Satcher Robert L, Ravi Vinod, Wang Wei-Lien, Oates Scott
Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Am J Orthop (Belle Mead NJ). 2017 Jul/Aug;46(4):E269-E275.
Giant cell tumors (GCTs) are aggressive benign lesions that occur in the bone epiphysis. They are most often found in the long bones of the lower extremities. Wrist bone involvement is rare, capitate bone involvement exceedingly rare. Treatment in the wrist usually consists of excision, local adjuvant treatment, and cementing and/or bone grafting. GCTs also metastasize to the lungs; pulmonary lesions are excised and systemic therapy provided. We present the case of a 19-year-old woman with GCT of the capitate bone. After initial excision and cementing, the GCT recurred with lung metastases during a pregnancy. Rapid expansion of the GCT during pregnancy was reversed with systemic treatment with denosumab after pregnancy. Excellent response to this chemotherapy permitted limb-sparing surgery and wrist reconstruction with structural cortical autogenous bone graft. Resection of pulmonary metastases after a year of treatment with denosumab revealed lung parenchyma with calcification and ossification and limited viable tumor.
骨巨细胞瘤（GCTs）是发生于骨骺的侵袭性良性病变。最常发生于下肢长骨。腕骨受累罕见，头状骨受累极为罕见。腕部骨巨细胞瘤的治疗通常包括切除、局部辅助治疗以及骨水泥填充和/或植骨。骨巨细胞瘤也可转移至肺部；肺部病变需切除并给予全身治疗。我们报告一例19岁女性头状骨骨巨细胞瘤病例。初次切除并填充骨水泥后，该骨巨细胞瘤在患者孕期复发并伴有肺转移。孕期骨巨细胞瘤的快速进展在产后经地诺单抗全身治疗得以逆转。对这种化疗的良好反应使得保肢手术和采用结构性自体皮质骨移植进行腕关节重建成为可能。地诺单抗治疗一年后切除肺转移灶，结果显示肺实质有钙化和骨化，存活肿瘤局限。
