• Acetabulum Reconstruction
• Autologous Femoral Head
• Periacetabular Tumors
• Total Hip Arthroplasty

• 2023NSFSC0733 The Science and Technology Research Program of Sichuan Province

• Blood loss
• Giant cell tumors of bone
• Preoperative embolization
• Sacrum
• Time of surgery

• Humans
• Embolization, Therapeutic/methods
• Giant Cell Tumor of Bone/pathology
• Giant Cell Tumor of Bone/surgery
• Giant Cell Tumor of Bone/therapy
• Bone Neoplasms/pathology
• Bone Neoplasms/surgery
• Bone Neoplasms/therapy
• Female
• Adult
• Case-Control Studies
• Male
• Sacrum/surgery
• Sacrum/pathology
• Preoperative Care
• Ilium/pathology
• Middle Aged
• Follow-Up Studies
• Prognosis
• Young Adult
• Pelvic Bones/pathology
• Pelvic Bones/surgery
• Curettage/methods

• oncology
• surgical oncology

• Humans
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Acetabulum/surgery
• Acetabulum/pathology
• Femur Head/surgery
• Femur Head/pathology
• Bone Neoplasms/pathology
• Margins of Excision
• Prosthesis Failure
• Retrospective Studies
• Treatment Outcome

• QML20200403 Beijing Hospitals Authority Youth Programme
• XKGG202108 Jishuitan Hospital Elite Young Scholar Programme
• ZR-202104 Beijing JST Research Funding

• giant cell tumor of bone
• ischiopubic ramus resection
• ischium
• musculoskeletal oncology
• orthopedics and trauma
• pelvic tumor
• surgical procedures
• treatment outcome

• 3D-printed implant
• Osseointegration
• Patient-specific bone-cutting guide
• Pelvic GCT

• Adult
• Female
• Humans
• Male
• Plastic Surgery Procedures
• Printing, Three-Dimensional
• Prostheses and Implants
• Retrospective Studies
• Surgical Wound/surgery
• Pelvic Bones/surgery
• Giant Cell Tumor of Bone/surgery
• Bone Neoplasms/surgery

• ZYJC18036 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University
• 2022YFG0109 the Science and Technology Research Program of Sichuan Province

Giant cell tumor (GCT) is a benign bone tumor typically seen in epiphysis or metaphysis of mature long bones. Multiple large multinucleated giant cells dispersed among mononuclear spindle cells and monocytes constitute characteristic histological background of GCT of bone (GCTB).

A 15-year-old girl was admitted to our hospital with the complaint of pain and swelling in the left leg with difficulty in walking for 2 years. On X-ray of the left leg, osteolytic, expansile, eccentric lesion with sclerotic bone margin on the diaphysis of the tibia was seen suggesting oesteofibrous dysplasia. MRI demonstrated findings compatible with adamantinoma. The subsequent histology report was rather surprising, consistent with giant cell tumor of the bone. Extended intralesional curettage was done with the help of a high-speed burr followed by chemical cauterization and bone grafting. The patient was followed up for 2 years. The patient could walk normally without assistance or any signs of a recurrence.

GCTB commonly affects people in their third and fourth decades of life and involves epiphysis of the long bone, but this is a case of diaphyseal GCT, at an age of 15 years. It is challenging to diagnose GCT, if present in an unusual location, unless confirmed by histopathological examinations.

A multi-disciplinary approach is required to correctly reach the diagnosis of GCT when it happens to be in an uncommon location(s). Early diagnosis with appropriate treatment and long-term follow-up is mandatory for the successful outcome of the treatment.

•

GCTB commonly affects people in their third and fourth decades of life and involves epiphysis of the long bone.

• Giant cell tumour
• fibula
• recurrence

• Epithelioid hemangioma
• Vascular anomalies

• Acetabulum/diagnostic imaging
• Acetabulum/pathology
• Acetabulum/surgery
• Bone Neoplasms/diagnostic imaging
• Bone Neoplasms/pathology
• Bone Neoplasms/therapy
• Bone Transplantation
• Curettage/methods
• Hemangioma/diagnostic imaging
• Hemangioma/therapy
• Humans
• Vascular Neoplasms/pathology

•

The preoperative application of denosumab can reduce tumor blood supply.

