RESUMO
Diffuse-type giant cell tumor (Dt-GCT), formerly known as pigmented villonodular synovitis, is the more aggressive entity belonging to the spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae, and tendon sheaths. Diffuse-type giant cell tumor's importance stems from its local aggressiveness and sequelae if left untreated. This review briefly describes Dt-GCT's clinical features, its imaging and pathology findings, and provides an extensive discussion of its available treatments. The management approaches of Dt-GCT can be divided into surgical management and non-surgical management, which includes radiation therapy or more novel molecular and biologic therapies. We also present an algorithm based on disease presentation and site involved to guide treatment.
Assuntos
Tumor de Células Gigantes de Bainha Tendinosa , Sinovite Pigmentada Vilonodular , Humanos , Tumor de Células Gigantes de Bainha Tendinosa/terapia , Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Tumor de Células Gigantes de Bainha Tendinosa/diagnóstico por imagem , Tumor de Células Gigantes de Bainha Tendinosa/patologia , Sinovite Pigmentada Vilonodular/terapia , Sinovite Pigmentada Vilonodular/cirurgia , Sinovite Pigmentada Vilonodular/diagnóstico , Resultado do Tratamento , AlgoritmosRESUMO
Metastatic bone lesions are often osteolytic, which causes advanced-stage cancer sufferers to experience severe pain and an increased risk of developing a pathological fracture. Gallium (Ga) ion possesses antineoplastic and anti-bone resorption properties, suggesting the potential for its local administration to impede the growth of metastatic bone lesions. This study investigated the chemotherapeutic potential, cytotoxicity, and osteogenic effects of a Ga-doped glass polyalkenoate cement (GPC) (C-TA2) compared to its non-gallium (C-TA0) counterpart. Ion release profiles revealed a biphasic pattern characterized by an initial burst followed by a gradually declining release of ions. C-TA2 continued to release Ga steadily throughout the experimentation period (7 d) and exhibited prolonged zinc (Zn) release compared to C-TA0. Interestingly, the Zn release from both GPCs appeared to cause a chemotherapeutic effect against H1092 lung cancer cellsin vitro, with the prolonged Zn release from C-TA2 extending this effect. Unfortunately, both GPCs enhanced the viability of HCC2218 breast cancer cells, suggesting that the chemotherapeutic effects of Zn could be tied to cellular differences in preferred Zn concentrations. The utilization of SAOS-2 and MC3T3 cell lines as bone cell models yielded conflicting results, with the substantial decline in MC3T3 viability closely associated with silicon (Si) release, indicating cellular variations in Si toxicity. Despite this ambiguity, both GPCs exhibited harmful effects on the osteogenesis of primary rat osteoblasts, raising concerns about excessive burst Zn release. While Ga/Zn-doped GPCs hold promise for treating metastatic bone lesions caused by lung cancers, further optimization is required to mitigate cytotoxicity on healthy bone.
Assuntos
Sobrevivência Celular , Gálio , Osteogênese , Gálio/química , Animais , Humanos , Linhagem Celular Tumoral , Osteogênese/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Camundongos , Zinco/química , Ratos , Cimentos de Ionômeros de Vidro/química , Antineoplásicos/química , Antineoplásicos/farmacologia , Teste de Materiais , Neoplasias Ósseas/tratamento farmacológico , Osteoblastos/efeitos dos fármacos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologiaRESUMO
PURPOSE: The primary objective of this study was to determine time to full weight-bearing after the use of a calcium-sulfate-calcium phosphate bone substitute (CaSO4/CaPO4) as a bone void filler in the treatment of primary benign bone tumours following intralesional curettage. The secondary objectives were to determine surgical complications and recurrence rates. METHODS: Retrospective review of patients identified from a surgeon-specific orthopaedic oncology database, who underwent curettage of benign bone tumours and subsequent bone void filling with CaSO4/CaPO4. RESULTS: A total of 39 patients (20 males, 19 females) met inclusion criteria with an average age of 31 years (range: 13 to 62 years), a median follow-up of 3.7 years, and a maximum follow-up of 11 years. The most common tumour diagnosis was giant cell tumour of bone (GCT) (n = 19), and the most common location was the proximal tibia (n = 9). The mean volume of tumour excised was 74.1 cm3 including extraosseous bone expansion due to tumour growth, with a mean of volume of 21.4 mL of CaSO4/CaPO4 used to fill the intraosseous cavitary defects to restore normal bone anatomy. None of the lesions required additional internal fixation. The primary outcome measure, average time to full weight-bearing/full range of motion, was 11 weeks and 6 weeks for upper and lower extremity lesions, respectively. Secondary outcomes included tumour recurrence requiring reoperation in five patients and infection requiring reoperation in two patients. CONCLUSION: This study demonstrates that CaSO4/CaPO4 is a viable option as a bone void filler in the reconstruction of cavitary defects following removal of primary benign bone tumours. CaSO4/CaPO4 provides sufficient bone regeneration early in the post-operative period to allow progression to full weight-bearing within weeks without the need for internal fixation. There were no graft-specific complications noted.
Assuntos
Neoplasias Ósseas , Substitutos Ósseos , Fosfatos de Cálcio , Sulfato de Cálcio , Curetagem , Suporte de Carga , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Neoplasias Ósseas/cirurgia , Fosfatos de Cálcio/uso terapêutico , Pessoa de Meia-Idade , Adolescente , Substitutos Ósseos/uso terapêutico , Adulto Jovem , Fatores de TempoRESUMO
Background: The formation of destructive pseudotumors is a well-documented, albeit rare, complication of total hip arthroplasties. They tend to be progressive and, if left untreated, can result in extensive periprosthetic bony destruction. The current case presents a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings demonstrating chronic hematoma. Case Description: An 86-year-old female with a metal-on-polyethylene total hip presented with a massive pseudotumor accompanied by extensive bony lysis. Due to pain and chronic anemia, a palliative debulking procedure was undertaken as a palliative measure. At one year follow-up, the patient reported significant pain relief and was able to ambulate safely with gait aids. Her hemoglobin stabilized post-operatively and ongoing transfusions were not required. Final pathology was not supportive of particle disease despite this being the leading diagnosis. Microscopic sections showed tissue mostly composed of fibrin and blood with multiple foci of calcification and reactive papillary endothelial hyperplasia which can be seen in chronic hematomas. Conclusions: This case presents the diagnostic dilemma of a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings consistent with a chronic hematoma. It highlights the importance of close follow-up and early intervention when periprosthetic osteolysis is detected.