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Giant cell tumor (GCT) of the bone is a locally aggressive and rarely metastasizing neoplasm. It is composed of neoplastic mononuclear stromal cells with a monotonous appearance admixed with macrophages and osteoclast-like giant cells. In a small subset of cases, GCT is malignant. Terminology previously related to this entity, and which is no longer supported by the World Health Organization, includes osteoclastoma and benign fibrous histiocytoma (BFH). Giant cells occur in numerous other pathologic conditions of the bone, which accounts for the misrepresentation of these non-GCT tumors in the early literature. Non-ossifying fibroma (NOF), aneurysmal bone cyst, and chondroblastoma have been erroneously labeled GCT for this reason. A single description of an ancient GCT was reported by Brothwell and Sandison and subsequently mentioned by Aufderheide and Rodrìguez-Martìn who were astonished that more of these tumors had not been identified in archaeological cases. To the best of our knowledge, no other cases of ancient GCT have been cited in the paleopathology literature. The study of this type of neoplasm in antiquity can be used as a means to better understand its characteristics and behavior and to expand the depth of time of the etiology of these lesions. We report a case of GCT of the left femur observed following the total body CT imaging of a partially mummified adult female, dating to eighteenth century.

Background: Patients with hand masses present for consultation either for pain, loss of function, or cosmetic embarrassment caused by the mass. The majority of hand masses are benign soft tissue tumors. The aim was to review the histology results of hand masses operated on at the Chris Hani Baragwanath Academic Hospital Hand Unit in Johannesburg, South Africa, to explore the relationship of the types of masses according to age, sex, side, and compare the findings with what is in the current literature. Methods: Patients operated on in the hand unit, for hand masses between April 2016 and April 2019 with histology results were included in the study for statistical analysis. Results: There were 64 males and 105 females with a mean age of 41.03 ± 18.81 years. The most frequent masses were ganglion cysts. Females appeared to be more affected than males by the different hand masses, but there were no statistically significant differences. Of the 21 giant cell tumors, 15 occurred on the right hand (p-value = 0.021). Conclusion: The profile of hand masses at a high-volume hand unit in Johannesburg, were comparable to the reported literature. There were no significant differences between sex and diagnosis, however, there was a relationship between diagnosis and side for giant cell tumors of tendon sheaths, requiring further exploration.

Introduction: Giant cell tumors (GCTs) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphysis of long bones. GCT of the femoral head is rarely encountered. Case Report: We report a rare case of GCT of the femoral head in a 20-year-old female. The patient presented with pathological fracture. The patient underwent total hip arthroplasty (THA). The aim of this paper is to present a case study with pathological fracture of the femoral head and to report the results of a literature review. Conclusion: The treatment of choice for GCT of the proximal femur is a hip arthroplasty with either a standard THA for small confined tumors or endoprosthesis insertion for more extensive tumors. Joint preserving procedures have a high revision rate (47.06%). Denosumab has been tried as a neoadjuvant treatment with some success in certain cases. Keywords: Giant cell tumor, pathological fracture, arthroplasty.

Background: The purpose of our study was to evaluate the osteolytic lesions of bone reported at the department of pathology in a tertiary care hospital in West Bengal. Materials and Methods: We performed a retrospective study over a period of 7 years from February 2013 to January 2020. Entirely osteosclerotic lesions were excluded from our study. The lesions were classified as nonneoplastic lesions, benign lesions, tumor like lesions and malignant lesions. Results: Over 7 years, 147 cases of osteolytic lesions of bone were reported. Of these, 36.1% were malignant lesions. The most common sites of osteolytic lesions were the femur (n = 46), tibia (n = 24), and humerus (n = 20). The most frequent histological diagnosis was of giant cell tumor (GCT) (n = 31), followed by chronic osteomyelitis (n = 19) and osteosarcoma (n = 17). The most frequent benign neoplasm was GCT and osteosarcoma was the predominant malignant lesion. Relatively uncommon lesions like adamantinoma were also reported. Conclusions: Malignant neoplasms are the most common osteolytic lesions. Bones of the extremities are the most frequent sites of involvement by both benign and malignant tumors. In addition to radiological correlation, a thorough knowledge of the age, sex, site of the common bone lesions is required for a correct histopathological diagnosis so that proper treatment can be instituted. Most of these lesions do not require immunohistochemistry for diagnosis. The possibility of rare tumors presenting at a given age and at a particular site is to be considered.

Introduction: The WHO defines giant cell tumor as a benign locally aggressive neoplasm with metastasizing capacity and aggressive behavior. Very rarely, these tumors are seen fungating, mostly when neglected. But when they do, the treatment option commonly conferred is amputation of the limb which is disabling and traumatizing. Case Report: We report three cases of fungating limb masses (proximal tibia, distal fibula, and distal radius) diagnosed with giant cell tumor histologically, undergoing limb saving surgeries with various reconstruction techniques to endorse a good quality of life and functioning limb. Conclusion: Our study is one of the earliest to report medium-term follow-up after such limb salvage procedure. We recommend that salvage procedures should be considered in giant cell tumors even in the presence of fungation if there is no neurovascular encasement. Keywords: Giant cell tumor, fungation, limb salvage surgery, endoprosthesis, mesh reconstruction.

Giant cell tumors (GCT) are generally benign, commonly affecting young adults, with a slight preponderance in females. They are locally aggressive with a high rate of local recurrence. Most of them are found in the epiphysis of long bones, making the base of the skull a rare site. We report the case of a 35-year-old female, who presented with neurological symptoms of headache and diplopia. On magnetic resonance imaging, a space-occupying lesion was discovered in the clivus. Histopathology was diagnostic of a GCT. GCT arising from the clivus is extremely uncommon, with about 15 cases published in the literature. The present case highlights the rarity of this tumor and contributes to the existing literature with analysis and evaluation of the management strategies and prognosis.

Highlights • The distal Ulna is an unusual site (0.45%–3.2%) for a primary bone GCT. • The functional reconstruction of the defect after resection has been a challenge. • Many surgeons try to retain the ulna and perform the only curettage and packing with polymethylmethacrylate. Unfortunately, there is a high recurrence rate of up to 40% when treated in such a manner. • Wide resection of the distal ulna with or without reconstruction or stabilization of the ulnar stump is the recommended treatment for GCTs in such locations. • We present two patients with GCT of the distal ulna, all of them treated by wide resection of the distal ulna followed by stabilization of the remaining ulna using one half of the extensor carpi ulnaris (ECU) tendon. All the patient satisfied with the treatment., Introduction Giant-cell tumor (GCT) of bone occurred in the distal end of the ulna is extremely uncommon. Wide resection is usually indicated in such cases and at times it may be necessary to remove a long segment of the distal ulna. The functional reconstruction of the defect after resection has been a challenge. Wide resection of the distal ulna with or without reconstruction or stabilization of the ulnar stump is the recommended treatment for GCTs in such locations. Presentation of case There were 2 cases of giant cells tumor of the distal ulna. They treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris tendon. We were evaluating outcomes using the Musculoskeletal Tumor Society (MSTS) Score for the upper extremity. The results from the evaluation of the MSTS Score were an average of 24 points. Discussion There were 2 patients. All of them present with lumps of their wrist and the pain over the lump. Patients treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris. The result from the evaluation of the Musculoskeletal Tumor Society (MSTS) score were 24 points. Conclusion Giant cell tumor of bone is a rare, generally benign, locally invasive tumor. The ulna distal extremity is an unusual site for a primary bone GCT. Any ulnar resection proximal to the insertion of the pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in a diminution of forearm rotation and weakness with grasp. The main goal of stabilization is the stable, pain-free, and functional outcome of the wrist. In this cases report our patient with giant cell tumor were treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris. All of the patients satisfied with our treatment.