The changes in the characteristics of the tumor blood supply of giant cell tumor of bone over time after treatment with denosumab remain unclear. The purpose of this study was to evaluate the change in the blood supply imaging characteristics of giant cell tumor of bone after preoperative denosumab treatment and to provide evidence for evaluating the reasonable time for preoperative treatment.

A total of 59 patients with giant cell tumor of bone who were treated in our hospital from 2014 to 2019 were enrolled in the study. All patients underwent enhanced CT examination of the tumor site before denosumab treatment and every month after treatment. The plain CT value and enhanced CT value of the tumor were measured, and the CT enhancement rate of the tumor was calculated. The change in the CT enhancement rate of the tumor over time after denosumab treatment was analyzed.

The average tumor enhancement rates were 2.14 (1.22–4.05), 1.60 (1.12–2.53), 1.38 (1.02–2.24), and 1.25 (1–2.11) before denosumab treatment and one month, three months, and six months after treatment, respectively. After denosumab treatment, the average monthly CT enhancement rate decreased as follows: 0.54 (25.2%) in the first month, 0.11 (5.15%) in the second to third months, and 0.04 (1.87%) in the fourth to sixth months. The tumor enhancement rate was no longer significantly reduced three months post-treatment. There was a significant correlation between the reduction in the CT enhancement rate and the initial CT enhancement rate (P = 0.000).

The preoperative application of denosumab can reduce tumor blood supply. The decrease in the blood supply is the most significant in the initial stage of treatment. Following treatment, the decrease in the blood supply gradually reduces over time. Therefore, for the purpose of reducing intra-operative bleeding and facilitating surgery, application of denosumab treatment is not recommended more than three months before surgery.

Giant cell tumor (GCT) is a locally aggressive tumor but with benignity features, representing approximately 18% of non-malignant bone tumors in European countries, with slight female predominance. Malignancy in GCT is rare, about <2% of cases and is more common at older ages. Is known that usually occurs at the epiphyses of long bones, but extremely rare may have another location, such as the pelvic bone. An atypical location – the posterior iliac bone, found at a 34-year-old male –, is the case report we studied and described. Starting from the patient’s complains, like a mass in the left buttock region described as “recently appeared”, firm, not-mobile, with no distinctive borders and no tenderness at palpation, and a recent history trauma, multiple investigations have been performed, which have highlighted an osteolytic lesion, close to the sacroiliac joint, only with infiltration of the gluteal, iliac and paravertebral muscles. The treatment of choice was hemi-pelvectomy, with wide tumoral resection, and selective embolization of the nutrient vessels 24 hours prior to the surgical procedure. At two years postoperative, we found a good functional result and the computed tomography (CT) scan revealed no signs of recurrence.

Bone lesions can present the multi-displinary team with a challenge by way of diagnosis as some lesions share many radiological and histological characteristics. Giant cell tumours of the bone (GCTB) are relatively common, benign bone tumours. Aneurysmal bone cysts (ABC) are less common benign osteolytic lesions that are histologically similar to GCTBs but produce blood filled cavities. Both GCTBs and ABCs are locally aggressive and are typically found on meta-epiphyseal regions of long bones with pelvic tumours being less common.

A 17-year old female presented with atraumatic right groin pain and was initially diagnosed with a GCTB on the right superior pubic ramus of the pelvis. The patient was treated successfully with a wide excision, curettage and bone graft and underwent open reduction and internal fixation of the right hemi-pelvis. Following further intra-operative histological investigations, the lesion was diagnosed as an ABC.

This patient has had an uncomplicated post-operative course, has returned to comfortable weight bearing and will be reviewed for minimum 5 yr in the out-patient setting to monitor for reoccurrence.

