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Kong, Hong, Lee, Cho, Song, Cho, Koh, and Jeon: Malignant Transformation of Benign Giant Cell Tumor
Original Article
The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(1): 14-19.

Published online: 27 June 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.1.14

Malignant Transformation of Benign Giant Cell Tumor

Chang-Bae Kong, M.D., Yun-Suk Hong, M.D., Kwang-Youl Lee, M.D., Sang-Hyun Cho, M.D., Won-Seok Song, M.D., Wan-Hyeong Cho, M.D., Jae-Soo Koh, M.D.*, Dae-Geun Jeon, M.D.

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

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

Correspondence to: Won-Seok Song, M.D. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. TEL: +82-2-970-1244, FAX: +82-2-970-2403, wssongmd@gmail.com

Received 29 March 2012       Revised 29 May 2012       Accepted 29 May 2012

Copyright © 2012 by The Korean Bone and Joint Tumor Society

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

We analyzed the oncologic outcome of the malignant transformed benign giant cell tumor of bone.

Materials and Methods

Between January 2000 and February 2012, 5 cases were referred with suspicious malignant transformation of benign giant cell tumor. No patients underwent radiation therapy.

Results

After referral, all patients received the wide excision of the tumor and its' pathologic diagnosis were osteosarcoma. As classified by the location of tumor lesion, 3 cases were located in the distal femur, 1 case was in the distal radius and 1 case was in the proximal femur. The average latent period between diagnosis of benign giant cell tumor and diagnosis of secondary malignant giant cell tumor was 49.2 months. (range, 24-126 months) The mean follow-up period was 21.6 months. There were subsequent local recurrence in 2 cases and 3 patients developed distant metastasis. All patients with lung metastasis were dead.

Conclusion

Malignant transformation of benign giant cell tumor of bone can be occurred within 5 years. Therefore, when benign giant cell tumor suspicious malignant transformation, it is necessary to do more aggressive treatment.

Keywords: giant cell tumor, malignant transformation, osteosarcoma

Figures and Tables

Figure 1
42-year-old man with secondary malignant giant cell tumor. (A) Initial plain radiographs of right proximal femur show osteolytic lesion. This lesion was treated with curettage and bone graft. (B) One month later pathologic fracture was occurred and treated with screw fixation. (C) Recurrence was detected 20 months later and treated with total hip arthroplasty. Postoperative diagnosis was benign giant cell tumor at that time. (D) Three months later patients had severe hip pain and there were huge mass in MRI. (E) After transferred to our hospital, histopathologic diagnosis was secondary malignancy in giant cell tumor at the time of recurrence. Wide excision and reconstruction with tumor prosthesis was performed. (F) The patient died of multiple metastasis in 12 months later.
jkbjts-18-14-g001
Figure 2
31-year old man with secondary malignant giant cell tumor. (A) Initial plain radiograph shows osteolytic lesion at medial condyle of right distal femur. This lesion was treated with curettage and bone graft. (B) Recurrence was found 33months later and transferred to our hospital. (C) MRI shows variable SI on T2WI with heterogeneous enhancement in meta-diaphysis and epiphysis of right distal femur. (D) Wide excision and reconstruction with tumor prosthesis was done. Final histopathologic diagnosis was secondary malignancy in giant cell tumor. (E) Initial diagnosis was benign giant cell tumor. Many osteoclastic giant cells are scattered among mononuclerar stromal cells. The stromal cells are moderately cellular, but uniform nuclear shape and not so-hyperchromatic cells (H&E, ×200). (F) Secondary malignant transformation. Spindle shape hyperchromatic tumor cells directly produce osteoid materials. The spindle shape tumor cells are more pleomorphic and hyperchromatic than initial stromal cells of GCT (H&E, ×400).
jkbjts-18-14-g002
Table 1
Patient Demographics and Treatment before Referral
jkbjts-18-14-i001

GCT, giant cell tumor; ABC, aneurysmal bone cyst; BFH, benign fibrous histocytoma.

Table 2
Secondary Malignant Giant Cell Tumor of Bone after Referral
jkbjts-18-14-i002

LP, latent period; CTx, chemotherapy; CDF, continuous disease free; DOD, die of disease; OS, osteosarcoma; OB, osteoblastic; FB, fibroblastic.

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