This report describes a pathologic fracture of the patella secondary to destruction by a giant cell tumour. Diagnosis was made after non-union of a patella fracture, with osteolysis and soft tissue invasion. Delayed union of any fracture should raise the possibility of an underlying pathologic process.

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Pathologic fracture of a giant cell tumour of the patella

Giant cell tumor (GCT) of bone is one type of giant cell-rich lesion of bone. This benign mesenchymal tumor has characteristic multinuclear giant cells. Mononuclear stromal cells are the physiologically active and diagnostic cell type. Most GCTs are located in the epiphyseal regions of long bones. The axial skeleton-primarily the sacrum-is a secondary site of involvement. Most patients present with pain, swelling, joint effusion, and disability in the third and fourth decades of life. Imaging studies are important for tumor staging and radiographic grading. Typically, these clinically active but slow-growing tumors are confined to bone, with relatively well-defined radiographic borders. Monostotic disease is most common. Metastatic spread to the lungs is rare. Extended intralesional curettage with or without adjuvant therapy is the primary treatment choice. Local recurrence is seen in ≤ 20% of cases, and a second local intralesional procedure is typically sufficient in cases that are detected early. Medical therapies include diphosphonates and denosumab. Denosumab has been approved for use in osteoporosis as well as breast and prostate cancer metastatic to bone. Medical therapy and radiotherapy can alter the management of GCT of bone, especially in multifocal disease, local recurrences, and bulky central/axial disease.

background

Giant cell tumor of bone.

Nine cases of extruded cervical disc herniation (7 with radiculopathy, 2 with acute myeloradiculopathy) were treated by radical anterior microdiscectomy, with opening of the posterior longitudinal ligament, removal of the extruded peridural disc material, bilateral resection of the posterior part of the uncovertebral joints; in 6 cases surgery was completed with Smith-Robinson intersomatic fusion In all of the cases symptoms rapidly regressed, with considerable neurological recovery There were no major complications in any of the cases, and 2-5 years after surgery results were evaluated as excellent in 7 cases and good in 2 The use of the operating microscope allows for removal of extruded disc herniations under magnification, in a bloodless surgical field and with no manipulation of the nervous structures Because of these features, this method is preferred to traditional posterior surgery and anterior surgery without magnification

Extruded cervical disc herniation: treatment with anterior microdiscectomy.

Curettage of giant cell tumor of bone. Introduction - material and methods

Giant cell tumor of bone (GCTB) is an osteolytic, usually benign neoplasm characterized by infiltration with osteoclast-like giant cells, and the osteoclast differentiation factor receptor activator of nuclear factor kappa-B ligand (RANKL) is heavily involved in its pathogenesis. Denosumab belongs to a new class of drugs that inhibit RANKL. Prior to denosumab, multimodality treatment in refractory, recurrent and metastatic GCTB has shown variable results. Recent phase II data have demonstrated denosumab's activity with regard to disease and symptom control, without significant adverse effects. On the basis of this data, the FDA approved denosumab for the treatment of patients whose GCTB is unresectable, or when surgery is likely to result in severe morbidity. Ongoing questions remain, including the optimal scheduling, patient selection, use in the adjuvant setting and long-term toxicity concerns.

Denosumab: a new treatment option for giant cell tumor of bone.

We report a 38-year old man with a giant-cell tumor in a rare site, the patella. Primary patellar neoplasms are highly unusual. According to a survey by the Bone and Soft Tissue Tumor Committee of the Japanese Orthopaedic Association, of more than 2,126 giant-cell tumors of bone reported since 1972, only 22 were primary patellar neoplasms. We present a case of this rare entity along with its clinical and radiographic features. The first clinical symptom was anterior knee pain. Though anterior knee pain has numerous and varied causes, it is necessary to consider patellar bone tumors in the differential diagnosis.

https://ousar.lib.okayama-u.ac.jp/files/public/4/48084/20160528090332581031/66_1_73.pdf

Pathologic fracture of a giant cell tumour of the patella

References

Giant cell tumor of bone.

Extruded cervical disc herniation: treatment with anterior microdiscectomy.

Curettage of giant cell tumor of bone. Introduction - material and methods

Denosumab: a new treatment option for giant cell tumor of bone.

Giant-cell Tumor of the Patella