Giant cell tumor is a benign primary bone neoplasm which most often occurs in a periarticular location. Involvement of the bones of the foot and ankle is rare, and there have been a limited number of previous case reports involving the talus. Here we report a case of giant cell tumor of the talus, which was initially radiographically occult in a 43-year-old female, with emphasis on MRI imaging characteristics. The patient underwent surgical excision and curettage. Histological examination revealed the presence of spindle cells admixed with giant cells, confirming GCT. We further provide an overview of the radiological findings of GCT. Giant cell tumor is a benign bone neoplasm of mesenchymal origin, identified by multinucleated giant cells [1]. GCT is locally aggressive and can destroy adjacent bone and articulations. The most commonly affected bones are the distal femur, proximal tibia, and distal radius, with an epiphyseal predominance in 90% of cases [2]. Presentations are mostly mono-ostotic, however multicentricity may occur in younger patients [3]. Very few cases have been reported in the bones of the feet, an incidence of 1%-2% have been previously reported [4]. GCT is seen between ages 20 and 40 years, with a 56% predominance in females [3]. Although benign, 1%-9% cases may “metastasize” to the lungs. The initial treatment is surgical removal, either en bloc, or more commonly intralesional curettage and the use of adjuvants. Even after resection, GCT has a high recurrence rate [2]. The trigger for GCT is currently unknown. However, a majority of cases have cytogenetic abnormalities of telomeric associations (tas). Involvement of the RANK pathway is also believed to contribute to the pathogenesis of GCT [2].

Giant cell tumor (GCT) is a locally aggressive tumor but with benignity features, representing approximately 18% of non-malignant bone tumors in European countries, with slight female predominance. Malignancy in GCT is rare, about

Highlights • Giant cell tumours are locally aggressive with a relatively high recurrence rate. • Common sites are distal femur, proximal tibia and distal radius. • Contained lesions at these sites managed by joint preservation procedures such as extended curettage with cementing or bone graft. • GCT in spine, calcaneum and distal ulna are rare, with no uniform consensus regarding the ideal treatment., Giant cell tumours, though benign, are locally aggressive bone tumours with a relatively high recurrence rate. These usually occur in distal radius, distal femur, proximal tibia and humerus. Treatment options for contained lesions at these sites include joint preservation procedures such as extended curettage with cementing or bone graft. GCT in spine, calcaneum and distal ulna are rare, with no uniform consensus regarding the ideal treatment. Here we report two cases of GCT distal ulna managed with extended curettage and polymethylmethacrylate cementing showing good functional and radiological outcomes without signs of recurrence during 2 years follow up.

Introduction GCT is a benign primary bone tumor which is known to cause local recurrence as well as distant metastases. The standard care of treatment of GCT in our institution is the extended intralesional curettage followed by the use bone cement and either phenol or alcohol as adjunct therapy. This offers preservation of joint closest to tumor and decreased risk of recurrence compared to curettage alone. Therefore, the objective of this study was to assess the recurrence of GCT of the bone and time of recurrence-free survival after primary surgery (curettage with adjunct therapy) and determine the influence of factors like site of tumor involvement and demographic factors on the risk of recurrence. Methods Non-funded, non-commercial single group retrospective cohort study was conducted at a tertiary care university hospital. Total of 44 patients treated for primary GCT of the bone between 1995 and 2015 at our institution were included. Medical record files were reviewed for demographic characteristics, intra-operative findings and post-operative follow-up. Risk factors for recurrence and mean recurrence free survival was calculated using appropriate statistical analysis. Results Proximal tibia was the most commonly involved bone followed by distal femur, while intralesional curettage with either phenol or alcohol as adjunct was the most common primary treatment. Mean follow-up period for all patients was 52.1 ± 43.9 months. Out of the 46 tumors operated primarily at our institution, recurrence developed in eight (17.4%) cases. Extra-compartmental spread of tumor and tumor grade were identified to have a significant association with recurrence (P = 0.013 and 0.043 respectively). Estimated recurrence free survival at 2 and 5 - year interval was 0.85 and 0.83 respectively. Conclusion Extra-compartmental extension of tumor and a higher-grade lesion is significantly associated with development of recurrence in cases of GCT of bone., Highlights • GCT is a benign primary bone tumor which is known to cause local recurrence as well as distant metastases. • Aim was to assess the recurrence of GCT of the bone and time of recurrence-free survival after primary surgery. • Total of 56 patients treated for GCT of the bone between 1995 and 2015 at our institution were included. • Extra-compartmental extension of tumor and a higher-grade lesion are significantly associated with the tumor recurrence.

Background The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value Results Forty-one benign and 9 malignant lesions were confirmed by histopathological results. Amongst malignant lesions, choline peak was positive in all but 1 case of low-grade lymphoma. MR spectra of 11 benign lesions showed the presence of choline peak. All 7 benign giant cell tumors (GCT) were positive for choline peak. The sensitivity, specificity, PPV, NPV of proton MR spectroscopy in differentiating benign from malignant lesions were 87.5%,71%,38.8%, and 96.4% respectively. p value was significant ( Conclusion 1HMRS in focal bone lesions can help in the differentiation of malignant from benign musculoskeletal tumors. Although some benign lesions may show false-positive result, absence of choline peak is a reliable reassurance against malignancy. GCT is an exception amongst benign bone tumors as it consistently shows the presence of choline peak on 1HMRS.

Introduction This study is to evaluate the outcomes of En bloc resection and reconstruction in patients with GCT of the bone around the knee and in the distal radius. Materials and methods We reviewed 41 cases of GCT of the bone that was treated by En bloc resection around the knee joint and in the distal radius from 2011 to 2018. The local recurrence, metastases, complications and functional score were evaluated for each operation technique. Results The average of MSTS score for all group was 78% (excellent). In the knee joint, the megaprostheses group had an excellent MSTS score of78.9% and good 21.1%. The MAMC group had an excellent MSTS score of40.0%, good 50.0% and fair 10.0%. One patient in the megaprostheses group had metastasis to the lung and 1 patient in the knee arthrodesis group has a recurrence. Infection occurred in 2 cases of megaprostheses while only 1 case in MAMC. Both of the groups in knee joint GCT had 1 patient with implant loosening. In the distal radius, FVFG group had an excellent MSTS score 100% and NVFG group had an excellent score 77.7%, good 11.1% and fair 11.1%. One patient in the NVFG group had an infection, 1 patient has implant loosening and another one patient had graft failure. Two patients in the NVFG group had a recurrence. No metastasis was found in both of the group types of surgery in distal radius GCT. Conclusion Functional outcome of a patient with GCT of the bone after En bloc resection and reconstruction with the above techniques had comparable results with previous studies., Highlights • Reconstruction after En bloc resection in GCT around knee and distal radius may be done in a variety of techniques. • Megaprosthesis or modified arthrodesis with MAMC may be used for reconstruction in GCTs around the knee. • Free or non vascularised fibular graft is a good option for reconstruction after En bloc resection of GCT distal radius. • Functional outcome of the patients with GCT of the bone after En bloc resection and reconstruction had good results.

