Abstract
Purpose
This study was done to investigate X-ray, computed tomography (CT) and magnetic resonance (MR) imaging features of recurrence in giant cell tumour of bone (GCTB) and to evaluate risk factors.
Materials and methods
Medical records and imaging data were reviewed for 55 cases of recurrent GCTB. All images were reviewed retrospectively and independently by two radiologists experienced in skeletal musculature. The common radiological findings; factors related to tumour recurrence such as gender, age, location; pathological fracture, Campanacci grading and surgical procedure were analysed by nonparametric test (Mann-Whitney U test for two independent samples test and Kruskal-Wallis H test for multiple independent samples test). p values <0.05 were considered to indicate a statistically significant difference.
Results
The imaging features of recurrent GCTB were as follows: osteolytic destruction or bone resorption of graft bone or around the polymethylmethacrylate (PMMA), soft tissue mass formation and expansile change. Tumour parenchyma showed markedly heterogeneous enhancement, except for necrotic cystic cavities, on contrast-enhanced MR images. Wide resection had a smaller (p=0.031) risk of local recurrence than did intralesional curettage. There was no statistical significance in gender, age, location, pathological fracture and Campanacci staging (p>0.05).
Conclusions
The risk of recurrence in GCTB was influenced by the type of surgery and adjuvants. Bone transformaresorption, soft tissue mass formation and aggravated expansile change are reliable signs of recurrence on imaging.
Riassunto
Obiettivo
Questo studio è stato condotto per valutare le caratteristiche radiografiche, di tomografia computerizzata (TC) e di risonanza magnetica (RM) della recidiva del tumore osseo a cellule giganti (GCTB) e valutarne i fattori di rischio.
Materiali e metodi
Sono state riesaminate le cartelle cliniche e le indagini radiologiche di 55 casi di GCTB recidivante. Tutte le immagini sono state valutate retrospettivamente ed in maniera indipendente da due radiologi esperti in radiologia muscolo-scheletrica. I rilievi radiologici ed i fattori correlati alla recidiva tumorale come sesso, età, sede, presenza di frattura patologica, classificazione di Campanacci e procedura chirurgica sono stato analizzate mediante test non parametrici (test U di Mann-Whitney U e test H di Kruskal-Wallis). Valori di p<0,05 sono stati considerati statisticamente significativi.
Risultati
Le principali caratteristiche radiologiche del GCTB recidivante sono risultate essere: distruzione osteolitica, riassorbimento dell’innesto osseo o in adiacenza al polimetilmetacrilato (PMMA), insorgenza di massa nei tessuti molli e comparsa di formazione espansiva. All’indagine RM il tessuto tumorale ha mostrato enhancement marcatamente eterogeneo, ad eccezione per le cavità cistiche necrotiche. Le resezioni radicali hanno avuto un minor rischio (p=0.031) di recidiva locale rispetto al curettage intralesionale. Non si è evidenziata differenza statisticamente significativa per quanto concerne sesso, età, sede, presenza di frattura patologica e classificazione di Campanacci (p>0.05).
Conclusioni
Il rischio di recidiva del GCTB è influenzato dal tipo di chirurgia e dalla presenza di innesti. Riassorbimento osseo, insorgenza di massa nei tessuti molli e comparsa di formazioni espansive sono segni radiologici affidabili di recidiva.
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References/Bibliografia
Faisham WI, Zulmi W, Halim AS et al (2006) Aggressive giant cell tumour of bone. Singapore Med J 47:679–683
Dahlin DC, Cupps RE, Johnson EJ (1970) Giant-cell tumor: a study of 195 cases. Cancer 25:1061–1070
McGough RL, Rutledge J, Lewis VO et al (2005) Impact severity of local recurrence in giant cell tumor of bone. Clin Orthop Relat Res 438:116–122
Ghert MA, Rizzo M, Harrelson JM, Scully SP (2002) Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res 201–210
Szendroi M (2004) Giant-cell tumour of bone. J Bone Joint Surg Br 86:5–12
Chang SS, Suratwala SJ, Jung KM et al (2004) Bisphosphonates may reduce recurrence in giant cell tumor by inducing apoptosis. Clin Orthop Relat Res 103–109
Balke M, Ahrens H, Streitbuerger A et al (2009) Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol 135:149–158
Su YP, Chen WM, Chen TH (2004) Giant-cell tumors of bone: an analysis of 87 cases. Int Orthop 28:239–243
McDonald DJ, Sim FH, McLeod RA, Dahlin DC (1986) Giant-cell tumor of bone. J Bone Joint Surg Am 68:235–242
Errani C, Ruggieri P, Asenzio MA et al (2010) Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 36:1–7
Remedios D, Saifuddin A, Pringle J (1997) Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br 79:26–30
Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69:106–114
Lackman RD, Hosalkar HS, Ogilvie CM et al (2005) Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res 438:123–127
Scully SP, Mott MP, Temple HT et al (1994) Late recurrence of giant-cell tumor of bone. A report of four cases. J Bone Joint Surg Am 76:1231–1233
Klenke FM, Wenger DE, Inwards CY et al (2011) Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res 469:1181–1187
Lackman RD, Crawford EA, King JJ, Ogilvie CM (2009) Conservative treatment of Campanacci grade III proximal humerus giant cell tumors. Clin Orthop Relat Res 467:1355–1359
Prosser GH, Baloch KG, Tillman RM et al (2005) Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 211–218
Gitelis S, Mallin BA, Piasecki P, Turner F (1993) Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am 75:1648–1655
Persson BM, Ekelund L, Lovdahl R, Gunterberg B (1984) Favourable results of acrylic cementation for giant cell tumors. Acta Orthop Scand 55:209–214
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Wang, CS., Lou, JH., Liao, JS. et al. Recurrence in giant cell tumour of bone: imaging features and risk factors. Radiol med 118, 456–464 (2013). https://doi.org/10.1007/s11547-012-0860-4
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DOI: https://doi.org/10.1007/s11547-012-0860-4