Giant Cell Tumors and Aneurysmal Bone Cysts of the Spine

BACKGROUND: Bone cysts are characteristic tumor-like bone lesions occurring in childhood. Overall, they represent 21% to 57% of all benign tumors and tumor-like bone lesions in children. Clinical and X-ray symptoms of aneurysmal and simple bone cysts are similar. Like some other, often occurring, benign bone lesions, such as enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects. AIM: This study aims to identify the main clinical and instrumental characteristics of simple and aneurysmal bone cysts that allow us to differentiate them from some similar destructive bone neoplasms (enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects) and to develop indications for various diagnostic surgical interventions. MATERIALS AND METHODS: A retrospective analysis of the results of the survey of 206 patients aged 3 to 18 years who were treated at our facility from 2000 to 2015 was performed. The features of the diagnostic tactics and their effectiveness were rated. RESULTS: The main clinical and instrumental diagnostic criteria have been established. They enable the differentiation of bone cysts from some similar benign bone lesions at the pre-morphological stage. The indications for diagnostic surgical interventions have been formulated. CONCLUSION: The main difficulties in the differential diagnosis of bone cysts and some similar benign bone lesions have been revealed. An algorithm for applying various diagnostic surgical interventions in patients with these diseases has been proposed.

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p63 Expression in Giant Cell–Containing Lesions of Bone and Soft Tissue

Archives of Pathology & Laboratory Medicine ◽

10.5858/2010-0291-oa.1 ◽

2011 ◽

Vol 135 (6) ◽

pp. 776-779 ◽

Cited By ~ 1

Author(s):

Gustavo de la Roza

Keyword(s):

Soft Tissue ◽

Giant Cell Tumor ◽

Giant Cell ◽

Predictive Value ◽

Cell Tumor ◽

Bone Cysts ◽

Giant Cell Tumors ◽

Aneurysmal Bone Cysts ◽

Tumors Of Bone ◽

Pigmented Villonodular

Abstract Context.—Previous studies have demonstrated p63 overexpression in giant cell tumors of bone and advocate its use as a potential diagnostic marker. Although routine histology is often all that is required to diagnose giant cell tumor of bone, immunohistochemistry could prove useful to distinguish it from other benign and malignant giant cell–containing lesions of bone and soft tissue on needle biopsies and unusual clinical settings. Objective.—To assess p63 expression in giant cell–containing lesions of bone and soft tissue. Design.—p63 immunohistochemistry was performed in 23 giant cell tumors of bone, 8 primary aneurysmal bone cysts, 12 chondroblastomas, 4 giant cell reparative granulomas, 4 osteosarcomas, 15 tenosynovial giant cell tumors, 6 nonossifying fibromas, and 4 pigmented villonodular synovitides. Results.—p63 overexpression was identified in 20 of 23 giant cell tumors of bone (86.9%), 5 of 8 primary aneurysmal bone cysts (62.5%), 10 of 12 chondroblastomas (83.3%), 4 of 4 giant cell reparative granulomas (100%), 2 of 4 osteosarcomas (50%), 1 of 15 tenosynovial giant cell tumors (6.6%), 1 of 6 nonossifying fibromas (16.6%), and 1 of 4 pigmented villonodular synovitides (25%). The sensitivity, specificity, positive predictive value, and negative predictive value of p63 immunohistochemistry for the diagnosis of giant cell tumor of bone were 86.95%, 53.36%, 45.45%, and 91.17%, respectively. Conclusions.—This study shows that although p63 is expressed by most giant cell tumors of bone, its lack of specificity limits its use as an immunohistochemical marker in the differential diagnosis of giant cell–containing lesions of bone and soft tissue.

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Hypercalcaemia after treatment with denosumab in children: bisphosphonates as an option for therapy and prevention?

World Journal of Pediatrics ◽

10.1007/s12519-020-00378-w ◽

2020 ◽

Vol 16 (5) ◽

pp. 520-527 ◽

Cited By ~ 1

Author(s):

Carmen Sydlik ◽

Hans Roland Dürr ◽

Susanne Bechtold-Dalla Pozza ◽

Claudia Weißenbacher ◽

Julia Roeb ◽

...