Surgical intervention remains a gold standard for the treatment of giant cell tumors (GCT) of long bones. The significant risk of recurrence after the curettage and a high complication rate after radical resections is still an unsolved problem. Targeted therapy with denosumab could solve this problem in favor of curettage, but recent studies have shown negative results with denosumab in such situation. Objective. To analyze the results of the denosumab application in patients with long bone GCP with indications for joint salvage surgery. Methods. We compared the treatment results in two groupsof patients: 1st retrospective (control) group — 57 patients, who underwent curettage with surgical treatment and the 2nd prospective (main) group — 42 patients with combination of surgery with neoadjuvant and adjuvant denosumab tretment. In the 2nd group of patients received 5 neoadjuvant and 5 adjuvant cycles of denosumab. The median follow-up period was 189 months in the control group, and 45 months in the main group. Results. Disease progression which identified as a local recurrence was revealed in the control group in 15 patients (25.4 %) and in 7 patients (16.7 %) in the maingroup (p = 0.19). In the main group, the median time to relapse was 19.8 months (8–34 months) from the date of surgery, in the control group — 15.1 months (9–28 months), respectively. The statistically significant difference in relapse-free survival (RFS) between patients in the main group and in the control group (p = 0.18) was not revealed. But the 5-year RFS in the main group was higher and reached to 85 % (95 % CI 74–96 %) versus 75 % (95 % CI 64–86 %) in control group, respectively. There was no evidence of malignant transformation in the main group and one case in retrospective group. Conclusions. The application of denosumab in the regimen before and after curettage is associated with lees number of relapses — 16.7 % vs. 25.4 % without denosumab, respectively. The lack of statistically significant difference between groups does not provide the sufficient reasons for denosumab prescription in neoadjuvant regimen. But adjuvant administration of denosumab can be considered as preventing factor of recurrence after primary tumor curettage, which may be perspective for further study and optimization of indications for its application in patients with GCT., Хірургічне втручання дотепер є золотим стандартом лікування гігантоклітинної пухлини (ГКП) довгих кісток. Проте існує значний ризик розвитку рецидивів після екскохлеації та велика кількість ускладнень після радикальних резекцій. Таргетна терапія деносумабом змогла б вирішити проблему на користь екскохлеації, але останні дослідження показали негативні результати використання препарату. Мета. Дослідити результати застосування деносумабу у хворих на ГКП довгих кісток із показаннями до збережних хірургічних втручань. Методи. Проведено порівняльний аналіз результатів лікування двох груп хворих: ретроспективної (контрольної) групи — 57 пацієнтів після хірургічного лікування у вигляді екскохлеації (кюретажу), проспективної (основної) — 42 особи після комбінації екскохлеації з неоад’ювантним і ад’ювантним введенням деносумабу (5 курсів перед операцією, 5 — після неї). Медіана часу спостереження за хворими склала в контрольній групі 189 міс., в основній — 45 міс. Результати. Прогресування захворювання у вигляді локального рецидиву відзначено в контрольній групі у 15 пацієнтів (25,4 %), в основній —у 7 (16,7 %) (p = 0,190). В основній групі час розвитку рецидиву склав у середньому 19,8 (8–34) міс. після втручання, у контрольній — 15,1 (9–28) міс. Суттєвої відмінності показника безрецидивної виживаності між групами пацієнтів не виявлено (p = 0,180). Утім, п’ятирічна безрецидивна виживаність в основній групі була вищою і склала 85 % (95 % ДІ 74–96 %), а в контрольній — 75 % (95 % ДІ 64–86 %). Висновки. Використання деносумабу в режимі до та після екскохлеації зменшує частоту рецидивів — 16,7 % проти 25,4 % без нього. Відсутність суттєвої різниці показникаміж групами не надає переконливих обґрунтованих аргументів до застосування деносумабу в неоад’ювантному режимі. Разом із тим, післяопераційне введення препарату можна розглядати як чинник профілактики виникнення рецидиву після первинної екскохлеації пухлини, що може бути перспективним для подальшого дослідження й оптимізації показань до його застосування у хворих на ГКП.

Objectives To explore the predictive value of preoperative imaging in patients with spinal giant cell tumor of bone (GCTB) for postoperative recurrence and risk stratification. Methods Clinical data for 62 cases of spinal GCTB diagnosed and treated at our hospital from 2008 to 2018 were identified. All patients were followed up for more than 2 years according to the clinical guidelines after surgery. Medical history data including baseline demographic and clinical characteristics, computed tomography (CT) and magnetic resonance imaging (MRI) findings of recurrent and non‐recurrent patients were compared. Two musculoskeletal radiologists read the images and were blinded to the clinical data. The imaging features associated with postoperative recurrence were analyzed by multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of the largest lesion diameter predicting recurrence after surgery. Results According to whether the disease recurred within the follow‐up period, patients were divided into the recurrence group and the non‐recurrence group. Of 62 patients (29 males and 33 females), 17 had recurrence and 45 did not. The recurrence rate was 27.4%. The mean follow‐up time was 73.66 (± 32.92) months. The three major treatments were total en bloc spondylectomy (n = 26), intralesional spondylectomy (n = 20), and curettage(n = 16). A total of 16 CT and MRI features were analyzed. A univariate analysis showed no significant difference in age, sex, treatment, multi‐vertebral body involvement, location, boundary, expansile mass, residual bone crest, paravertebral soft tissue mass, CT value, and MRI signal on T1‐weighted imaging (WI), T2‐WI, and T2‐WI fat suppression (FS) sequences (P > 0.05). The largest lesion diameter [(4.68 ± 1.79) vs (5.92 ± 2.17) cm, t = 2.287, P = 0.026] and the vertebral compression fracture (51% vs 82%, χ 2 = 5.005, P = 0.025) were significantly different between the non‐recurrence and recurrence groups. Logistic regression analysis showed that both largest lesion diameter (odds ratio [OR], 1.584; 95% confidence interval [CI], 1.108–2.264; P = 0.012) and compression fracture (OR, 8.073; 95%CI, 1.481–11.003; P = 0.016) were independent predictors of postoperative recurrence. When we set the cutoff value for the largest lesion diameter at 4.2 cm, the sensitivity and specificity for distinguishing the recurrence and non‐recurrence of GCTB were 94.1% and 42.2%, respectively, and the area under the curve (AUC) was 0.671. The combined model achieved a sensitivity, specificity and accuracy of 47.1%, 97.8% and 83.9%, respectively. Conclusions In spinal GCTB, maximum lesion diameter and the vertebral compression fracture are associated with tumor recurrence after surgery, which may provide helpful information for planning personalized treatment., Giant cell tumor of bone (GCTB) is currently classified as an intermediate tumor. This current study of 62 patients found that the largest diameter of the tumor and the vertebral compression were independent predictors of tumor recurrence after surgery, which may provide more helpful information for development of a personalized treatment plan.

