GIANT CELL TUMOR OF THE SACRUM: RADIOLOGICAL AND MORPHOLOGICAL CHARACTERISTICS

DOI: https://doi.org/10.29296/24999490-2019-04-08

Yu.A. Stepanova, A.A. Gritskevich, A.F. Kharazov, M.V. Morozova, D.V. Kalinin, N.A. Karelskaya, A.B. Varava A.V. Vishnevsky National Medical Research Center of Surgery, B. Serpukhovskaya, 27, Moscow, 117997, Russian Federation Е-mail: stepanovaua@mail.ru

Introduction. Giant cell tumors (GCT) of bones are benign tumors with the potential for the aggressive course and ability to metastasize. GCT accounts for approximately 5% of all primary bone tumors. Materials and methods. The clinical case of the patient L., 35 years old, with a giant cell tumor of the sacrum is presented. During the preoperative examination according to ultrasound, MSCT and MRI, the patient showed the destruction of the cortical sacrum along the internal contour; a large, extra organized in the form of a rounded shape with clear, uneven contours, cystic-solid structure proceeded from this zone. The lesion was hypervascular, with large lacunae filled with blood. The difficulties in the diagnosis of this lesion and the possibilities of surgical treatment are shown. Establishing diagnosis was possible only according to histological and immunohistochemical studies. Results and discussion. The histogenesis of GCT is still unknown and in the International Histological Classification of Bone Tumors is referred to as an independent rubric – tumors of unknown origin. The GCT tissue is represented by 3 cell lines: stromal fibroblast-like, mononuclear macrophages, giant multinucleated cells. Truly tumorous of them are only stromal fibroblast-like cells, the cells of other lines play an important role in the manifestation of the characteristic properties of GCT. Thus, histological examination reveals a complex of characteristic pathological changes in GCT, which, however, can be differently combined and have different severity even in within one large focus, which often makes differential histological diagnosis difficult, especially with a small unrepresentative histo- or cytobioptate. Therefore, it is necessary to perform an immunohistochemical study. Conclusion. Localization of GCT in the pelvis and in the sacrum is extremely rare. However, although only 6% of GCTs are found in the sacrum, these tumors are the second most common type of primary tumor of the sacrum. Due to the extremely rare occurrence of this tumor, despite the criteria for identifying them according to MSCT and MRI, which are quite clearly described in the literature, erroneous preoperative differentiation of this tumor is possible due to the lack of general surgeons, gynecologists and urologists in these departments, with a larger share the chances of such patients getting wary of detecting of GCT of the sacrum
Keywords: 
giant cell tumor of the sacrum, clinical and morphological characteristics, ultrasound, MSCT, MRI, angiography, endovascular occlusion of afferent vessels, surgical treatment

Список литературы: 
  1. Sobti A., Agrawal P., Agarwala S., Agarwal M. Giant Cell Tumor of Bone – An Overview. Archives of Bone and Joint Surgery. 2016; 4 (1): 2–9.
  2. Григоровский В.В. Гигантоклеточная опухоль кости: морфогенез, клинико-морфологические особенности, дифференциальная диагностика, подходы к лечению. Онкология. 2012; 14 (1): 64–76.
  3. [Grigorovsky V.V. Giant cell tumor of bone: morphogenesis, clinical and morphological features, differential diagnosis, treatment approaches. Oncology. 2012; 14 (1): 64–76 (in Russian)]
  4. Cooper S.A., Trovers B. Surgical Assays. London: Cox and Son and Longmans, 1818; 195.
  5. Kim Y., Nizami S., Goto H., Lee F.Y. Modern Interpretation of Giant Cell Tumor of Bone: Predominantly Osteoclastogenic Stromal Tumor. Clinics in Orthopedic Surgery. 2012; 4 (2): 107–16. https://doi.org/10.4055/cios.2012.4.2.107.
  6. Lebert H. Physiologie pathologieque ou reserches clin-iqiues, experimentales et microscopiques. Sur l'inflammation, latuberculisation, les tumeur la formation du cal. Paris: J.B. Baillière. 1845.
  7. Nelaton E. Tumeurs benigns des os ou tumeurs a myeloplaxes. Paris, 1860; 364.
  8. Virchow R. in: Die krankhaften Geschwulste. 2 Bd. 1st ed., Berlin; August Hirschwald. 1863; 543.
  9. Gross S.W. Sarcoma of the long bones; based upon a study of one hundred and sixty-five cases. Am. J. M. Sc. 1879; 78: 17–57.
