Advertisement

Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 827–833 | Cite as

Metastatic Giant Cell Tumor of Bone: Are There Associated Factors and Best Treatment Modalities?

  • Seethalakshmi Viswanathan
  • N. A. Jambhekar
Clinical Research

Abstract

Giant cell tumors of bone are sometimes locally aggressive and may metastasize, although uncommonly. We attempted to identify associations of clinical and histopathologic parameters with metastasis, the long-term outcome with metastases, and the best treatment. We identified distant metastases in 24 of 470 patients with giant cell tumors during a 20-year period. The median age of these 24 patients at presentation was 26 years (range, 16–76 years), and the male:female ratio was 1.6:1, with no predilection for primary site. Metastasis occurred at a mean of 2 years (range, 4 months–11 years) after initial diagnosis. Sites for distant metastases were the lung (21 of 24 patients), scalp, calf muscle, and regional lymph nodes. The 24 patients had a mean followup of 3.5 years (range, 0–16 years). Thirteen of the 24 patients has local recurrence before or at the time of metastasis. Two patients refused treatment, eight underwent metastasectomy, and 14 were inoperable (four had chemotherapy, 10 were treated symptomatically). We observed disease progression with hemoptysis in one of 14 patients. None of the patients died of their metastatic disease. None of the risk factors we studied was associated with metastasis in giant cell tumors. Although the overall outcome was favorable, metastasectomy is recommended where feasible.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Local Recurrence Metastatic Lesion Pulmonary Metastasis Giant Cell Tumor Giant Cell Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Alacacioglu A, Bengi G, Oztop I, Canda T, Balci P, Osma E, Yilmaz U. Metastasis of giant cell tumor to the breast: case report and review of the literature. Tumori. 2006;92:351–353.PubMedGoogle Scholar
  2. 2.
    Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumors of bone. Cancer. 2003;97:2520–2529.CrossRefPubMedGoogle Scholar
  3. 3.
    Boghani A, Gayathri K, Ratnakar KS. Endobronchial metastasis from giant cell tumor of bone. Chest. 1994;106:1599–1601.CrossRefPubMedGoogle Scholar
  4. 4.
    Caballes RL. The mechanism of metastasis in the so-called “benign giant cell tumor of bone”. Hum Pathol. 1981;12:762–767.CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng JC, Johnston JO. Giant cell tumor of bone: prognosis and treatment of pulmonary metastasis. Clin Orthop Relat Res. 1997;338:205–214.CrossRefPubMedGoogle Scholar
  6. 6.
    Connell D, Munk PL, Lee MJ, O’Connell JX, Janzen D, Vu M, Masri BA. Giant cell tumor of bone with selective metastases to mediastinal lymph nodes. Skeletal Radiol. 1998;27:341–345.CrossRefPubMedGoogle Scholar
  7. 7.
    Dominkus M, Ruggieri P, Bertoni F, Briccoli A, Picci P, Rocca M, Mercuri M. Histologically verified lung metastases in benign giant cell tumours: 14 cases from a single institution. Int Orthop. 2006;30:499–504.CrossRefPubMedGoogle Scholar
  8. 8.
    Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone: an analysis of two hundred and eighteen cases. J Bone Joint Surg Am. 1970;52:619–664.PubMedGoogle Scholar
  9. 9.
    Gupta R, Seethalakshmi V, Jambhekar NA, Prabhudesai S, Merchant N, Puri A, Agarwal M. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol. 2008;12:239–248.CrossRefPubMedGoogle Scholar
  10. 10.
    Katz E, Nyska M, Okon E, Zajicek G, Robin G. Growth rate analysis of lung metastases from histologically benign giant cell tumor of bone. Cancer. 1987;59:1831–1836.CrossRefPubMedGoogle Scholar
  11. 11.
    Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone: six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994;302:219–230.PubMedGoogle Scholar
  12. 12.
    Ladanyi M, Traganos F, Huvos AG. Benign metastasizing giant cell tumors of bone: a DNA flow cytometric study. Cancer. 1989;64:1521–1526.CrossRefPubMedGoogle Scholar
  13. 13.
    Notarianni C, Abreo F, Nanda A. Cranial vault metastasis of giant cell tumor. Ann Diagn Pathol. 2008;12:286–289.CrossRefPubMedGoogle Scholar
  14. 14.
    Present DA, Bertoni F, Springfield D, Braylan R, Enneking WF. Giant cell tumor of bone with pulmonary and lymph node metastases: a case report. Clin Orthop Relat Res. 1986;209:286–290.PubMedGoogle Scholar
  15. 15.
    Rock M. Curettage of giant cell tumor of bone: factors influencing local recurrences and metastases. Proceedings of Combined European Musculoskeletal Oncology Society and Musculoskeletal Tumor Society Meeting. Bologna, Italy: Capelli Editore; 1989:204–205.Google Scholar
  16. 16.
    Rock M, Capanna R. The treatment of giant cell tumor of bone. In: Stauffer RN, ed. Advances in Operative Orthopaedics. Vol 1. St Louis, MO: Mosby-Year Book Inc; 1993:367-390.Google Scholar
  17. 17.
    Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant cell tumor of bone. J Bone Joint Surg Am. 1984;66:269–274.PubMedGoogle Scholar
  18. 18.
    Sanerkin NG. Malignancy, aggressiveness, and recurrence in giant cell tumor of bone. Cancer. 1980;46:1641–1649.CrossRefPubMedGoogle Scholar
  19. 19.
    Siebenrock KA, Unni KK, Rock MG. Giant-cell tumour of bone metastasising to the lungs: a long-term follow-up. J Bone Joint Surg Br. 1998;80:43–47.CrossRefPubMedGoogle Scholar
  20. 20.
    Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol. 1992;158:331–334.PubMedGoogle Scholar
  21. 21.
    Tyler W, Barrett T, Frassica F, MacCarthy E. Skin metastasis from conventional giant cell tumor of bone: conceptual significance. Skeletal Radiol. 2002;31:166–170.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  1. 1.Department of PathologyTata Memorial HospitalMumbaiIndia

Personalised recommendations