Purpose: To present a patient with giant cell tumor (GCT) of the orbit by changing behavior from an intraorbital mass to an intraosseous tumor. Methods: A 16-year-old boy presented with pain, swelling, erythematous of the left upper and lower eyelids, proptosis, and diplopia. Ophthalmic examination revealed chemosis, conjunctival injection, limited elevation, depression as well as abduction in the left eye. Results: Multislice computed tomography scan (CT scan) of the orbit and paranasal sinuses showed a hyperdense, oval, extraconal mass with bone erosion. Magnetic resonance imaging of the orbit showed an inferior lateral isointense, oval, extraconal mass that had indented the globe. The patient underwent superior lateral orbitotomy, and the orbital mass was excised. Two months later, the patient developed proptosis, severe chemosis, and eyelid erythema in the same eye. CT scan showed an intraosseous mass in the lateral wall of the orbit that had pushed the globe anteromedially. Intraosseous tumor was resected, and the lateral orbital wall was drilled during the second surgery. GCT was diagnosed based on pathological survey. Conclusion: Following the resection of the orbital GCT, the tumor behavior may change to an intraosseous lesion.

Primary benign tumors of the sternum are an exceedingly rare entity. Surgical techniques regarding intervention for these lesions are not clearly defined in the literature given their scarcity. Operative techniques include en-bloc resection of the tumor, and this has proven to be successful in preventing local recurrence despite benign nature of the lesion. Given the often extensive defect created by the excision, reconstruction is frequently necessary; depending on the size of the defect, either autologous bone grafting or the use of synthetic materials may be indicated. This study serves to present two cases of rare primary benign tumors of the sternum, giant cell tumors and osteoma spongiosum and to summarize the available literature. We present a review of the literature of 17sternal giant cell tumor cases reported so far including our patient and unique case of osteoma spongiosum of the sternum, that discusses their surgical management, as well as reconstructive techniques that provided an excellent clinical result and a lack of recurrence on long term follow-up.

Zoledronic acid is a bisphosphonate that has recently gained interest in adjuvant therapy for giant cell tumor of bone (GCTB). It has an apoptotic effect on osteoclasts that are precursors of GCTB. However, the evidence suggesting the role of zoledronic acid in preventing GCTB recurrence is mixed, and therefore, a consensus is yet to be established. The purpose of the current meta-analysis was to analyze the impact of zoledronic acid supplementation on tumor recurrence in surgical treated GCTB. A systematic search was conducted on PubMed, Embase, and Web of Science databases to identify studies that analyzed the impact of local or systemic zoledronic acid supplementation on clinical outcomes in surgically treated GCTB. The data from the comparative studies were pooled and analyzed to investigate the association of zoledronic acid supplementation with tumor recurrence. Additionally, other factors such as age, gender, soft tissue extension, polymethyl methacrylate (PMMA) cement application, recurrent presentation, and extended curettage were also investigated for any association with tumor recurrence. Of the 271 results, 13 unique studies reported the clinical outcomes in GCTB. Seven studies compared the outcomes of zoledronic acid supplementation with control groups. Six studies presented the tumor recurrence-related data among the comparison groups. The zoledronic acid supplementation was associated with significantly lower tumor recurrence rates (p = 0.007). Additionally, a significant association of soft tissue extension and non-usage of PMMA cement with tumor recurrence were observed. The current meta-analysis suggests that zoledronic acid supplementation reduces tumor recurrence rates in surgically treated GCTB. We, therefore, recommend the use of zoledronic acid following aggressive extended curettage of the tumor. Further, well-planned randomized controlled trials will help strengthen this evidence.

A giant cell tumor of the tendon sheath (GCTTS) is a benign, soft tissue (synovial membrane) tumor that frequently involves the fingers. However, the localized form of the GCTTS can be rarely seen in large joints such as knees, ankles, and shoulders. GCTTS may occur due to questionable etiology that includes inflammation, trauma, or chromosomal abnormalities. This is a case of a 30-year-old female, who presented with a painful mass in her right knee. Examination revealed a palpable, tender, slightly mobile mass lateral to the patella. MRI demonstrated a cystic lesion that underwent excision. Data from the reported cases imply that local recurrence was observed in 10%-20% of patients due to incomplete primary resection. Physicians should consider the likelihood of a GCTTS when an intra-articular knee prominence is found. Early diagnosis and appropriate treatment can help with rapid clinical improvement.

Introduction: Giant cell tumor (GCT) of the bone is a benign–malignant intermediate tumor with locally destructive growth and a relatively high local recurrence rate. Neurological symptoms may develop in patients with GCT of the spine, and surgical treatment is prioritized in cases where resection is possible. However, the local recurrence rate of GCT of the bone is higher than that of GCT at other sites owing to the associated surgical challenges, and treatment is often difficult. No study to date has reported long-term remission of recurrent tumors for more than 5 years by treatment with carbon ion beam radiotherapy after resection of GCT of the cervical spine. Patient concerns: A 14-year-old boy who experienced recurrence after surgery for GCT of the cervical spine. Diagnosis: The patient presented with cervical pain, and computed tomography revealed a mass of the C2 vertebral body. He underwent surgery for tumor resection and autologous bone grafting, and the final pathological diagnosis was GCT. The transplanted bone exhibited gradual progression of resorption, and recurrent tumors were observed on computed tomography and magnetic resonance imaging 1 year and 4 months after surgery. Interventions: The patient was started on denosumab at 15 years of age and received carbon ion beam therapy with 70.4 Gy administered in 32 sessions over 7 weeks. Outcomes: No progressive tumor growth was observed, there were no neurological symptoms such as paralysis or pain were noted, and the patient was in remission for 5 years after irradiation. Conclusion: These findings suggest that carbon ion radiotherapy is a safe and effective therapeutic option for patients with recurrent GCT of the cervical spine.

Giant cell tumor (GCT) is classically described as a locally aggressive, epiphyseo-metaphyseal osteolytic tumor occurring in young adults. They are mostly seen in long bones while some are also found in the iliac bone and spine and a very small proportion occurs in hand bones. Due to the rarity of GCT in metacarpal, there is a paucity of treatment options available. In an extensive literature search on PubMed, Embase, Medline, and Ovid from 2004 till date, very few cases were reported. The various treatment options available are intralesional curettage with or without adjuvant therapy, wide resection, free osteoarticular metatarsal transfer, and, occasionally, ray amputation may also be done. After simple curettage, a reasonably high recurrence rate also imposes comprehensive en-bloc excision, but still, there are many case reports of recurrence. Experience with a case of GCT of the whole first metacarpal extending from the carpometacarpal to the metacarpophalangeal joint is not thoroughly described in the literature. We hereby report a mammoth GCT of the first metacarpal treated by excision and reconstruction by free fibular graft and adjacent joint fusion with an excellent functional outcome at one-year follow-up.

Introduction and importance: Giant cell tumors of the tendon sheath in children have rarely been reported in the literature. This study aims to present a case of giant cell tumors of the tendon sheath on the big toe of a 5-year-old child. Case presentation A 5-year-old girl presented with a painless swelling over the dorsal aspect of right big toe for 2 weeks. Physical examination revealed non-tender rubbery like swelling over the dorsal aspect of the right big toe. Ultrasound scan of the swelling showed a 17 × 7 mm oval-shaped subcutaneous hypoechoic lesion. Magnetic resonance imaging showed evidence of 20× 8 mm well-defined fusiform soft tissue lesion scalloping the bone. Under general anesthesia, the mass was totally excised. Microscopic sectioning showed a mixture of fibroblasts and histiocyte like cells associated with multinucleated giant cells in the vascular connective tissue stroma with the definite diagnosis of the giant cell tumor of the tendon sheath. Discussion These tumors mostly compose of several types of cell like synovial, siderophages, foam, inflammatory and multinucleate giant cells. The major etiological factors that induce development of this tumor could be traumatic, inflammatory, metabolic or neoplastic disease. Conclusion although it is a sporadic finding, giant cell tumors of the tendon sheath might affect the lower limb in children. Complete excision is the main modality of treatment., Highlights • A giant cell tumor of tendon sheath is a painless benign soft tissue tumor. • There are only a few cases that have been reported in the feet of children. • In this study a case of giant cell tumor of tendon sheath in a 5-year-old child discussed.

