Adams Sheila Conway, Potter Benjamin K, Robinson Philip G, Temple H Thomas
Department of Orthopedics and Rehabilitation, University of Miami Miller School of Medicine, Miami Florida, USA.
Orthopedics. 2010 Sep 7;33(9):688. doi: 10.3928/01477447-20100722-20.
Giant cell tumor is a benign tumor of bone with a predilection for juxta-articular locations. Although not malignant, giant cell tumor often exhibits unpredictable and locally aggressive behavior, and in rare cases can metastasize in the absence of histologic malignancy. Partial tumor necrosis has been infrequently reported within typical giant cell tumor. A 17-year-old girl presented with a right distal femur giant cell tumor associated with complete tumor necrosis on histopathologic analysis. The etiology, prevalence, and implications of complete necrosis in previously untreated giant cell tumor of bone remain unclear, as there are no previously published reports. Despite the complete necrosis evident in our patient, she nonetheless presented with pain. There were no radiographic signs of the necrotic tumor space remodeling with new bone. The patient was treated with standard extended intralesional curetting through a generous cortical window permitting visualization of the entire lesion, and systematic high speed burring and thermal electrocautery ablation of the periphery, followed by micro particulate allogenic bone grafting. At short-term follow-up, she had healed well with no evidence of tumor recurrence. This article presents the first case, to our knowledge, of complete spontaneous tumor necrosis in a previously untreated bone giant cell tumor. Increased understanding of spontaneous tumor necrosis associated with giant cell tumor may help guided future targeted medical and surgical treatment modalities.
骨巨细胞瘤是一种好发于关节周围部位的骨良性肿瘤。尽管骨巨细胞瘤并非恶性肿瘤，但它常常表现出不可预测的局部侵袭性行为，并且在罕见情况下，即使组织学上无恶性表现也可发生转移。在典型的骨巨细胞瘤中，部分肿瘤坏死的情况鲜有报道。一名17岁女孩被诊断为右股骨远端骨巨细胞瘤，组织病理学分析显示肿瘤完全坏死。由于此前没有相关报道，骨巨细胞瘤在未经治疗时出现完全坏死的病因、发生率及意义尚不清楚。尽管我们的患者肿瘤明显完全坏死，但她仍有疼痛症状。影像学检查未发现坏死肿瘤区域有新骨重塑的迹象。该患者接受了标准的扩大病灶内刮除术，通过一个宽大的皮质骨窗口可以看到整个病变，然后对周边进行系统的高速磨钻和热灼烙切除，随后进行微粒异体骨移植。短期随访时，她恢复良好，没有肿瘤复发的迹象。据我们所知，本文首次报道了未经治疗的骨巨细胞瘤出现完全自发性肿瘤坏死的病例。对骨巨细胞瘤相关的自发性肿瘤坏死的进一步了解，可能有助于指导未来针对性的药物和手术治疗方式。
