Clinical Observation on Giant Cell Tumor: Treatment and prognosis / 대한정형외과학회잡지

ABSTRACT

Giant cell tumor is an uncommon neoplasm, arising from the mesenchymal cells of bone marrow. The lesion was first described by Sir Astley Cooper in 1818. Levert in 1845 gave a detailed delineation of this tumorous condition. Paget in 1853 provided an excellent description of what remains a guiding treatise. In 1940, Jaffe, Lichtenstein, and Portis identified it as an entity with distinctive roentgenographic, hiatological, and clinical characteristics. Since then, frequent detailed reports analyzing the treatment and prognosis were published by many authors. The classic grading system is that of Jaffe, Lichtenstein, and Portis. Grade I,II, and III correspond respectively to insignificant, moderate, and marked atypism of the nuclei of the stromal cells. Tumors of Grade III are considered to be frankly malignant. While Dahlin and associates and Goldenberg and his co-workers found the grading of no prognostic value, Lichtenstein, in 1972, still claimed that in his experience the grading of giant cell tumor is of practical value. Twenty seven cases of giant cell tumor were seen and treated at Severance Hoepital during the 18 years from July 1960 to June 1978. The tumors were mostly diatributed 55% in the 21 to 40 years group and mostly located around the knee (52%). According to the pathologlcal grading, these casosbelonged to Grade I and Grade III in 19% each and to Grade Il in 62%. The treatment consisted of curettage and bone graft in 14 cases, amputation in 4 cases, en bloc excision in 3 cases, partial resection and fusion, curettage and bone graft with radiotherapy in 2 cases each, curettage and bone cement, and en bloc excision and endoprosthsis in one case each. On following up the end results, the over all recurrence rate was 18.5% (5 cases) and the malignant change rate was 3.7% (1 case). In this study one case was changed into malignant degeneration in Grade II and a pulmonary metastasis was found. Among our cases, 5 were of recurrences, primarily treated by curettage and bone graft in to cases, partial excision with fusion in one case, and curettage, and bone graft with radiotherapy in one case. The recurrence rate seems not to be correlated with the grade. In the treatment of this tumor, surgical treatment if pcssible is recommended. The definitive procedures for removal of the tumors in this series were curettage-and bone graft, excision or resection with or without bone graft, and amputation. Resection and prosthesis replacement was employed in our cases for one lesion in the proximal end of humerus. A new alternative in the choice of surgery has been tried in many authors. This alternative is a thorough curettage of the tumor and filling with bone or acylic bone cement. In our series bone cement filled up the lesion of the distal end of tibia. Tumors located around the knee and distal radius showed higher recurrence than other sites. The results obtained from this study led us to conclude that 1) The highest incidence was in the age group from 21 to 40 years in 15 cases (55%) and sex distribution was almost equal 2) The most frequent sites of this tumor are the lower end of the femur, upper end of tibia, and lower end of the radius (18 cases, 67%). 3) The pathological grading in this series showed 5 cases in Grade I, 17 cases in Grade II, and 5 cases in Grade III. 4) Recurrence rate was 18.5% and all cases recurred within 2 years after first surgery. 5) A case who is in Grade II in pathological finding was changed into malignant degeneration and pulmonary metastasis. 6) Tumors located around the knee and distal radius were higher in recurrence than at other sites.