Background Undifferentiated carcinoma with osteoclast-like giant cells (UCOGCs) is a rare and aggressive non endocrine pancreatic carcinoma characterized by the presence of osteoclastic giant cells mixed with mononuclear cell. Very few cases have been reported in the literature and the histogenesis is controversial as, at the time of diagnosis, the tumor is often of advanced size and stage and it is difficult to pathologically observe its relationship with the pancreatic duct. Case presentation We present a case of 65-year-old male patient presenting with abdominal pain, nausea, and weight loss, which was treated with surgical resection. Histological examination revealed an undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient underwent to a routine pylorus preserving pancreatoduodenectomy. Actually, the patient was in good performance status and disease-free five months. Conclusions Based on the present case and limited previous data, further researches preferably with large cohorts are necessary to clarify the pathogenesis of the neoplasm. However, as show in this case, histopathological and immunohistochemically studies are the gold standard for the diagnosis of UCPOGC. Investigation of the genomic alterations in UPOGCs could help to explain the histologic diversity of variant tumor and could provide a genetic basis for prognosis and treatment.

BACKGROUND: Giant cell tumor (GCT) of distal radius poses problems for reconstruction following tumor resection. Reconstructive procedures such as vascularized and non-vascularized fibular graft, osteoarticular allograft, ceramic prosthesis, and mega prosthesis have been implanted for substitution of the defect in distal radius following resection. We described the outcome of distal radius GCT following wide resection and reconstruction with a locking plate and pedicle screw. CASE REPORT: A 35-years-old female came with a chief complaint of a painful lump in the right wrist for 8 months. Magnetic resonance imaging (MRI) showed the appearance of a cutaneous GCT, Campanacci 3. We performed wide resection and reconstruction with a locking plate and pedicle screw system. In 6 months follow-up, there was no significant pain, no sign of infection, and a functional range of movement, wrist extension 0–60°, wrist flexion 0–30°, and preserved hands movements. CONCLUSION: Reconstruction of distal radius GCT with a locking plate and pedicle screw system showed excellent functional outcomes. This method is a viable option as it provides good pain relief and functional improvement. However, the long-term outcome needs further evaluation.

Objective The purpose of this retrospective study was to evaluate the clinical and oncological results of combination treatment of short-term preoperative denosumab (the receptor activator of nuclear factor kappa-B ligand inhibitor) with surgery in unresectable or recurrent cases of giant cell tumor of the bone (GCTB). Methods Between 2016 and 2018, 11 eligible patients (1 man, 10 women, mean age 38.1 years) with grade 3 GCTB were treated with a combination of short-term (six doses) preoperative denosumab and surgery in a single institution. The clinical, radiological, and pathological alteration after the denosumab treatment were compared. The oncological results of the combination therapy were also recorded. Meanwhile, adverse effects or complications of denosumab, if any, were reported. Results The median follow-up time after surgical procedure was 30 months (range 13-45 months). After 3-4 denosumab injections, pain relief was observed in all patients. In two spine patients, the neurological status improved after four doses of treatment. Intraoperatively, the margin of the tumor became clear and the intensity of the tumor increased while the blood supply around and within the lesion decreased. Within the lesion, the typically soft and loose tissue were replaced by the tough and dense fibro-osseous tissue. The mean diameter of the lesion before and after treatment was 61.55 ± 22.49 mm and 51.81 ± 21.12 mm, respectively, and the T-score was 1.02 (P = 0.32). Variable calcification was observed at the periphery and within the lesion. A total of three patients experienced local recurrence in this study. In the resection group, only one extremity patient had soft tissue recurrence that was treated with en-bloc excision. In the curettage group, two of three sacral tumor patients had local occurrence. Both refused re-operation and restarted the monthly denosumab injection thereafter, and the lesions remained stable at the final follow up. Finally, no adverse effects or complications related to denosumab treatment were found. Conclusion For the unresectable or recurrent GCTB cases, short-term (six doses) preoperative use of denosumab improved clinical symptoms, decreased the tumor size, and increased the tumor density. The changes in tumors, in turn, simplified the tumor removal manipulation and, subsequently, decreased the local recurrence for the resection surgery. For the curettage, the denosumab-induced changes had mixed impacts, and shorter term (fewer than six doses) usage may be more appropriate. Our six-dose regime was deemed safe, while the safety of long-term use remains unknown.

Introduction: Cancer of the patella is a rare condition. Giant cell tumor of the patella is an extremely rare and a difficult to solve therapeutic problem. Depending on the degree of bone destruction, it may cause significant knee joint dysfunction. It is assumed that surgery is the treatment of choice. Material/Methods: This study presents an innovative treatment of a giant cell tumor of the patella in a 40-year-old male with significant dysfunction of the knee extensor mechanism. Complex therapy included neoadjuvant treatment using a human monoclonal antibody IgG2 that binds to RANKL (Denosumab) and follow-up allogeneic grafting of knee extension mechanism. Results: Follow-up CTs showed correct positioning and healing of grafted knee extensor mechanism. Early functional outcome was perfect. Seven weeks after the surgery, reduction of pain, improvement of the contour of the joint, full active extension and flexion of 110° were noticed. Fifteen months after the surgery, the patient presented complete active extension and flexion of the knee joint, actively participated in professional life and CT tests did not reveal features of tumor recurrence. Conclusions: Treatment of isolated giant cell tumor of the patella with destruction of patella and joint dysfunction does not have a clear solution in the available literature. Such a condition may also exclude traditional procedures. In such cases, grafting of the whole extensor mechanism appears to be the appropriate treatment.

Background The ideal treatment for giant cell tumor of bone (GCTB) is still controversial. The purpose of this study was to evaluate whether curettage was successful in the treatment of GCTB. Intralesional curettage with adjuvant therapies, such as high-speed burring, polymethylmethacrylate, phenol, ethanol, and liquid nitrogen, may be used to reduce the local recurrence rate. However, there is no consensus on the optimal use of curettage, along with fillers and adjuvants, to limit the recurrence rate. Methods We performed a systematic review of articles using the terms long bones, GCTB, and treatment. Case reports, reviews, opinion articles, or technique notes were excluded based on the abstract. Twenty-six articles included in this review were then studied to establish the index in suggesting the surgical treatment of GCTB. Results The patient’s gender, their age, the Campanacci grade of their tumor, and the type of surgery they had were not significantly associated with the local recurrence rate. Local recurrences seemed to be associated with the site of the tumor, occurring more frequently in the proximal femur or distal radius. A pathological fracture was not a contraindication for intralesional curettage. Treatment with denosumab did not decrease the local recurrence rate in patients who had been treated with curettage. Conclusion The current literature seems to suggest that the ideal treatment for GCTB is to remove the tumor while preserving as much of the joint as possible. Local recurrent tumors can be treated with curettage to keep the re-recurrence rate within an acceptable limit. The choice for how to treat GCTB in the proximal femur or distal radius requires special attention.

Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown because of its characteristic brown color believed to have occurred after accumulation of blood, fibrous tissue, and hemosiderin. Hyperparathyroidism can result in a brown tumor whether it is primary or secondary, but this case is much rarer in primary hyperparathyroidism. It rarely affects the spine, while it is extremely rare to compromise the spinal canal. Purpose: To report a rare case of lumbar spinal brown tumor with primary hyperparathyroidism. Study Design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae). Patients and Methods: Our case was a forty-year-old female patient presenting with persistent dull aching low back pain. There was no history of any chronic illness. She had a 5-month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae invading the left pedicle and compressing the spinal canal. Results: Team did neural decompression, biopsy harvesting, and partial corpectomy with reconstruction of the affected lumbar vertebra (L5) followed by fixation by rods and screws. The patient showed relief of the radicular pain and back pain on VAS. Histopathological analysis of the biopsy showed evidence of giant-cell tumor (brown tumor). Parathyroid survey was done and showed normal calcium levels. By revising the literature, we claim that this present study is reporting the 10th case of brown tumor of lumbar spine in patient with primary hyperparathyroidism. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with lytic spine lesions. (2019ESJ192) Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown as its characteristic brown color that believed to be occurred after accumulation blood, fibrous tissue and hemosiderin. Hyperparathyroidism can cause it whatever it is primary or secondary. It is rarely affects the spine and extremely rare compromises the spinal canal. Purpose: To describe a case presentation of brown tumor affecting the lumbar spine. Study design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae) Patients and Methods: Our case was a forty years old female patient presenting with persistent dull aching low back pain. She had a 5 month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae that invading the left pedicle and compressing the spinal canal. Results: Under general anesthesia, prone position, low back midline skin incision and dissection, insertion of paired poly-axial screws at the level above (L4) and level below (S1) the affected vertebra (L5) was done. The team started by anchoring the rod in-between the screws in the right side then open left transpedicular corpectomy of L5 with excision much of the lesion that was dark red suckable mild vascular tissue. Formal L5 laminectomy was done followed by insertion of transpedicular polyaxial screw on right side only of L5 and insertion of bone cement while it was semi-solid in consistency to augment preservation of the vertebral height and fusion. Neurolysis of the spinal roots and completing the fixation system were done he lesion was partially excised. The patient showed relief of the radicular pain and back pain on VAS. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with slowly progressive persistent back pain.

Background: giant cell tumor of the tendon sheath is the most common form of giant cell tumors and is the second most common soft tissue tumor of the hand region after ganglion cyst. Magnetic resonance imaging is the diagnostic tool of choice for both diagnosis and treatment planning. The current standard treatment of choice is simple excision. The main concern about the treatment is related to the high recurrence rates. Besides incomplete excision, there is no consensus concerning the effect of other risk factors on recurrence. The literature lacks detailed reports on surgical excision of these tumors with a standardized surgical treatment and an appropriate patient follow up. The aim of this study was to investigate the recurrence rate and the associated recurrence risk factors for giant cell tumor of tendon sheath of the hand following a standardized treatment. Methods: the records of patients treated for giant cell tumor of tendon sheath of the hand treated by the same hand surgeon were evaluated retrospectively. The features obtained from preoperative magnetic resonance imaging, final physical examination, patients' age and sex, anatomical site of the tumor, relationship of the tumor with bone, joint or neurovascular structures, bone invasion, recurrence after surgery and complications like skin necrosis, digital neuropathy or limitation in range of motion were documented. Chi-square test was used to compare categorical variables. Results: Fifty patient were included in the study. The average follow-up time was 84 months. Three recurrences (6%) were recorded. The only significant risk factor for the recurrence was tumor adjacency to the interphalangeal joints of the fingers other than thumb. No major or minor complications were encountered in the postoperative period. Conclusion: With adequate surgical exposure and meticulous dissection provided by the magnification loupes, we were able demonstrate one of the lowest recurrence rates in the literature. Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence., NA

A clinical case of a single-step transoral removal of C2 and C3 vertebral bodies with subsequent stabilization of the C1–C4 spinal segment through the same approach (with additional submandibular approach to insert screws into the C4 vertebra body) without dissection of the mandible and tongue is presented. The first experience of anterior stabilization of the C1–C4 spinal segment using a custom-made instrumentation system demonstrated its effectiveness. It was shown that, taking into account the length of the cervical spine resection, the anterior stabilization with a custom-made plate should be combined with standard methods of posterior fixation. Innovative surgical technologies allow optimizing the surgical technique of cervical spine stabilization and provide earlier rehabilitation of a patient.

The malignant transformation of conventional giant cell tumor of bone (GCTOB) is rare and usually occurs with irradiation. Here we report two neglected cases of conventional GCTOB with spontaneous malignant transformation at 11 and 16 years after initial diagnosis. In the former case, the patient refused to receive any treatment following the incisional biopsy, and in the latter, the first recurrence that occurred 5 years after initial treatment, was neglected. Although rare, the occurrence of sarcomatous changes in these cases indicates that secondary malignant transformation may be part of the natural course of this tumor. In addition, in both cases, immunohistochemistry showed diffuse and strong p53 expression in the malignant tumor but not in the primary lesion. It suggests that p53 overexpression may play a key role in the malignant transformation of GCTOB and that investigating for p53 expression in recurred lesions may help in predicting cases of giant cell tumor, prone to malignant transformation.

Background In this study, the influence of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of giant cell tumor (GCT) of the extremities were investigated. Methods The clinical parameters of 163 patients who were diagnosed with GCT of the extremities between July 2008 and January 2018 were retrospectively analyzed. Optimal cutoff values of NLR and PLR were determined using receiver operating characteristic (ROC) analysis. According to optimal cutoff values, patients were divided into high NLR and low NLR groups or high PLR and low PLR groups. Kaplan-Meier and log-rank methods were used to compare the recurrence-free survival (RFS) between the high and low NLR groups, and between the high and low PLR groups. Univariate analysis was performed to determine the influence of age, gender, neutrophil count, lymphocyte count, platelet count, white blood cell count, tumor size, surgical approach and Campanacci stage on the prognosis of giant cell tumor of bone. The main predictors of RFS were determined by Cox multivariate regression analysis. Results The optimal cutoff value of NLR in giant cell tumor of the extremities was 2.32, which was used to classify patients into high and low NLR groups. The optimal cutoff value of PLR was 116.81, and was used to classify patients into high and low PLR groups. Campanacci stage, tumor maximum diameter, alkaline phosphatase, and C-reactive protein (CRP) were significantly associated with the high NLR and PLR. Cox multivariate regression analysis revealed that the Campanacci stage (HR = 3.28, 95% CI: 1.24~8.69) and NLR (HR = 4.18, 95% CI: 1.83~9.57) were independent prognostic factors for giant cell tumor of the extremities. Conclusion As a novel inflammatory index, NLR has some predictive power for the prognosis of patients with giant cell tumor of the extremities.

