Distal femur giant cell tumor - therapeutic challenge: A case report (original) (raw)
Related papers
Cureus, 2020
Objective: To find the recurrence and outcomes of giant cell tumors treated with scooping curettage, burr down technique, phenolization, and bone cement. Method: We conducted a descriptive case series using a non-probability consecutive sampling technique at the Department of Orthopedics, Lahore General Hospital, Lahore, Pakistan, from May 2014 to June 2018. A total of 40 patients aged between 20 to 40 years with Compannacci grade I, II & III giant cell tumors (GCT) were included and patients unfit for the surgery, those with multiple, recurrent, malignant giant cell tumors, tumors involving the axial skeleton, and previously treated cases were excluded. We recorded the side, site of the tumor, post-operative distal neurovascular status, and recurrence of giant cell tumors. The patients were follow-up in the out-patient department (OPD) at the second week, fourth week, 12th week, 24th week, 48th week, 96th week, and 144th week after the surgery. Side, site of the tumor, and post-ope...
Present day controversies and consensus in curettage for giant cell tumor of bone
Journal of Clinical Orthopaedics and Trauma, 2019
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. Twentysix 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.
Acta Orthopaedica, 2012
Background and purpose Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB. Methods Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis. Results The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture. Interpretation Curettage with adjuvants is a feasible firstchoice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not. Giant-cell tumor of bone (GCTB) is aggressive locally with recurrence rates of 27-65% after curettage with bone grafting (
JPMA. The Journal of the Pakistan Medical Association, 2015
Giant cell tumour (GCT) of bone is generally a benign tumour composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but non-sclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. The current study was planned to summarise our experiences with GCTB, and to evaluate individual effect of bone cement, high-speed burring and hydrogen per oxide (H2O2) on local recurrence. GCT can mimic or be mimicked by other benign or malignant lesions at both radiological evaluation and histological analysis. In the past, the mainstay of treatment was surgical, primarily consisting of curettage with cement placement, with recurrence rates of 15%-25%. Recurrence is suggested by development of progressive lucency at the cement-bone interface....
Late recurrence of giant cell tumour of bone after curettage and adjuvant treatment: a case report
Journal of orthopaedic surgery (Hong Kong), 2010
We report a rare case of late recurrence of a giant cell tumour (GCT) of bone 16 years after curettage and cryosurgery treatment. A 46-year-old man presented with swelling and progressively worsening pain in the lateral aspect of his right distal femur. He had undergone 4 procedures elsewhere to manage a GCT of bone and its recurrence 16 to 23 years previously. He underwent en bloc resection with an adequate wide margin and reconstruction with prosthesis. At the one-year follow-up, there was no evidence of recurrence or metastasis.
Treatment of giant cell tumours of bone by radical curettage and bone cement
International Journal of Research in Medical Sciences
Background: Giant cell tumour of bone remains a difficult and challenging management problems because there are no absolute clinical radiographic or histologic parameters that accurately predict the tendency of any single lesion to recur or metastasize.Methods: We performed surgery on 12 patients of GCT with radical curettage and bone cement over a period of 5.8 years. Results were evaluated using the musculoskeletal skeletal grading system.Results: The present series consists of 12 case of GCT age ranging from 16-45 years. Painful swelling was the commonest presentation, limitation of motion was seen in 9 cases and pathological fracture was seen in 1 case. 9 of the tumour occurred around knee joint. Rare involvement of talus was seen in 1 case. Overall 9 patients had a perfect functional score of 30 points and 1 patient scored less than 20 points.Conclusions: Acrylic cement reconstruction is safe and effective procedure that provides local adjuvant therapy, the cement field defect ...
Giant cell tumor: Curettage and bone grafting
Indian Journal of Orthopaedics, 2007
Background: Curettage and wide resection are accepted methods of treatment of giant cell tumor (GCT) of bone. The success rate with curettage in different reports varies widely. There is a paucity in the literature regarding selection of cases for curettage. Present study is an analysis of outcome of 34 cases treated by curettage and bone grafting. Materials and Methods: Thirty-four cases of GCT of bone, 28 fresh and six with recurrence were treated by curettage and bone grafting. All cases of Campanancci grade 1, 2 and grade 3 which on computerized tomography scan showed break in the cortex confined to one surface and cortical break less than one third of circumference were treated by curettage and bone grafting. Results: 4 (14%) of these lesions treated primarily by us showed recurrence after one and half year. Conclusion: Curettage and bone grafting is a reliable method in the treatment of GCT, provided guidelines regarding selection of cases and principles of tumor surgery are strictly adhered to.
Does Curettage without Adjuvant Therapy Provide Low Recurrence Rates in Giant-Cell Tumors of Bone?
Clinical Orthopaedics and Related Research, 2005
Adjuvant treatment or filling agents have been recommended for reducing recurrence rates of giant-cell tumors of bone. However, reports of low recurrence rates without either caused us to question this concept. We retrospectively reviewed 193 patients treated during a 27-year period, comparing our results with historic controls. One hundred thirty-seven patients had curettage as a primary treatment, and of these, 26 (19%) had local recurrences. The local recurrence rate of giant-cell tumors confined to bone (Campanacci Grades I and II) was only 7% compared with 29% in tumors with extraosseous extension (Campanacci Grade III). Six patients (4%) had a fracture after curettage. Twenty-nine patients who were referred to us with local recurrences after treatment elsewhere had curettage, and 10 (34%) of these patients had local recurrences develop. Twenty-seven patients had excision as their primary treatment, and two (7%) of these patients had local recurrence develop. We recommend primary curettage for intraosseous giant-cell tumors without adjuvant treatment or filling agents, but tumors with soft tissue extension or with local recurrence require more aggressive treatment. Level of Evidence: Therapeutic study, Level IV (case seriesno, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
Annals of Medicine and Surgery, 2019
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.