• Pelvic
• Tumour
• Aneurysmal bone cyst
• Giant cell tumour
• Open reduction internal fixation of pelvis
• Case report

The purpose of this retrospective study was to evaluate the clinical and oncological results of combination treatment of short‐term preoperative denosumab (the receptor activator of nuclear factor kappa‐B ligand inhibitor) with surgery in unresectable or recurrent cases of giant cell tumor of the bone (GCTB).

Between 2016 and 2018, 11 eligible patients (1 man, 10 women, mean age 38.1 years) with grade 3 GCTB were treated with a combination of short‐term (six doses) preoperative denosumab and surgery in a single institution. The clinical, radiological, and pathological alteration after the denosumab treatment were compared. The oncological results of the combination therapy were also recorded. Meanwhile, adverse effects or complications of denosumab, if any, were reported.

The median follow‐up time after surgical procedure was 30 months (range 13–45 months). After 3–4 denosumab injections, pain relief was observed in all patients. In two spine patients, the neurological status improved after four doses of treatment. Intraoperatively, the margin of the tumor became clear and the intensity of the tumor increased while the blood supply around and within the lesion decreased. Within the lesion, the typically soft and loose tissue were replaced by the tough and dense fibro‐osseous tissue. The mean diameter of the lesion before and after treatment was 61.55 ± 22.49 mm and 51.81 ± 21.12 mm, respectively, and the T‐score was 1.02 (P = 0.32). Variable calcification was observed at the periphery and within the lesion. A total of three patients experienced local recurrence in this study. In the resection group, only one extremity patient had soft tissue recurrence that was treated with en‐bloc excision. In the curettage group, two of three sacral tumor patients had local occurrence. Both refused re‐operation and restarted the monthly denosumab injection thereafter, and the lesions remained stable at the final follow up. Finally, no adverse effects or complications related to denosumab treatment were found.

For the unresectable or recurrent GCTB cases, short‐term (six doses) preoperative use of denosumab improved clinical symptoms, decreased the tumor size, and increased the tumor density. The changes in tumors, in turn, simplified the tumor removal manipulation and, subsequently, decreased the local recurrence for the resection surgery. For the curettage, the denosumab‐induced changes had mixed impacts, and shorter term (fewer than six doses) usage may be more appropriate. Our six‐dose regime was deemed safe, while the safety of long‐term use remains unknown.

• Bone
• Denosumab
• Giant cell tumor
• Preoperative
• Short-term

• Local control
• Overall survival
• Pelvis
• Sacral giant cell tumor
• Selective arterial embolization

The management of pelvic giant cell tumors (GCTs) involving the acetabulum remains a challenge for surgeons on how to balance the relative benefits of minimizing recurrence and maintaining postoperative hip function. The present study was to present and evaluate the clinical indications, operative technique, and outcomes of pelvic GCTs involving partial acetabulum treated with multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless total hip arthroplasty (THA).

We retrospectively reviewed seven patients with pelvic GCTs involving partial acetabulum who underwent multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA from January 2010 to October 2014. We assess the outcome including the bone graft healing, nonunion, hardware failure, infection, tumor recurrence, and metastasis. And the functional outcome was evaluated by the Musculoskeletal Tumor Society (MSTS)93 score.

All patients were followed up for a mean of 38.1 months (range 26–61 months). All bone grafts are union. No failure of acetabular components, wound healing problem, or deep infection was suspected. No patient experienced metastasis. Recurrence was observed in one out of seven patients, treated by extended resection and implanting iodine ions in the surgical area. The mean MSTS93 score was 29.4 (range 28–30). All patients were disease-free and resumed activities of daily living at the most recent follow-up.

As long as one of the two columns is retained and the resulting defect does not exceed the supra-acetabular line, multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA is a viable strategy for the treatment of pelvic GCTs involving partial acetabulum. However, a large-scale prospective clinical study is still needed to verify these procedures.

• Acetabulum
• Bone graft
• Giant cell tumor
• Osteotomy
• Surgical treatment

• Giant cell tumor
• Pregnancy
• Spine
• Treatment