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'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab.

Vaishya R, Agarwal AK, Vijay V - Cureus (2015)

Bottom Line: Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible.Denosumab may play a crucial role, especially in the management of such difficult lesions.We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedics, indraprastha Apollo Hospital.

ABSTRACT
Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

No MeSH data available.


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Post-denosumab histopathological picture (Case #1) showing osseo-fibrous conversion of the lesion with disappearance of multinucleated giant cells.
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FIG4: Post-denosumab histopathological picture (Case #1) showing osseo-fibrous conversion of the lesion with disappearance of multinucleated giant cells.

Mentions: Histopathological examination showed fragments of dense fibro-osseous tissue, comprised of abundant osteoid separated by mildly cellular fibrous tissue. Focal calcification and islands of woven bone were also present at places. These features were consistent with effects of denosumab therapy in a known case of GCTB (Figure 4).


'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab.

Vaishya R, Agarwal AK, Vijay V - Cureus (2015)

Post-denosumab histopathological picture (Case #1) showing osseo-fibrous conversion of the lesion with disappearance of multinucleated giant cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524749&req=5

FIG4: Post-denosumab histopathological picture (Case #1) showing osseo-fibrous conversion of the lesion with disappearance of multinucleated giant cells.
Mentions: Histopathological examination showed fragments of dense fibro-osseous tissue, comprised of abundant osteoid separated by mildly cellular fibrous tissue. Focal calcification and islands of woven bone were also present at places. These features were consistent with effects of denosumab therapy in a known case of GCTB (Figure 4).

Bottom Line: Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible.Denosumab may play a crucial role, especially in the management of such difficult lesions.We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedics, indraprastha Apollo Hospital.

ABSTRACT
Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

No MeSH data available.


Related in: MedlinePlus