Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws.

PURPOSE: Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. MATERIALS AND METHODS: Patients with a biopsy-confirmed giant cell lesion satisfying criteria for "aggressive giant cell tumor" were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m(2)) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. RESULTS: Eight patients (7 females), with a mean age of 18.7 +/- 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. CONCLUSION: Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment.

[Quantitative histopathological criteria in predicting the giant bone cell tumors's grading]. / Criterii histopatologice cantitative de apreciere a încadrarii tumorilor osoase cu celule gigante.

The giant bone cell tumour is a benign osteolitical tumour of spongious tissue. The evolving characters claimed the identification of the high-risk tumours for improving the prognostics. There were used samples of primitive tumours from 69 patients, paraffin included and coloured H&E and then examined with interactive digital video software. The quantitative standard measurements of giant cells (aria, perimeter and diameter), stereology (percentual volumes of cells, blood vessels and stroma) and proliferative activity assessment were made on the representative sections. The dimensions of the giant cells are higher in the Grade I and are lower in Grade II and III, with a dimensional variability. Bone giant cell tumours with mitotic rate less 1/mm2 were exclusively nonaggressive. Quantitative studies reveal the morphopathological changing specific for the grading and evolving forms of giant bone cell tumours. The stereology and mitotic activity index are essential predictive indicators and may be used in early detection of agressiveness and malignancy.

Relationship between histologic grade and cytofluorometric cellular DNA and RNA content in primary bone tumors.

The diagnosis and grading of bone tumors remains a challenging problem. We studied the relationship between histologic grade and cytofluorometric cellular DNA and RNA content in 108 primary bone tumors. The data included DNA ploidy, mean DNA content (MDC), S-phase fraction (SPF), mean RNA content (MRC) and RNA/DNA ratio (RDR; MRC/MDC) which represents the RNA content normalized for the DNA content. Benign tumors had a diploid stem line with low MDC (mean; 1.04), low SPF (0.9), high MRC (2.41) and high RDR (2.31). Giant cell tumors of bone, which are locally aggressive benign tumors, showed diploidy with relatively higher MDC (1.07, p < 0.01) and SPF (2.6, p < 0.01) and lower MRC (1.81, p < 0.01) and RDR (1.69, p < 0.01). Similar results were obtained in low-grade sarcomas. In high-grade sarcomas, the data depended on the histologic findings. Pleomorphic sarcomas such as osteosarcomas revealed aneuploidy with remarkably higher MDC (1.70 in osteosarcomas, p < 0.01) and SPF (6.5, p < 0.01), but lower RDR (1.70, p < 0.01). In contrast, small cell sarcomas, such as Ewing's sarcomas, showed diploidy with low MDC (1.11 in Ewing's sarcomas, N.S.) and SPF (2.5, p < 0.01) and extremely low RDR (1.34, p < 0.01). The RDR value was higher in well-differentiated tumors than in primitive tumors, rendering it useful in grading bone tumors with a diploid stem line. By combining the RDR value with the MDC value, 96% of diploid sarcomas could be distinguished from benign tumors. These results indicate that cellular DNA and RNA content analysis may be of value in assessing the malignant potential of diploid as well as aneuploid bone sarcomas.

Treatment of stages 2 and 3 giant-cell tumor.

During the period from August 1986 to August 1992, we treated 23 patients with giant cell tumors stage 2 or 3, according to the classification by Campanacci et al.. We analyzed the therapeutic options, complications, local recurrence rate, and functional results after a mean follow-up of 56 months (range 31-89 months). Intralesional resections were performed in 15 and wide resections in 8 patients. The majority of intralesional resections were performed for stage 2 tumors and the majority of en-bloc resections for stage 3 tumors. The overall local recurrence rate was 8.7%, but we observed local recurrence only in intralesional resections. Our experiences suggest that a subtle surgical technique with respect to oncological requirements is the most important element in the avoidance of local recurrence. Stage 2 tumors associated with weight-bearing anatomical structures should be treated with intralesional curettage and bone cement. Stage 3 tumors are limited as to their surgical options and are determined in some cases by their localization and the degree of bone destruction. Wide resections should be reserved mainly for stage 3 tumors.

Giant cell tumor of the foot phalanges in children: a case report.

Giant cell tumor of the bone is infrequent in the phalanges of the toes and is extremely rare in children. A case of giant cell tumor of the proximal phalanx of the big toe on the left foot in a 12-year-old boy is reported. The tumor was treated by partial resection of the phalanx and repair of the osseous defect with an autologous iliac crest graft. A literature review showed few cases of giant cell tumor at this site.

Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases.

We studied the value of histopathological grading in determining the prognosis of giant cell tumour (osteoclastoma) and the rate of local and distant recurrences in a consecutive series of 31 patients. We found that grading had no prognostic value. Eighteen patients were treated by intralesional curettage and 13 by wide excision. Ten patients (56%), who were all treated by curettage, had local recurrences, but none of the tumours with wide excision recurred (p < 0.05). Five (16%) had local recurrences as well as distant metastases, usually to the lungs. The recurrences developed later than an average of 12 years after primary treatment in 3 patients. Wide excision and life-long follow up should be considered in the management of these tumours.

Tumores óseos benignos. Revisión morfológica y clasificación (1978-1991)

En este estudio retrospectivo (1978-1991) se examinaron 177 tumores oseos benignos, casuística recogida en el servicio de patología del Hospital Carlos Andrade Marín de la ciudad de Quito (H.C.A.M). La distribución por histogénesis demostró que los tumores formadores de tejido cartilaginosos (77 por cientos) son las neoplasias más frecuentemente reportadas. Nuestra serie reveló porcentajes de presentación similares entre osteocondroma (38 por ciento y condroma (36 por ciento); el hemangioma representó un 8 por ciento de la patología estudiada. El análisis comparativo entre la patología tumoral benigna y maligna mostró en esta serie mayor proporción de los primeros en una relación 1.5: 1. La frecuencia de presentación de las restantes neoplasias óseas benignas y su perfil epidemiológico en cuanto a edad, sexo y localización principal concuerdan con los reportes de estadísticas mundiales...