Giant cell tumor of the distal femur associated with complete tumor necrosis.

Giant cell tumor is a benign tumor of bone with a predilection for juxta-articular locations. Although not malignant, giant cell tumor often exhibits unpredictable and locally aggressive behavior, and in rare cases can metastasize in the absence of histologic malignancy. Partial tumor necrosis has been infrequently reported within typical giant cell tumor. A 17-year-old girl presented with a right distal femur giant cell tumor associated with complete tumor necrosis on histopathologic analysis. The etiology, prevalence, and implications of complete necrosis in previously untreated giant cell tumor of bone remain unclear, as there are no previously published reports. Despite the complete necrosis evident in our patient, she nonetheless presented with pain. There were no radiographic signs of the necrotic tumor space remodeling with new bone. The patient was treated with standard extended intralesional curetting through a generous cortical window permitting visualization of the entire lesion, and systematic high speed burring and thermal electrocautery ablation of the periphery, followed by micro particulate allogenic bone grafting. At short-term follow-up, she had healed well with no evidence of tumor recurrence. This article presents the first case, to our knowledge, of complete spontaneous tumor necrosis in a previously untreated bone giant cell tumor. Increased understanding of spontaneous tumor necrosis associated with giant cell tumor may help guided future targeted medical and surgical treatment modalities.

Consequences and prevention of inadvertent internal fixation of primary osseous sarcomas.

UNLABELLED: The evaluation and treatment of aggressive bone tumors continue to be diagnostic and therapeutic challenges for orthopaedic surgeons. Despite compelling data regarding the hazards of biopsy, incomplete preoperative evaluation, inappropriate biopsy techniques, and premature surgical interventions continue to compromise optimal treatment of primary bone sarcomas. We retrospectively identified eight patients who had internal fixation of a primary bone sarcoma before referral to an orthopaedic oncology service. Six of the eight patients subsequently underwent amputations and two patients underwent limb salvage for local disease control. Biopsy techniques from referring institutions were highly variable, with only two of seven rendering an accurate diagnosis. The average Musculoskeletal Tumor Society functional score was 10.6 and four of eight patients were disease-free and alive at a minimum followup of 8 months (mean, 26.9 months; range, 8-80 months). Implant violation of primary bone malignancies was associated with frequent high-level amputation for local disease control and low Musculoskeletal Tumor Society functional scores. Common errors in the initial evaluation and treatment included inadequate attention to patient history, incomplete radiographic evaluation, and improper biopsy and surgical techniques, which violated compartmental boundaries. LEVEL OF EVIDENCE: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.