  10. Bloodgood J.C. II. The conservative treatment of giant-cell sarcoma, with the study of bone transplantation. Ann Surg. 1912; 56 (2): 210–39.
  11. Русаков А.В. Патологическая анатомия болезней костной системы. Введение в физиологию и патологию костной ткани. В кн.: Руководство по патологической анатомии. Под ред. Т.П. Виноградовой. М.: МЕДГИЗ, 1959; 381–95.
  12. [Rusakov A.V. Pathological anatomy of diseases of the skeletal system. Introduction to the physiology and pathology of bone tissue. In book: Guide to pathological anatomy. Ed. T.P. Vinogradova. M.: MEDGIZ, 1959; 381–95 (in Russian)]
  13. López-Pousa A., Martin Broto J., Garrido T., Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol. 2015; 17 (6): 419–30. https://doi.org/10.1007/s12094-014-1268-5
  14. Enneking W.F. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986; 204: 9–24.
  15. Campanacci M., Baldini N., Boriani S., Sudanese A. Giant-cell tumor of bone. J. Bone Joint Surg Am. 1987; 69 (1): 106–14.
  16. Пальцев М.А., Аничков Н.М. Атлас патологии опухолей человека. М.: Медицина, 2005; 159–61.
  17. [Paltsev M.A., Anichkov N.M. Atlas of human tumor pathology. M.: Medicine, 2005; 159–61 (in Russian)]
  18. Колесов A.A. Новообразования лицевого скелета. М.: Медицина, 1969; 169.
  19. [Kolesov A.A. Neoplasms of the facial skeleton. M.: Medicine, 1969; 169 (in Russian)]
  20. Нейштадт Э.Л., Маркочев А.Б.. Опухоли и опухолеподобные заболевания кости. СПб.: Фолиант, 2007; 139–41.
  21. [Neystadt E.L., Markochev A.B. Tumors and tumor-like bone diseases. SPb.: Foliant, 2007; 139–41 (in Russian)]
  22. Mirra J.M. Bone tumors. – Philadelphia: Lea & Febiger, 1989; 1831.
  23. Topouchian V., Mazda K., Hamze B., Laredo J.D., Penneçot G.F. Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology. 2004; 232 (2): 522–6. https://doi.org/10.1148/radiol.2322031157
  24. Jaffe H.L., Lichtenstein L., Portis P.B. Giant-cell tumour of bone: Its pathologic appearance, grading, supposed variants and treatment. Arch. Path. 1940; 30 (5): 993–1031.
  25. Netherlands Committee on Bone Tumours: Radiological Atlas of Bone Tumours. Vol. 1. The Hague, Mouton & Co. Baltimore, Md.: Williams & Williams Co, 1966.
  26. Baak J.P., Oort J.A. A Manual of Morphometry in Diagnostic Pathology. Berlin, Heidelberg, New-York, Tokyo: Springer Science & Business Media, 2012; 208.
  27. Schajowicz F. Tumors and Tumorlike Lesions of Bone. Pathology. Radiology and Treatment. Berlin: Springer, 1994; 649.
  28. Dorfman H.D., Czerniak B. Bone Tumors. St Louis: Mosby, 1998; 1261.
  29. Reid R., Banerjee S.S., Sciot R. Giant cell tumour. In: WHO Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon: IARC Press, 2002; 310–2.
  30. Unni K.K., Inwards C.Y., Bridge J.A., Kindblom L.G., Wold L.E. Tumors of the Bones and Joints. AFIP Atlas of Tumor Pathology. 4-th Ser., Fasc. 2. Silver Spring: ARP Press, 2005; 399.
  31. Зацепин С.Т. Костная патология взрослых. Руководство для врачей. М.: Медицина, 2001; 266–72.
  32. [Zatsepin S.T. Bone pathology of adults. A guide for doctors. M.: Medicine, 2001; 266–72 (in Russian)]
  33. Bertoni F, Present D, Sudanese A, et al. Giant-Cell Tumour of Bone with Pulmonary Metastases. Six Case Reports and a Review of the Literature. Clin Orthop Rel Res. 1988; 237: 275–85.
  34. Sanjay B.K., Frassica F.J., Frassica D.A., Unni K.K., McLeod R.A., Sim F.H. Treatment of giant-cell tumor of the pelvis. J. Bone Joint Surg Am. 1993; 75 (10): 1466–75.
