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Giant cell carcinoma of the lung. A case report

TOCK PC

Med J Malaya, 1962 Mar;16:219-24.
PMID: 13921481
Matched MeSH terms: Giant Cell Tumors*
Giant cell tumor of the tendon sheath in the knee of an 11-year-old girl

Abdullah A, Abdullah S, Haflah NH, Ibrahim S

J Chin Med Assoc, 2010 Jan;73(1):47-51.
PMID: 20103492

Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.

Matched MeSH terms: Giant Cell Tumors/diagnosis*; Giant Cell Tumors/pathology; Giant Cell Tumors/surgery
Fulltext Reconstruction of the Second Metatarsal with Non-vascularised Fibular Graft following En-bloc Resection for Giant Cell Tumour: A Case Report

Rengsen P, Tiong K, Teo Y, Goh T, Sivapathasundram N

Malays Orthop J, 2013 Nov;7(3):15-7.
PMID: 25674301 DOI: 10.5704/MOJ.1311.001

Giant cell tumour in the metatarsal of a skeletally immature person is uncommon. Adequate surgical resection in this region can be difficult to achieve as there is little space between the rays of the foot. Furthermore, there is the challenge of restoring the metatarsophalangeal articulation after resection of the tumor. We describe a technique using non-vascularised fibular graft for reconstructing the 2nd metatarsal after en-bloc resection for giant cell tumour in a 14 year old adolescent female.

Matched MeSH terms: Giant Cell Tumors
Endoprosthetic reconstruction for giant cell tumors of the distal tibia: a short term review

Ajit Singh V, Nasirudin N, Bernatt M

Asia Pac J Clin Oncol, 2013 Jun;9(2):182-9.
PMID: 22897856 DOI: 10.1111/j.1743-7563.2012.01553.x

Custom-made endoprosthetic reconstruction for distal tibia tumors is a viable option of treatment in carefully selected patients. It maintains satisfactory function and provides good pain relief. We report four cases of giant cell tumors of the distal tibia successfully treated by endoprosthetic reconstruction. This is a feasible option in cases of this nature and offers a better function than the other available options.

Matched MeSH terms: Giant Cell Tumors/pathology; Giant Cell Tumors/radiography; Giant Cell Tumors/surgery*
Neurological Recovery in Two Patients with Cauda Equina Syndrome Secondary to L5 Lumbar Spine Giant Cell Tumour after Treatment with Denosumab without Surgery

Randhawa SS, Kwan AK, Chiu CK, Chan CY, Kwan MK

Asian Spine J, 2016 Oct;10(5):945-949.
PMID: 27790326

We report two patients with cauda equina syndrome (CES) secondary to L5 giant cell tumour (GCT) who achieved good neurological recovery after treatment with denosumab without surgery. The first patient was a 26-year-old man with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 2 to grade 4 and Oswestry disability index (ODI) improvement from 48 to 23 after denosumab treatment. The second patient was a 25-year-old woman with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 0 to grade 4 and ODI improvement from 42 to 20 after denosumab treatment. The usage of denosumab in the treatment of patients with CES due to GCT allows potential neurological recovery without any surgical intervention. If surgery is not contraindicated, more time is obtained to prepare the patient preoperatively to attain safer surgery and to achieve complete tumour clearance.

Matched MeSH terms: Giant Cell Tumors
Fulltext Neurological recovery in a patient with recurrent aggressive giant cell tumour of the axis--a case report

Razak MA, Fazir M

Med J Malaysia, 2000 Sep;55 Suppl C:97-100.
PMID: 11200052

A rare case of an aggressive recurrent giant cell tumour of axis is presented. The problems encountered in diagnosis and management are discussed. High dose dexamethasone was found to be useful managing this inoperable aggressive tumour which was compressing the cord. Early diagnosis would facilitate wide excision of the tumour with good prognosis.

Matched MeSH terms: Giant Cell Tumors/complications*; Giant Cell Tumors/radiography; Giant Cell Tumors/radiotherapy; Giant Cell Tumors/surgery*
Fulltext Biomarkers for Bone Tumors: Discovery from Genomics and Proteomics Studies and Their Challenges

Wan-Ibrahim WI, Singh VA, Hashim OH, Abdul-Rahman PS

Mol. Med., 2016 Mar;21(1):861-872.
PMID: 26581086 DOI: 10.2119/molmed.2015.00183

Diagnosis of bone tumor currently relies on imaging and biopsy, and hence, the need to find less invasive ways for its accurate detection. More recently, numerous promising deoxyribonucleic acid (DNA) and protein biomarkers with significant prognostic, diagnostic and/or predictive abilities for various types of bone tumors have been identified from genomics and proteomics studies. This article reviewed the putative biomarkers for the more common types of bone tumors (that is, osteosarcoma, Ewing sarcoma, chondrosarcoma [malignant] and giant cell tumor [benign]) that were unveiled from the studies. The benefits and drawbacks of these biomarkers, as well as the technology platforms involved in the research, were also discussed. Challenges faced in the biomarker discovery studies and the problems in their translation from the bench to the clinical settings were also addressed.

