Massachusetts General Hospital, Boston, MA, USA.
J Am Acad Orthop Surg. 2013 Feb;21(2):118-26. doi: 10.5435/JAAOS-21-02-118.
Giant cell tumor (GCT) of bone is one type of giant cell-rich lesion of bone. This benign mesenchymal tumor has characteristic multinuclear giant cells. Mononuclear stromal cells are the physiologically active and diagnostic cell type. Most GCTs are located in the epiphyseal regions of long bones. The axial skeleton-primarily the sacrum-is a secondary site of involvement. Most patients present with pain, swelling, joint effusion, and disability in the third and fourth decades of life. Imaging studies are important for tumor staging and radiographic grading. Typically, these clinically active but slow-growing tumors are confined to bone, with relatively well-defined radiographic borders. Monostotic disease is most common. Metastatic spread to the lungs is rare. Extended intralesional curettage with or without adjuvant therapy is the primary treatment choice. Local recurrence is seen in ≤ 20% of cases, and a second local intralesional procedure is typically sufficient in cases that are detected early. Medical therapies include diphosphonates and denosumab. Denosumab has been approved for use in osteoporosis as well as breast and prostate cancer metastatic to bone. Medical therapy and radiotherapy can alter the management of GCT of bone, especially in multifocal disease, local recurrences, and bulky central/axial disease.
骨巨细胞瘤（GCT）是一种富含巨细胞的骨良性间叶性肿瘤。这种肿瘤具有特征性的多核巨细胞。单核基质细胞是生理活性和诊断性细胞类型。大多数 GCT 位于长骨的骺区。轴性骨骼——主要是骶骨——是次要受累部位。大多数患者在第三和第四十年出现疼痛、肿胀、关节积液和功能障碍。影像学研究对于肿瘤分期和影像学分级很重要。这些临床上活跃但生长缓慢的肿瘤通常局限于骨骼，具有相对明确的放射学边界。单发性疾病最为常见。转移至肺部的情况罕见。主要治疗选择是广泛切除肿瘤，辅以或不辅以辅助治疗。局部复发率<20%，早期发现的病例通常只需再次进行局部广泛切除。药物治疗包括双膦酸盐和地舒单抗。地舒单抗已被批准用于骨质疏松症以及乳腺癌和前列腺癌骨转移。药物治疗和放疗可以改变骨巨细胞瘤的治疗方式，特别是在多发病灶、局部复发和中央/轴性巨大肿瘤的情况下。
