal: abdominal, dolor de forma difusa sin viseromegalias o masas palpables.

Osteoclast-type giant cells (CGTO) of the pan-creas are not frequent originally described by Rosaien 1968, characterized by osteoclasts that are giant cells identical mononuclear stromal cells in bone tumors observed. Since then, there are few reports of tumors contai-ning giant cells in other anatomic locations. The CGTO can be distinguished from the pleo-morphic type giant cells (CGTP), due to the lack of an associated marked nuclear pleo-morphism. Often a pancreatic carcinoma histologically recognizable CGTO accompa-nies, leading to a bad result. CGTO pure for-ms have a better prognosis because it takes a long time to develop metastases, but this form is very rare, with few cases reported in the English literature. Most times the benign diagnosis of these tumors based on immuno-histochemistry evaluation is discussed.This case is a female patient 56 years old with picture characterized by cramping pain that improves with antispasmodics, several mon-ths of evolution, with periods of remission and exacerbation. A physical exam features: light skin and mucous subictérico dye, abdominal level: diffusely painful abdomen without vise-romegalias or palpable masses.

Importance of Conventional Radiography in Diagnosis and Management of Giant Cell Tumour at an unusual location.

Giant cell tumour (GCT) or osteoclastoma of the bone is mostly benign but locally aggressive primary tumour of unknown origin occurring at epiphysis. It is a tumour of long bones and rarely seen in bones of hand and foot. The cases are reported in tarsal and carpal bone but involvement of metatarsal bone is very rare. We present a case of twenty years old female patient with GCT of second metatarsal of left foot. The patient underwent aggressive curettage and filling with bone chips and is on regular follow up.

Brown Tumor of the Cervical Spines: A Case Report with Literature Review

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.

Tumor pardo bimaxiliar superior e hiperparatiroidismo terciario: reporte de un caso y revisión de la literatura / Brown tumor bimaxiliar upper and tertiary hyperparathyroidism: a case report and literature review

El tumor pardo u osteoclastoma constituye una manifestación de la osteítis fibrosa quística, siendo esta última el estadio terminal del proceso de remodelación ósea que ocurre en el hiperparatiroidismo. Su localización más frecuente es en los huesos largos, siendo la afectación de los maxilares poco común. Se presenta el caso de una paciente de 37 años de edad, con enfermedad renal crónica e hiperparatiroidismo terciario con tumor pardo bimaxilar. Se discuten los aspectos clínicos radiológicos y terapéuticos de estos procesos.

Brown tumor or osteoclastoma, is a manifestation of osteitis fibrosa cystica, which represents the terminal stage of the bone remodeling process in hyperparathyroidism. Brown tumors are preferentially situated in the long bones, being maxillary presentation very rare. We present a 37 year old female patient with chronic renal disease and tertiary hyperparathyroidism with bimaxillary brown tumor. Clinical, radiological and therapeutic aspects of these processes are discussed.

Extensive Brown Tumors of Spine, Distal femur and Patella Presenting with Acute Cord Compression. A Case Report

We report a case of end stage renal failure in a patient who presented with acute cord compression and extensive brown tumour involving the spine, distal femur and patella. Brown tumours of the long bone, spine and pelvis have been documented previously. However, the occurrence of brown tumour in sesamoid bones such as the patella is extremely rare and is indicative of widespread lesions and severe secondary hyperparathyroidism. These tumours typically respond poorly to medical treatment alone. The acute c

A Case of Recurrent Osteoclastoma of the Paranasal Sinuses in a Patient with Paget's Disease / 대한이비인후과학회지

Paget's disease is a well-known disorder of unclear etiology that results in deformity and enlargement of single or multiple bones due to abnormal osteoclastic-osteoblastic remodeling of bone. Osteoclastoma, also known as giant cell tumor, is a rare complication of Paget's disease that usually occurs in the skull or facial bones. This is a report of a 35-year-old woman with recurrent osteoclastoma of the sino-nasal tract, a complication of Paget's disease, for which she underwent 4 operations. Clinicopathological features of this rare disease are described here.

Resección tumoral ósea en bloque y sustitución del defecto óseo creado en pacientes del hospital Teodoro Maldonado Carbo: análisis 1993 – 2003 / Osseous tumoral block resection and substitution of osseous defect created in patients at Teodoro Maldonado Carbo hospital: analysis 1993-2003

