Prabowo Yogi, Abubakar Irsan
Musculoskeletal Oncology Division, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
Int J Surg Case Rep. 2018;52:67-74. doi: 10.1016/j.ijscr.2018.08.042. Epub 2018 Aug 29.
Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and/or its capsule are rarely invaded. Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion.
We reported a case of 24-years-old male with Giant cell tumor (GCT) of the right proximal humerus. Patient presented with chief complaint of pain on the right shoulder and had a history of fell on the right elbow. Radiographic examination showed a primary bone tumor of the proximal humerus. MRI provided excellent depiction in suggesting the diagnosis of cutaneous GCT Campanacci 3, which was later, affirmed by biopsy. Patient underwent successful wide excision and reconstruction. The limb salvage procedure consisted of shoulder resection type 1B and reconstruction with pedicle screw and rod system. During 5 days post-operative period, there was no major event observed. Patient could do shoulder flexion forward 0-30, shoulder extension 0-20, elbow extension - Flexion, wrist flexion extension, and fingers flexion.
GCT of bone typically shown as an epiphyseal, eccentric, expansive lytic lesion with a 'soap-bubble appearance'. MRI is useful to assess extracortical spread and intramedullary extension. Surgery is the treatment of choice. Curettage is usually combined with cementing or bone grafting. Hemi-articular and total elbow allografts have been used for reconstruction of the defects following tumor excision, but the complication rates are high, and these techniques are reserved as salvage procedures following failed total elbow arthroplasty.
Wide resection and total elbow arthroplasty enables good functional outcome and lower risk for recurrence. Pedicle and rod system for shoulder reconstruction is a viable option, as it provides good pain relief and functional improvement with lower complication rates.
骨巨细胞瘤（GCT）是具有侵袭性行为和转移能力的良性肿瘤。尽管被认为是骨的良性肿瘤，但GCT的复发率相对较高。肿瘤常延伸至关节软骨下骨，甚至紧邻软骨。关节和/或其关节囊很少被侵犯。手术切除是治疗骨GCT的通用标准治疗方法。确保通过充分暴露病变来进行充分的手术治疗以完全切除肿瘤是关键。
我们报告了一例24岁男性右肱骨近端骨巨细胞瘤（GCT）。患者以右肩部疼痛为主诉就诊，有右肘部跌倒史。影像学检查显示肱骨近端原发性骨肿瘤。MRI对提示Campanacci 3型皮肤GCT的诊断有很好的表现，后来经活检证实。患者接受了成功的广泛切除和重建。保肢手术包括1B型肩部切除术和带蒂螺钉和棒系统重建。术后5天内未观察到重大事件。患者可进行肩关节前屈0-30度、后伸0-20度、肘关节屈伸、腕关节屈伸和手指屈伸。
骨GCT通常表现为骨骺部、偏心性、膨胀性溶骨性病变，呈“肥皂泡样外观”。MRI有助于评估皮质外扩散和髓内延伸。手术是首选治疗方法。刮除术通常与骨水泥填充或骨移植相结合。半关节和全肘关节异体移植已用于肿瘤切除后缺损的重建，但并发症发生率高，这些技术仅在全肘关节置换失败后作为挽救手术保留。
广泛切除和全肘关节置换可实现良好的功能结果并降低复发风险。带蒂棒系统用于肩部重建是一种可行的选择，因为它能提供良好的疼痛缓解和功能改善，且并发症发生率较低。
