Xu Leilei, Jin Jing, Hu Annan, Xiong Jin, Wang Dongmei, Sun Qi, Wang Shoufeng
Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China.
Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China.
J Bone Oncol. 2017 Sep 20;9:10-14. doi: 10.1016/j.jbo.2017.09.002. eCollection 2017 Nov.
Recurrence of giant cell tumor of bone (GCTB) in the soft tissue is rarely seen in the clinical practice. This study aims to determine the prevalence of soft tissue recurrence of GCTB, and to characterize its radiographic features.
A total of 291 patients treated by intralesional curettage for histologically diagnosed GCTB were reviewed. 6 patients were identified to have the recurrence of GCTB in the soft tissue, all of whom had undergone marginal resection of the lesion. Based on the x-ray, CT and MRI imaging, the radiographic features of soft tissue recurrence were classified into 3 types. Type I was defined as soft tissue recurrence with peripheral ossification, type II was defined as soft tissue recurrence with central ossification, and type III was defined as pure soft tissue recurrence without ossification. Demographic data including period of recurrence and follow-up duration after the second surgery were recorded for these 6 patients. Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate functional outcomes.
The overall recurrence rate was 2.1% (6/291). The mean interval between initial surgery and recurrence was 11.3 ± 4.1 months (range, 5-17). The recurrence lesions were located in the thigh of 2 patients, in the forearm of 2 patients and in the leg of the other 2 patients. According to the classification system mentioned above, 2 patients were classified with type I, 1 as type II and 3 as type III. After the marginal excision surgery, all patients were consistently followed up for a mean period of 13.4 ± 5.3 months (range, 6-19), with no recurrence observed at the final visit. All the patients were satisfied with the surgical outcome. According to the MSTS scale, the mean postoperative functional score was 28.0 ± 1.2 (range, 26-29).
The classification of soft tissue recurrence of GCTB may be helpful for the surgeon to select the appropriate imaging procedure to detect the recurrence. In addition, the marginal resection can produce a favorable outcome for the patients.
骨巨细胞瘤（GCTB）软组织复发在临床实践中较为罕见。本研究旨在确定GCTB软组织复发的发生率，并描述其影像学特征。
回顾性分析291例经组织学诊断为GCTB并接受病灶内刮除术治疗的患者。6例患者被确定为GCTB软组织复发，均接受了病变的边缘切除术。根据X线、CT和MRI影像，将软组织复发的影像学特征分为3型。I型定义为伴有周边骨化的软组织复发，II型定义为伴有中央骨化的软组织复发，III型定义为无骨化的单纯软组织复发。记录这6例患者的人口统计学数据，包括复发时间和二次手术后的随访时间。采用肌肉骨骼肿瘤学会（MSTS）评分系统评估功能结果。
总体复发率为2.1%（6/291）。初次手术与复发的平均间隔时间为11.3±4.1个月（范围5 - 17个月）。复发病灶位于2例患者的大腿，2例患者的前臂，另外2例患者的小腿。根据上述分类系统，2例患者为I型，1例为II型，3例为III型。边缘切除术后，所有患者均持续随访，平均随访时间为13.4±5.3个月（范围6 - 19个月），末次随访时未观察到复发。所有患者对手术结果满意。根据MSTS评分，术后平均功能评分为28.0±1.2（范围26 - 29）。
GCTB软组织复发的分类可能有助于外科医生选择合适的影像学检查方法来检测复发。此外，边缘切除可为患者带来良好的治疗效果。