Endometrial carcinoma is the most common genital malignancy in women. Endometrioid type is the most common variant of endometrial carcinoma described in literature. Giant cell carcinoma is a rare, and infrequently reported variant of endometrial carcinoma. We present a 75-year-old patient admitted with vaginal bleeding. Transvaginal ultrasound revealed a 26x28 mm hypodense lesion without any adnexal pathology. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic, and paraaortic lymph node dissection. The final histopathology report indicated a 3.8x2x9 cm giant cell carcinoma variant of endometrial carcinoma and one positive external iliac lymph node metastasis. Administration of adjuvant carboplatin and paclitaxel chemotherapy was given. As far as we know, this is the fifteenth case reported in the English literature.

Introduction: Giant cell tumors (GCT) are benign lesions that are generally locally aggressive tumors with occasional malignant behavior. These tumors are most frequently encountered in long bones; however, they also occur rarely in the spine. GCT of the spine are rare pathological entities, and spinal involvement shows a sacral predilection, with only a few cases involving the supra-sacral segment (mobile spine). Only a few cases of thoracic spinal GCT are reported in the literature; these tumors are particularly uncommon in the thoracic segment. Presentation of Case: A 29-year-old man presented with a complaint of neck pain over the previous six months that radiated to his left hand. GCT of the upper thoracic spine was diagnosed, which was surgically managed using a 2-stage approach involving total resection of the tumor followed by spondylectomy and multilevel spinal fixation. Discussion: Accurate diagnosis of vertebral column lesions, and choosing an optimum management plan are crucial. In the majority of cases, En-bloc resection of GCTs is not feasible ought to the close contact of the lesion with the spinal cord. Larger studies are encouraged to ascertain the efficacy of variable management approaches, particularly compared with piecemeal resection techniques. Conclusion: Spinal GCT are a unique group of tumors with an uncommon and unexpected presentation. Although surgery is the mainstay of treatment for spinal GCT, the management of this tumor can be challenging. No clear management algorithm has been established, and the tumor displays an unpredictable course. Therefore, each case needs tailored treatment.

Highlights • Giant cell tumor is locally aggressive and destructive to the affected area. • Reconstruction after tumour resection is challenging. • Single stage surgery is performed and give satisfactory result., Introduction Giant cell tumor is a type of benign tumor which has the characteristic of rapidly growing and a chance to metastasis. It is however locally aggressive and would typically affect young patients. They commonly present with pain and associated with pathological fracture. Presentation of case This is an uncommon case of 29 years old male with pathological fracture and giant cell tumor in proximal humerus. A plain radiograph revealed pathological fracture in head of humerus and histopathology examination was consistent with giant cell tumor. The patient had surgical option with en bloc giant cell tumor resection following hemiarthroplasty with cementless endoprosthetic implant for humerus, which aimed to provide a single step surgery without any interval debulking surgery. The patient had achieved bony union between 6 weeks after the surgery and recurrence was not found by the time of the last follow-up. Discussion Based on Campanacci’s classification the tumor is divided into 3 stages. The management of giant cell tumors continues to be one of the most challenging areas in orthopedic oncology. Surgery is the first line option; however, it is depending on the tumor staging and can vary from intralesional curettage to total resection of the tumor. Since the local behavior of giant cell tumors has a high risk of local recurrence, en bloc resection and reconstruction were chosen for these Grade III lesions. Conclusion The aim of this procedure is to preserve the shoulder joint shown satisfaction in a clinical, radiological, functional and esthetic result.

Giant cell tumors usually arise in the epiphyseal region of the limbs, and their occurrence in the ribs is unusual. We presented a case of a 26-year-old male with a 2 years progressively growing lump on his right anterolateral chest. There was no pain and cardiopulmonary symptoms. Chest radiograph revealed an osteolytic lesion over the right 10th rib with chondroid matrix and a wide transition zone that grew expansively accompanied with the destruction of the 10th rib. Abdominal computed tomography scan confirmed a soft-tissue mass with 15 cm × 11 cm × 10 cm in dimension with the destruction of anterolateral 10th rib. The patient underwent en bloc-wide excision, including the 9th–11th ribs, followed by diaphragm repair and chest wall reconstruction.

Background: Giant cell tumor of bone is a locally aggressive, rarely metastasizing tumor that accounts for about 5% of bone tumors and generally occurs in patients between 20 and 45 years old. A driver mutation in the histone 3.3 (H3.3) gene H3F3A has been identified in as many as 96% of giant cell tumors of bone. The immunohistochemical expression of H3F3A H3.3 G34 expression was found in 97.8% of cases. In the present study, we describe our series of cases of giant cell tumor of bone in pediatric patients &lt, 16 years old. Methods: All cases of giant cell tumor of bone in pediatric patients &lt, 16 years old treated in our institute between 1982 and 2018 were reviewed. Immunohistochemistry and/or molecular analysis for H3F3A gene mutations was performed to confirm the diagnosis. A group of aneurysmal bone cysts in patients &lt, 16 years old was used as a control group. Results: Fifteen cases were retrieved. A pronounced female predominance (93%) was observed. A pure metaphyseal central location occurs in 2 skeletally immature patients. Conclusions: Giant cell tumor of bone should be distinguished from its mimickers due to differences in prognosis and treatment. Immunohistochemical and molecular detection of H3F3A gene mutation represents a reliable diagnostic tool.

The sacrum is a triangular shaped bone made up of five fused vertebral bodies. It is composed of bone, cartilage, marrow elements as well as notochord remnants and is a common site for both benign and malignant (primary and secondary) tumors. Familiarity with the imaging features and clinical presentations of sacral bone tumors could be helpful in narrowing the differential diagnosis. Magnetic resonance imaging and computed tomography are the preferred imaging modalities for evaluating sacral masses. This pictorial review will highlight imaging features of common sacral tumors with pathologic correlation. Additionally, this article will review some critical principles and helpful tips to successfully biopsy these lesions.

Background To evaluate the effect of reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone. Methods We conducted a retrospective analysis of 12 HIV positive patients with giant cell tumor of long bone. A non-HIV-positive cohort of patients, matched for age, sex, and disease type, was selected as the control group. From June 2012 to August 2020, curettage by ultrasonic scalpel was performed in all patients, combined with min- plate and bone graft treatment. All patients were followed- up for 18 to 60 months. Limb function was evaluated, using the MSTS93 scoring system, and any examples of postoperative recurrence, distant metastasis, complications, MSTS93 score, and fracture prognosis were recorded. Results The mean age of HIV group was 43.5 years. The ratio of men to women was 11: 1. In all cases the histopathological diagnosis was clear, except the patients with primary malignant giant cell tumor of bone, including five, three, two, and two cases in the proximal tibia, distal femur, distal tibia, and talus, respectively. Following their surgery, all patients were followed up with an average of 31.24 ± 11.84 months. No local recurrence or pulmonary metastases were observed. Post-surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing, good joint function, and no pathological fractures around their lesion. In the HIV group, one case of giant cell tumor in the proximal tibia showed mild articular surface collapse and mild valgus deformity of the knee joint but retained good joint function. The MSTS scores of excellent or good in the two groups comprised 83.3%, thus, there was no significant difference between them (P > 0.05). Compared with preoperatively, the MSTS scores in the HIV group were significantly improved, ranging from 7 to 11 points preoperatively to 24 to 27 points postoperatively; this difference was statistically significant (P Conclusion Reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone can achieve satisfactory results. The mini- plate requires little space and is flexible during reconstruction and fixation, significantly reducing complications such as surgical site infection, as well as preserving joint function and avoiding amputation; therefore, it is a safe and effective treatment method.

