PMC8184137_01
Radiological images of the proximal right tibia. Radiograph (A and B) and CT (C and D) showed osteolytic bony destruction. SPECT (E) images were negative for metastatic lesions.
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Radiography and computed tomography (CT) revealed eccentric, well-defined osteolytic destruction in the proximal metaphysis of the right tibia, suggesting the imaging diagnosis of GCTB (Campanacci grade II) (Figure 1A-D). Chest CT scan (Figure 2A) and single-photon emission CT (Figure 1E) did not reveal any metastatic lesions.An open biopsy from a lateral incision was performed thereafter, and pathological results showed multinucleated osteoclast giant cells with a large number of nuclei scattered among mononuclear tumor cells, which confirmed the diagnosis of a benign GCTB (Figure 3A).
CT of the chest. (A) Local recurrence but without pulmonary metastasis. (B) Multiple pulmonary metastases were found and denosumab initiated. (C) 4 months after denosumab therapy. (D) 3 months after denosumab and apatinib therapy. (E) 15 months after denosumab and apatinib therapy. (F) 33 months after denosumab and apatinib therapy.
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Chest CT scan (Figure 2A) and single-photon emission CT (Figure 1E) did not reveal any metastatic lesions.An open biopsy from a lateral incision was performed thereafter, and pathological results showed multinucleated osteoclast giant cells with a large number of nuclei scattered among mononuclear tumor cells, which confirmed the diagnosis of a benign GCTB (Figure 3A). The lung CT scans were evaluated by experienced musculoskeletal surgeons and radiologists who verified more than 100 pulmonary nodules in both lungs (Figure 2B). The lung CT scan showed the metastatic nodules had increased in size and number, indicating progression of disease (Figure 2C). After three months of denosumab and apatinib treatment, the patient showed noticeable improvement of hemoptysis and visibly reduced tumor size (Figure 2D). The largest one had greatly decreased in size from 12.2x8.5 cm to 3.5x1.5 cm (Figure 2E and F), and the tumor volume shrinkage rate was 95%.
Pathological features of the local lesions. (A) High-magnification observation of numerous multinucleated giant cells (Hematoxylin and eosin stain, 200x). (B) High-magnification observation of local recurrence but without sarcomatous change (Hematoxylin and eosin stain, 200x). (C) Presence of multinucleated giant cells indicates a recurrence of GCTB (Immunohistochemical staining, 100x). (D) Expression of VEGFR-2 as assessed by immunohistochemistry (Immunohistochemical staining, 100x).
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Chest CT scan (Figure 2A) and single-photon emission CT (Figure 1E) did not reveal any metastatic lesions.An open biopsy from a lateral incision was performed thereafter, and pathological results showed multinucleated osteoclast giant cells with a large number of nuclei scattered among mononuclear tumor cells, which confirmed the diagnosis of a benign GCTB (Figure 3A). Postoperative pathologic features and presence of multinucleated giant cells were detected by immunohistochemical (IHC) staining with a monoclonal antibody against CD68 (PG-M1) and were similar to that of the pre-surgical specimens, revealing the recurrence of GCTB without malignant transformation (Figure 3B and C). The IHC staining also identified tumor cells positive for VEGFR-2 (Figure 3D).
Radiological images of the proximal right tibia. Radiograph (A and B), postoperative films following the curettage and packing with cement; Radiograph (C and D), and CT (E, bone window) showed a circumferential lucency around the bone cement and local cortical bone destruction. MRI (F, T1-weight) showed a soft tissue mass.
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The remaining cavity was then packed with cement (Figure 4A and B). CT, and magnetic resonance imaging revealed local cortical bone destruction with soft tissue extension (Figure 4C-F) which indicated Campanacci grade III. Chest CT showed no evidence of metastases.