Keyword(s):

Giant Cell ◽

High Dose ◽

Bone Cysts ◽

Preventive Strategies ◽

Giant Cell Tumors ◽

Severe Hypercalcemia ◽

Aneurysmal Bone Cysts ◽

Tumors Of Bone ◽

Denosumab Treatment

Abstract Background Pharmacologic options for treatment of osteolytic diseases especially in children are limited. Although not licensed for use, denosumab, a fully humanized antibody to RANKL, is used in children with good effects. Among others, one possible indication are giant cell tumors and aneurysmatic bone cysts. However, there are reports of severe hypercalcemia during weeks to months after termination of denosumab, that are rarely seen in adults. Methods We collected data of four patients, aged 6–17 years, who experienced severe hypercalcemia after completion of treatment with denosumab for unresectable giant cell tumors of bone or aneurysmal bone cysts and methods of their treatment. The detailed case information were described. Results One patient was treated with long-term, high-dose steroid therapy, leading to typical Cushing’s syndrome. Another patient was restarted on denosumab repeatedly due to relapses of hypercalcemia after every stop. Finally, in two patients, hypercalcemia ceased definitely after treatment with bisphosphonates. However, several applications were necessary to stabilize calcium levels. Conclusions There is a considerable risk of hypercalcemia as an adverse effect after denosumab treatment in children. Therapeutic and, preferably, preventive strategies are needed. Bisphosphonates seem to be an option for both, but effective proceedings still remain to be established.

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Brown tumor of the iliac crest initially misdiagnosed as a giant cell tumor of the bone

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0029 ◽

2020 ◽

Vol 2020 ◽

Author(s):

S Hamidi ◽

S Mottard ◽

M J Berthiaume ◽

J Doyon ◽

M J Bégin ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Iliac Crest ◽

Cell Tumor ◽

Bone Lesions ◽

Bone Cysts ◽

Giant Cell Tumors ◽

Surgical Interventions ◽

Aneurysmal Bone Cysts ◽

Brown Tumors

Summary Brown tumors (BTs) are expansile osteolytic lesions complicating severe primary hyperparathyroidism (PHPT). Clinical, radiological and histological features of BTs share many similarities with other giant cell-containing lesions of the bone, which can make their diagnosis challenging. We report the case of a 32-year-old man in whom an aggressive osteolytic lesion of the iliac crest was initially diagnosed as a giant cell tumor by biopsy. The patient was scheduled for surgical curettage, with a course of neoadjuvant denosumab. Routine biochemical workup prior to denosumab administration incidentally revealed high serum calcium levels. The patient was diagnosed with PHPT and a parathyroid adenoma was identified. In light of these findings, histological slices of the iliac lesion were reviewed and diagnosis of a BT was confirmed. Follow-up CT-scans performed 2 and 7 months after parathyroidectomy showed regression and re-ossification of the bone lesion. The aim of this case report is to underline the importance of distinguishing BTs from other giant cell-containing lesions of the bone and to highlight the relevance of measuring serum calcium as part of the initial evaluation of osteolytic bone lesions. This can have a major impact on patients’ management and can prevent unnecessary invasive surgical interventions. Learning points: Although rare, brown tumors should always be considered in the differential diagnosis of osteolytic giant cell-containing bone lesions. Among giant cell-containing lesions of the bone, the main differential diagnoses of brown tumors are giant cell tumors and aneurysmal bone cysts. Clinical, radiological and histological characteristics can be non-discriminating between brown tumors and giant cell tumors. One of the best ways to distinguish these two diagnoses appears to be through biochemical workup. Differentiating brown tumors from giant cell tumors and aneurysmal bone cysts is crucial in order to ensure better patient care and prevent unnecessary morbid surgical interventions.

