Giant Cell-Rich Osteosarcoma: A Tumor Simulating Borderline Lesion

Won Seok Song; Dae-Geun Jeon; Wan Hyeong Cho; Jae Soo Koh; Chang-Bae Kong; Sung Woo Choi; Seung Yong Lee; Bum Suk Kim; Soo-Yong Lee

doi:10.4055/jkoa.2015.50.3.225

Journal List > J Korean Orthop Assoc > v.50(3) > 1013372

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Song, Jeon, Cho, Koh, Kong, Choi, Lee, Kim, and Lee: Giant Cell-Rich Osteosarcoma: A Tumor Simulating Borderline Lesion

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(3): 225-231.

Published online: 30 June 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.3.225

Giant Cell-Rich Osteosarcoma: A Tumor Simulating Borderline Lesion

Won Seok Song, M.D., Dae-Geun Jeon, M.D., Wan Hyeong Cho, M.D., Jae Soo Koh, M.D.^*, Chang-Bae Kong, M.D., Sung Woo Choi, M.D., Seung Yong Lee, M.D., Bum Suk Kim, M.D., Soo-Yong Lee, M.D.

Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.

^*Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea.

Correspondence to: Dae-Geun Jeon, M.D. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 75 Nowon-ro, Nowon-gu, Seoul 139-706, Korea. TEL: +82-2-970-1242, FAX: +82-2-970-2403, dgjeon@kirams.re.kr

Received 12 January 2015 Revised 24 February 2015 Accepted 9 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Giantcell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma. We reviewed; 1) radiological finding of GCRO and clinical impression-related diagnostic workup at referral center, 2) diagnostic delay until a proper diagnosis is made, 3) impact of diagnostic delay on the oncologic outcome.

Materials and Methods

We reviewed 17 patients with GCRO. We investigated the plain radiographic finding, tumor size and location, presence of pathologic fracture, clinical impression and pathological diagnosis at referral center, diagnostic delay, definitive treatment, local recurrence, metastasis, and survival rate.

Results

Eleven cases (64.7%) showed a plain radiographically, purely osteolytic pattern while 6 cases (35.3%) showed mixed osteolytic and sclerotic lesion. Diagnosis at primary center was osteosarcoma in 7 (41.2%), giant cell tumor in 7 (41.2%), and benign bone tumor in 3 (17.6%). Six patients (35.3%) experienced diagnostic delay. Mean diagnostic delay was 3.1 months (1 to 8). At final follow-up 5-year actuarial survival rate of 17 patients was 65%±25%. Although 11 patients without diagnostic delay showed a tendency of high survival over 6 patients with diagnostic problem, there was no statistical significance (p=0.14).

Conclusion

GCRO is a rare subtype of osteosarcoma simulating giant cell tumor both pathologically and radiologically. Careful diagnostic approach is required in order not to misdiagnose this malignant tumor.

Keywords: giant cell rich osteosarcoma, giant cell tumors, diagnostic errors

Figures and Tables

Figure 1

Plain radiograph of a 13-year-old female shows a mixed osteolytic and sclerotic lesion in the distal metaphysis of the femur (Case 4).

Figure 2

Twelve-year-old female with giant cell rich osteosarcoma in the metaphysis of the distal radius (Case 2). (A) Initial radiograph shows a purely osteolytic lesion with cortical destruction. (B) During diagnostic delay of 2 months, the lesion showed marked progression.

Figure 3

Twenty-one-year-old male showing a huge scapula mass (Case 9). (A) Plain radiograph shows a purely osteolytic lesion in the scapula with a huge soft tissue shadow. (B) T1-weighted post-enhancement axial magnetic resonance imaging shows destruction of the scapula and marked extra-osseous mass formation.

Figure 4

Five-year continuous disease free and actuarial survival of 17 patients with giant-cell rich osteosarcoma.

Figure 5

Continuous disease free survival of patients with adequate and inadequate diagnosis (p=0.14).

Figure 6

Actuarial survival of patients with adequate and inadequate diagnosis (p=0.14).

Table 1

Demographics and Clinical Data of 17 Cases of Giant Cell-Rich Osteosarcoma

Table 2

Radiologic Findings and Treatment Outcome of 17 Cases of Giant Cell-Rich Osteosarcoma

LR, local recurrence; F/U, follow-up; CDF, continuous disease free; DOD, died of disease; NED, no evidence of disease.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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