Tipo de estudio: retrospectivo, descriptivo y observacional. Objetivo general: determinar si la técnica de resección tumoral ósea en bloque es una buena alternativa como parte del tratamiento multidisciplinario para la cirugía de salvataje de miembros. Objetivos específicos: conocer cuáles son los tipos más frecuentes de tumores óseos sometidos a resección tumoral en bloque según clasificación histológica de la OMS. Establecer la relación entre el tipo histológico del tumor según clasificación de la OMS con el sexo de los pacientes. Determinar de acuerdo a la clasificación de Enneking en que estadiaje es más frecuente la resección en bloque. Precisar la viabilidad y funcionalidad de los miembros post-resección en bloque, con o sin el uso de agentes sustitutos del defecto óseo. Resultados: de los 37 pacientes sometidos a resección en bloque, 23 eran hombres y 14 mujeres. Según la clasificación de la OMS, los tumores malignos predominaron en la muestra con 20 casos (54), el TCG u osteoclastoma fue el tipo de tumor más encontrado con un 43,2 (16 casos). Según la estadificación de Enneking los tumores en estadío IIB fueron los de mayor incidencia con 7 casos (18,9), las endoprótesis no convencionales predominaron con 15 casos. Para el análisis de los 28 pacientes que pasaron a la segunda fase de estudio, fue necesaria la evaluación de los pacientes por medio de la escala de funcionalidad para miembros inferiores de la clínica Mayo, encontrándose los siguientes resultados: de los 28 pacientes 2 (7), presentaban dolor moderado; 13(46), podían caminar más de 10 cuadras; 20, no necesitaban ningún medio de apoyo para movilizarse; 21 (75), podían movilizarse en un vehículo fácilmente; 24(86), no presentaban ninguna dificultad en el cuidado de sus pies, ninguno presentaba claudicación en la marcha, 15 pacientes podían subir escaleras normalmente. De la suma de 80 puntos, la media de los resultados en esta investigación fue de 72,5 puntos y se reportaron.

Study type: retrospective, descriptive, and observational. General objective: to determine if the technique of osseous tumoral block resection is a good alternative as part of the multidisciplinary treatment for the member salvation surgery. Specific objectives: to get to know which are the most frequent types of osseous tumours subjected to osseous tumoral block resection according to the histological classification of the WHO. To establish the relationship between the histological types of tumour according to the WHO’s classification against the patient’s sex. To determine, according to Enneking stratification, in which stage the block resection is most frequent. To define the viability and functionality of the members after the block resection with or without the use of substitutes for the osseous defect. Results: out of the 37 patients subjected to block resection, 23 were men and 14 women. According to WHO’s classification, malignant tumours were predominant in the sample with 20 cases (54), “GCM” or osteoclastoma was the most found type of tumour with a 43.2 (16 cases). According to Enneking stratification the tumours in stage IIB were majority with 7 cases (18.9), unconventional endoprosthesis predominated with 15 cases. For the analysis of the 28 patients who passed to the second phase of the study, the patients’ evaluation at the Mayo Clinic was necessary through functionality scale for the lower limbs, the following results were found: out of the 28 patients 2 (7) presented moderate pain; 13 (46), were able to walk more than 10 blocks; 20, didn’t need any support to move; 21 (75), were able to move easily in a vehicle ; 24 (86), didn’t present any difficulty in the care of their feet, none presented claudication, 15 patients were able to climb stairs normally. In the addition of 80 points, the ratio of the results in this research.

Tumor oseo de celulas gigantes (Osteoclastoma) de perone: a propósito de un caso / Giant cell tumor bone (Osteoclastoma) of perone: a purpose of a case

El tumor óseo de células gigantes es generalmente benigno, raro, grande, solitario agresivo localmente; denominado así por las células que lo constituyen las cuales son del tipo de los osteoclastos multinucleados, de ahí su otro nombre osteoclastoma. La experiencia acumulada evidencia que estos afectan en el adulto a la epífisis y metafisis, pero en los adolescentes solo afecta las zonas proximales confinadas por las placas de crecimiento. La mayoría de estos tumores aparecen en la zona periférica de la rodilla en mas de un 50 por ciento de los casos. Se reporta como síntoma mas evidente el dolor periarticular que es el estímulo que lleva a la consulta. Es considerado una neoplasia traicionera ya que histológicamente no hay diferencia entre osteoclastoma benigno y el infrecuente osteoclastoma maligno complicando el tratamiento. Existen características radiológicas que orientan al diagnóstico como la expansión excesiva de la cáscara perióstica a nivel epi-metafisiario; siendo el método gold standard de diagnóstico la RMN, donde podemos diferenciar características macroscópicas especificas del tumor; es importante tener en cuenta el rastro óseo (Survey, gammagrafía), ya que se han reportado casos de tumores multicentricos generalmente entre 2 y 3 focos neoplásicos distintos. Según su patogenia se ha establecido una gradación actual dada por la sinergia clinicoradiopatológica como elemento predictivo pero que no aporta significancia a la hora del tratamiento. Anteriormente se manejaban estas neoplasias conservadoramente, en la actualidad el tratamiento se inclina a la resección total en bloque buscando la curación total con posterior reemplazo con injerto o implante; ya que el tratamiento local mediante curetaje reporta una gran tasa de recidivas alrededor de un 50 por ciento. El uso de radioterapia en esta patología esta proscrito por la prevalencia de degeneración sarcomatosa. Presentación del caso: se presenta el caso de una paciente femenina de 17 años.

Osteoclastoma of occipital bone

Osteoclastoma of the calvarial bone of membranous origin is a rare entity. This paper presents a case of osteoclastoma of the occipital bone and a brief review of literature.