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Giant Cell Tumor of the Talar Neck

Journal of the American Podiatric Medical Association ◽

10.7547/0970225 ◽

2007 ◽

Vol 97 (3) ◽

pp. 225-228 ◽

Cited By ~ 7

Author(s):

Hakan Selek ◽

Hamza Özer ◽

Sacit Turanli ◽

Özlem Erdem

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Clinical Signs ◽

Cell Tumor ◽

Giant Cell Tumors ◽

Radiographic Appearance ◽

Aneurysmal Bone Cysts ◽

Tumors Of Bone ◽

Brown Tumors ◽

Small Bones

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot. (J Am Podiatr Med Assoc 97(3): 225–228, 2007)

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Radiologic Evaluation of Bone Incorporation of Strut Allografting in Bone Defects After Curettage of Benign Bone Tumors

Journal of Musculoskeletal Research ◽

10.1142/s0218957797000153 ◽

1997 ◽

Vol 01 (02) ◽

pp. 141-148

Author(s):

H.-N. Shih ◽

Y.-J. Chen ◽

K.-Y. Hsu ◽

T.-J. Huang ◽

C.-F. Tan ◽

...

Keyword(s):

Functional Results ◽

Long Bone ◽

Bone Cysts ◽

Giant Cell Tumors ◽

Intralesional Curettage ◽

Radiographic Appearance ◽

Radiologic Evaluation ◽

Pathologic Fractures ◽

Aneurysmal Bone Cysts

Large osseous defects have long been a challenge to the reconstructive surgeon. In a series of 104 patients (average age of 26 years; range, 11–60 years) with space occupying lesions of the long bone, we implanted deep-frozen (-70° C) cortical strut allografts into the defects after intralesional curettage. Because of the relatively few published reports on the radiographic appearance of the postoperative course of bone grafting healing, this study was done to investigate the course of radiographic change. This series included 36 fibrous dysplasias, 29 unicameral bone cysts, 22 giant cell tumors, 12 aneurysmal bone cysts, 3 benign fibrous histiocytomas and 2 ossifying fibromas. Fifty-six patients had pathologic fractures. The mean volume of the defect after curettage was 210 ml (range, 56–460 ml). All the patients were followed up for an average of 4 years (range, 2–6 years). At follow-up, good or excellent functional results were found in 97% of the patients (101/104). The radiographs demonstrated complete incorporation of the allogeneic implant and new bone formation in the cavity in 83% of the patients (86/104) (using a semiquantitative method). All pathologic fractures healed. There was no local recurrence or fracture of the cortical graft. There were no other serious complications except for one avascular necrosis of the femoral head. The process of allograft incorporation was similar to that of fresh autograft, though remodeling was rather delayed.

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Aggressive osteoblastoma with a secondary aneurysmal bone cyst treated with denosumab

Rare Tumors ◽

10.1177/20363613211034710 ◽

2021 ◽

Vol 13 ◽

pp. 203636132110347

Author(s):

Karlton Wong ◽

Jomjit Chantharasamee ◽

Scott Nelson ◽

Mark A Eckardt ◽

Kambiz Motamedi ◽

...

Keyword(s):

Giant Cell ◽

Case Reports ◽

Bone Cyst ◽

Young Patients ◽

Axial Skeleton ◽

Giant Cell Tumors ◽

Bony Lesions ◽

Aneurysmal Bone Cysts ◽

Secondary Aneurysmal Bone Cyst ◽

Primary Bone

Osteoblastomas and aneurysmal bone cysts (ABC) are rare benign bone tumors that make up about 1%–2% of primary bone malignancies, typically occurring in young patients with a median age of 20 years, most commonly effecting the axial skeleton. ABCs may develop independently as primary lesions, or secondary to other bony lesions including osteoblastomas, chondroblastomas, and giant cell tumors. Treatment of unresectable or extensive osteoblastomas can be challenging. In 2013, the Food and Drug Administration (FDA) approved denosumab for the treatment of giant cell tumors of the bone due to its efficacy in these morbid bony lesions. Various case reports have shown that osteoblastomas can respond to denosumab. Furthermore, numerous ABC case reports have described the efficacy of denosumab in these situations. We herein describe a unique case of a young patient with an aggressive osteoblastoma and secondary ABCs who was successfully treated with denosumab.

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