Background: Giant cell tumor is locally aggressive benign tumor that occur more common in distal femur, proximal tibia, and distal radius, and has tendency for recurrence and has capability for metastatize. Giant cell tumor in foot ankle are rare, and comprise less than four percent of giant cell tumor of the bone. Case Report: A 33 years old man presented with complains of pain and swelling in right ankle since 6 months ago with no history of trauma. Physical examination revealed increasing swelling over the distal-posteromedial aspect of lower leg and limitation ankle movements due to pain. Routine blood investigations showed slight increase of alkaline phosphatase. X-ray and Magnetic Resonance Imaging showed the lesion with morphology suggestive of giant cell tumor. Histopathology examination showed multinucleated giant cells and spindle shaped of mononuclear cells suggestive of giant cell tumor. The patient was treated with en-bloc-excision followed with distal tibial reconstruction using reverse intramedullary tibial nail combined with T-plate (tibio-talar arthodesis). Discussion: The main treatment of giant cell tumor of the bone is surgical removal to achieve tumor-free by eradication of the tumor, with various surgical techniques for reconstructing the cavity left. In this case we performed distal tibial reconstruction using reverse intramedullary tibial nail combined with T-plate. Conclusion: The patient at 12-month follow up is doing well, walking comfortably without any pain, has no limitation in range of motion with no signs of recurrence and good MSTS score (90).

BackgroundThis study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes.MethodsFrom December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded.ResultsThe mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively.ConclusionThe application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.

Diffuse type tenosynovial giant cell tumor (D-TGCT) is a locally aggressive benign proliferation. Knee joint is the most commonly affected site. We present a case report with a 16 months follow up after recurrent surgery and postoperative radiotherapy.

A 23-year-old man received denosumab therapy for histologically proven multiple pulmonary metastases from a giant cell tumor of the distal femur after surgery. Pulmonary metastases decreased in size six months after the initial denosumab administration. The toxicities of denosumab such as hypocalcemia and osteomyelitis of the jaw were not observed during the treatment period. Denosumab therapy resulted in the achievement of an objective response and disease stability for pulmonary metastases within five years of its initiation.

Tenosynovial giant cell tumor (TGCT) is a rare entity that is not well described in the neurosurgical literature. We present a case of a 37-year-old woman with a diffuse subtype TGCT of the cervical spine, affecting the left cervical 6-7 facet joint, with co-incidental cervical trauma. Initial management consisted of subtotal resection and cervical stabilization with cervical 6 to 7 laminectomy, and cervical 4 to thoracic 2 posterior instrumented fusion. Gross total resection was achieved at a later date with a plan for postoperative radiation to prevent a recurrence. The patient was lost to follow-up for radiation treatment and returned 2.5 years later with minor symptoms and recurrence at the surgical site.

Sacral giant cell tumors (GCTs) are rare entities that exhibit slow progressive growth and become clinically apparent when they reach a considerable size. The current case report discusses the presentation, investigation, and management of a young male patient diagnosed with a large sacral mass. A 17-year-old male patient presented with uremia, bilateral lumbar pain, and severe weakness of his lower extremities. Imaging revealed a midline sacral mass causing bilateral upper tract obstruction. The patient underwent bilateral nephrostomies followed by a partial en bloc sacrectomy and curettage of the tumor bulk. Histopathology revealed a giant cell tumor of the sacrum. Postoperatively, the patient received adjuvant radiotherapy and rehabilitation for his neurological symptoms. Sacral GCTs are essentially benign but behave like a malignant tumor in view of frequent recurrences and reports of malignant transformation. Surgery with wide local excision remains the ideal modality for complete clearance of sacral tumors. Nevertheless, limitations include their large size, difficult operative access, risk of fatal intraoperative bleeding, and inevitable high postoperative morbidity.

Objective Primary tumors of bone are relatively uncommon. Little information is available about the etiology, pathophysiology, risk factors and epidemiologic features of bone tumors. In this article, we present the epidemiological data about the primary (benign and malignant) bone tumors in Jordan. Methods Retrospectively, we identified and assessed those patients who were diagnosed with primary bone tumor between January 2004 and December 2018 at King Abdullah University Hospital. The following information was obtained: demographics (age, sex), clinical presentation, and location of the tumor. Also, the histopathological results and finding and recurrence of the tumors were retrieved. The included primary bone tumors were those tumors fulfill the World Health Organization classification of soft tissue and bone tumors. Results During the study period, four-hundred and thirty-seven cases of the primary bone tumor were diagnosed in our institution. More than half of the cases were males (52.5% males and 47.5% females). In most cases, young adults are affected. The mean age for the diagnosis of giant cell tumor of bone (GCTB) is 34.1 years. The appendicular skeleton was involved in 269 (81.5%) patients while the axial skeleton in 60 patients. The most common encountered pathology is the multiple myeloma with 120 patients. After that, osteochondroma was diagnosed in 110 patients. Females were mostly affected by giant cell tumor while the osteochondroma and chondrosarcoma were seen mostly in males. Multiple myeloma tends to develop in elderly while juvenile ossifying fibroma occurred in young pediatrics and Ewing sarcoma in school-age children and adolescents. Giant cell tumor and osteoid osteoma have the tendency to recur. Conclusion The diagnosis of primary bone tumors is of particular important. The reporting of epidemiological studies is essential in order to expand our knowledge regarding this uncommon type of tumors.

Giant cell tumor (GCT) of bone is a benign aggressive bone lesion with significant recurrence rates following surgical curettage. Historically, these tumors were approached by performing an intralesional curettage of the tumoral tissue by filling the resulting cavity using morselized iliac bone autograft. The major problems of this therapy were the high recurrence rates of up to 40&ndash, 50%. Several adjuvant treatments have been proposed in order to augment resection margins, including liquid nitrogen (LN), phenol, ethanol, hydrogen peroxide (H2O2) and bone cement (polymethyl methacrylate (PMMA)). LN can be used either to preserve tissues or for controlled necrosis depending on the cycles of freezing and thawing. Usually, a quick freeze followed by a slow thaw will lead to destruction of human cells. This article reviews the results of cryosurgery with LN associated with surgical resection and the additional use of PMMA in a small group of patients with a histopathological confirmation of bone GCT with different localizations (i.e., tibia, distal radius and iliac bone). Cryosurgery with LN of bone GCT proved to be an efficient tool to decrease the recurrence rate for this tumoral type. In our series of cases, there were no complications, oncological or otherwise, at the two-year minimum follow-up, with good and excellent functional results.

Shoulder metallosis with giant cell tumor formation is rarely seen in shoulder surgery. With an increase in shoulder arthroplasty and complex revision shoulder surgeries, clinicians should have an index of suspicion for possible metallosis in patients that presents with unexplained persistent pain with metal components on both the glenoid and humeral side. This case describes a 43-yearold female with a history of six prior shoulder surgeries who presented with shoulder metallosis and giant cell tumor formation after a screw from her open Latarjet procedure began rubbing against her Hemicap implant. She successfully underwent a revision total shoulder arthroplasty for post traumatic arthritis with pectoralis major transfer for her chronic subscapularis rupture and had complete symptom resolution.

Giant cell tumors (GCT) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphyses of long bones. Their incidence in craniofacial skeleton is rare, particularly in the maxilla. We report a case of a 12-year-old patient with a GCT of the left maxilla, who underwent a surgical excision of whole mass, and showed no recurrence one year after intervention.