Matched MeSH terms: Giant Cell Tumors
Fulltext Three Level Thoracolumbar Spondylectomy for Recurrent Giant Cell Tumour of the Spine: A Case Report

Faruk NA, Mohd-Amin MZ, Awang-Ojep DN, Teo YY, Wong CC

Malays Orthop J, 2018 Nov;12(3):50-52.
PMID: 30555648 MyJurnal DOI: 10.5704/MOJ.1811.013

Giant cell tumour (GCT) is a benign tumour but can be locally aggressive and with the potential to metastasise especially to the lungs. Successful treatments have been reported for long bone lesions; however, optimal surgical and medical treatment for spinal and sacral lesions are not well established. In treating spinal GCTs, the aim is to achieve complete tumour excision, restore spinal stability and decompress the neural tissues. The ideal surgical procedure is an en bloc spondylectomy or vertebrectomy, where all tumour cells are removed as recurrence is closely related to the extent of initial surgical excision. However, such a surgery has a high complication rate, such as dura tear and massive blood loss. We report a patient with a missed pathological fracture of T12 treated initially with a posterior subtraction osteotomy, who had recurrence three years after the index surgery and subsequently underwent a three level vertebrectomy and posterior spinal fusion.

Matched MeSH terms: Giant Cell Tumors
Laryngeal giant cell tumour presenting as a tongue base lesion causing severe dysphagia

Saud MRM, Salahuddin Z, Hassan A, Yunus MRM, Mohamad I, Zulkifli MM

J Taibah Univ Med Sci, 2018 Apr;13(2):201-204.
PMID: 31435324 DOI: 10.1016/j.jtumed.2017.10.002

Giant cell tumours are benign lesions that are uncommonly found in the larynx. Patients with these tumours may present with dysphagia, hoarseness and anterior neck swelling. Giant cell tumours are extremely rare and only a few cases have been reported. We present a case of an elderly woman who presented with severe dysphagia and a mass at the base of her tongue. The mass was found to be a laryngeal giant cell tumour and was successfully treated with chemotherapy.

Matched MeSH terms: Giant Cell Tumors
Fulltext Reconstruction of the second metatarsal with nonvascularised fibular graft following en-bloc resection for giant cell tumour: A case report

Rengsen, P., Tiong, K.L., Teo, Y.M., Goh, T.C., Sivapathasundram, N.

Malays Orthop J, 2013;7(3):15-17.
MyJurnal

Giant cell tumour in the metatarsal of a skeletally immature person is uncommon. Adequate surgical resection in this region can be difficult to achieve as there is little space between the rays of the foot. Furthermore, there is the challenge of restoring the metatarsophalangeal articulation after resection of the tumor. We describe a technique using non-vascularised fibular graft for reconstructing the 2nd metatarsal after en-bloc resection for giant cell tumour in a 14 year old adolescent female.

Matched MeSH terms: Giant Cell Tumors
Fulltext Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts

Singaravadivelu V, Kavinkumar V

Malays Orthop J, 2020 Nov;14(3):42-49.
PMID: 33403061 DOI: 10.5704/MOJ.2011.008

Introduction: Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage.
Materials and Methods: This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score.
Results: There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%.
Conclusion: Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.

Matched MeSH terms: Giant Cell Tumors
Fulltext Assessment of Extra-Cortical Bone Bridge Interface in Cemented Mega Endoprosthesis for Limb Salvage Surgery

Murugan K, Faisham WI, Zulmi W

Malays Orthop J, 2021 Mar;15(1):93-99.
PMID: 33880154 DOI: 10.5704/MOJ.2103.014

Introduction: Mega endoprosthesis replacement for resection of primary malignant bone tumour requires immediate and long-term stability, particularly in the young and active patient. Extracortical bone bridge interface (EBBI) is a technique whereby autograft is wrapped around the interface junction of bone and porous-coated implant to induce and enhance bone formation for biological incorporation. This procedure increases the mean torsional stiffness and the mean maximum torque, which eventually improves the implant's long-term survival.
Material and methods: The extracortical bone bridge interface's radiological parameter was evaluated at the prosthesis bone junction two years after surgery utilising a picture archiving and communication system (PACS). The radiograph's anteroposterior and lateral view was analysed for both thickness and length in all four cortices. The analysis was done in SPSS Version 24 using One-Way ANOVA and independent T-Test. Results were presented as mean and standard deviation and considered significant when the p-value was < 0.05.
Results: The mean average thickness was 2.2293mm (SD 1.829), and the mean average length was 31.95% (SD 24.55). We observed that the thickness and length of EBBI were superior in the young patient or patients with giant cell tumour that did not receive chemotherapy, compared to patients treated for osteosarcoma. The distal femur also had better EBBI compared to the proximal tibia. However, the final multivariable statistical analysis showed no significant difference in all variables. EBBI thickness was significantly and positively correlated with EBBI Length (p<0.001). We conclude that, for each 1mm increase in EBBI thickness, the length will increase by 0.06% on average. About 17.2% of patients out of the 29 showed no radiological evidence of EBBI.
Conclusion: From our study, there were no factors that significantly contributed to the formation and incorporation of EBBI.

