Benign, Multicentric, Recurrent and Metastasizing Giant Cell Tumor of Bone: Review of Literature with Role of Immunohistochemistry in Determining Prognosis
Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 7
Abstract
Objective: Giant cell tumor (GCT) represents around 4-5% of all primary bone tumors. The purpose of this article is to report this unusual case of benign metastasizing GCT and simultaneously emphasize on the role of immunomarkers in predicting the aggressive behaviour of such lesions and a brief review of literature along with the proposed management strategies in these patients. Case: We report a rare case of benign GCT in a 24 years old Asian female. Initial presentation of the disease was 9 years back with involvement of lower end of right humerus; development of a multicentric lesion in right 4th metacarpal 2 years after the humerus lesion, and elbow tumor recurrence after 6 years. In all instances en-block tumor resection with bone grafting was performed. Now, the patient presented to us with recurrent tumor at both sites; radiological types 2&3 lesions, local lymphatic involvement and metastatic nodules in bilateral upper pulmonary lobes. Right shoulder disarticulation with biopsy of pulmonary metastases was performed. Histopathology revealed a benign GCT morphology. Immunohistochemistry for Ki67 showed higher expression, while p53 showed negative staining. Conclusion: GCT is still one of the most obscure and intensively examined tumors of bone. Histology does not predict the clinical outcome & few studies have been performed to identify new markers predictive of aggressive behaviour. A relationship between increased proliferative rate (higher Ki67 expression) and possibility of recurrence has been found. Few pilot studies have demonstrated correlation of p53 mutation with local recurrence and malignant transformation.
Authors and Affiliations
Anshu Jain
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