Matched MeSH terms: Giant Cell Tumors
Fulltext Curettage and Cementation in Giant Cell Tumour of the Distal Tibia Using Polypropylene Mesh for Containment: A Case Report

Pan, K.L., Chan, W.H.

Malays Orthop J, 2010;4(2):51-53.
MyJurnal

Giant cell tumours of bone are best treated by extended curettage and filling in of the defect with cement or bone graft. In more advanced stages, when there is extensive loss of cortical bone cover, containment of the filling material is not possible and resection and reconstruction is required. We report a case of a recurrent giant cell tumour of the distal tibia in a 21-year-old female with extensive cortical bone loss in which polypropylene surgical mesh was used to contain the bone cement, thus avoiding a resection.

Matched MeSH terms: Giant Cell Tumors
Fulltext Giant cell tumour of tendon sheath masquerading as trigger finger

Rahimawati N, Roohi SA, Naicker AS, Zanariah O

Malays Orthop J, 2010;4(3):32-35.
MyJurnal

We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.

Matched MeSH terms: Giant Cell Tumors
Fulltext Tuberculosis of the distal end of the radius mimicking a giant-cell tumour

Pan KL, Ibrahim S

Med J Malaysia, 2000 Sep;55 Suppl C:105-6.
PMID: 11200036

We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.

Matched MeSH terms: Giant Cell Tumors/radiography*
Fulltext The Values of Receptor Activator Nuclear Kappa-B Ligand Expression in Stage III Giant Cell Tumor of the Bone

Ghani SA, Wan Ismail WF, Md Salleh MS, Yahaya S, Syahrul Fitri ZM

Indian J Orthop, 2018 2 9;52(1):31-34.
PMID: 29416167 DOI: 10.4103/ortho.IJOrtho_153_17

Background: Giant cell tumor (GCT) of bone is a benign locally aggressive primary bone tumor which is risky for local recurrences and pulmonary metastasis. Till date, there are still many uncertainties in predicting the aggressiveness of GCT. We aim to investigate whether receptor activator nuclear kappa-B ligand (RANKL) expression may determine the prognosis of the lesion.
Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.
Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.
Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.

Matched MeSH terms: Giant Cell Tumors
Fulltext Reconstruction of metacarpal bone with giant cell tumour by metatarsal bone: a rare case

Loh, Li Loong, Raffael B. Ismail, Goh, Kian Liang, Kamarul Ariffin Khalid

Borneo Journal of Medical Sciences, 2021;15(1):49-55.
MyJurnal

Giant cell tumour (GCT) of the metacarpal bone is rare, and it behaves more aggressively with a higher recurrence rate as compared to other long bones. Modalities such as bone curettage with or without bone grafting, ray amputation, or wide resection and reconstruction have been described as surgical management for this condition. Wide resection (en block) is often preferred as it has a lower recurrence rate among the rests. Reconstruction techniques options available include vascularised or non-vascularised fibular graft, iliac crest strut graft with loss of metacarpophalangeal joint function or with metatarsal substitution resulting in a more preserved function of the hand. This case report is about a 15-year-old teenager girl with a giant cell tumor of her left second metacarpal bone, which was confirmed with a plain radiograph and magnetic resonance imaging. This case report focuses the operative technique of the metacarpal reconstruction using the third metatarsal bone. The aim was to preserve hand function and cosmesis while achieving good local control of the disease without compromising the lower limb function. The transfer of osteoarticular ligamentous complex of the third metatarsal bone for the reconstruction of the second metacarpal bone defects is a possible operative procedure that provides good cosmetic and excellent functional outcomes while not compromising the donor’s foot function.

Matched MeSH terms: Giant Cell Tumors
A Rare Case of Giant Cell Tumour of Bilateral Achilles Tendon Sheath - Reconstruction with Dual Tendon Transfer: A Case Report

Samal P, Mohapatra NC, Mishra J, Mylarappa A, Das P

Malays Orthop J, 2020 Mar;14(1):84-87.
PMID: 32296488 DOI: 10.5704/MOJ.2003.014

Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years follow-up, functional result was satisfactory.

Matched MeSH terms: Giant Cell Tumors
Fulltext Avoiding diagnostic pitfalls in mimics of neoplasia: the importance of a comprehensive diagnostic approach

Samsudin EZ, Kamarul T, Mansor A

Singapore Med J, 2015 May;56(5):e92-5.
PMID: 26034328 DOI: 10.11622/smedj.2015082

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.

Matched MeSH terms: Giant Cell Tumors/diagnosis

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