  35. Bertoni F., Present D., Enneking W.F. Giant-Cell Tumour of Bone with Pulmonary Metastases. J. Bone Goint Surg. 1985; 67-A (6): 890–900.
  36. Siebenrock K.A., Unni K.K., Rock M.G. Giant-cell tumor of bone metastasising to the lungs. A long-term follow-up. J. Bone Joint Surg 1998; 80-B (1): 43–7.
  37. Виноградова Т.П. Опухоли костей. М.: Медицина, 1973; 330.
  38. [Vinogradova T.P. Bone tumors. M.: Medicine, 1973; 330 (in Russian)]
  39. Szendröi M. Giant-Cell Tumour of Bone. J. Bone Joint Surg. 2004; 86-B (1): 5–12.
  40. Mondal A., Kundu R., Misra D.K. Factors regulating the metastatic potential of benign giant cell tumour of bone – study of an unusual case with short review of literature. Ind J. Pathol Microbiol. 2001; 44 (1): 31–5.
  41. Проценко В.В. Нові підходи до лікування хворих на гігантоклітинну пухлину кістки. Автореф. дис. ... докт. мед наук. Київ, 2010; 38.
  42. [Protsenko V.V. New pidhodi to lіkuvannya hvoryh on gigantoklіtinnu puhlinu kistki. Author. dis. ... dokt. med. scie. Kiev, 2010; 38 (in Russian)]
  43. Зайцева М.Ю., Засульский Ф.Ю. Морфологические особенности вариантов строения гигантоклеточной опухоли костей. Травматол ортопед России. 2010; 1: 139–46.
  44. [Zaytseva M.Yu., Zasulsky F.Yu. Morphological features of the variants of the structure of giant cell bone tumors. Travmatol orthopedic Russia. 2010; 1: 139–46 (in Russian)]
  45. Демичев Н.П., Иванов В.Н. Дифференциальная диагностика гигантоклеточных опухолей костей. Ортопед травматол. 1991; 6: 51–8.
  46. [Demichev N.P., Ivanov V.N. Differential diagnosis of giant-cell bone tumors. Orthopedist travmatol. 1991; 6: 51–8 (in Russian)]
  47. Vult von Steyern F., Bauer H.C.F., Trovik C., Kivioja A., Bergh P., Holmberg Jörgensen P., Follerås G., Rydholm A. Treatment of local recurrences of giant-cell tumour in long bones after curettage and cementing. J. Bone Joint Surg. 2006; 88-B (4): 531–5.
  48. Arbeitsgemeinschaft Knochentumoren, Becker W.T., Dohle J., Bernd L., Braun A., Cserhati M., Enderle A., Hovy L., Matejovsky Z., Szendroi M., Trieb K., Tunn P.U. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J. Bone Joint Surg Am. 2008; 90 (5): 1060–7. https://doi.org/10.2106/JBJS.D.02771.
  49. Werner M. Giant cell tumour of bone: morphological, biological and histogenetical aspects. International Orthopaedics. 2006; 30 (6): 484–9. https://doi.org/10.1007/s00264-006-0215-7.
  50. Hoeffel J.C., Galloy M.A., Grignon Y., Chastagner P., Floquet J., Mainard L., Kadiri R. Giant cell tumor of bone in children and adolescents. Rev Rhum Engl Ed. 1996; 63 (9): 618–23.
  51. Shih H.N., Hsu R.W., Sim F.H. Excision curettage and allografting of giant cell tumor. World J Surg. 1998; 22 (5): 432–7.
  52. Bridge J.A., Neff J.R., Mouron B.J. Giant cell tumor of bone. Chromosomal analysis of 48 specimens and review of the literature. Cancer Genet Cytogenet. 1992; 58 (1): 2–13.
  53. Osaka S., Toriyama S. Surgical treatment of giant cell tumors of the pelvis. Clin Orthop Relat Res. 1987; 222 (3): 123–31.
  54. Leggon R.E., Zlotecki R., Reith J., Scarborough M.T. Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the literature. Clin. Orthop Relat Res. 2004; 423: 196–207.
  55. Martin C., McCarthy E.F. Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature. The Iowa Orthopaedic J. 2010; 30: 69–75.
  56. Zheng K., Yu X., Hu Y., Wang Z., Wu S., Ye Z. Surgical treatment for pelvic giant cell tumor: a multi-center study. World Journal of Surgical Oncology. 2016; 14: 104. https://doi.org/10.1186/s12957-016-0862-0.
  57. Turcotte R.E., Sim F.H., Unni K.K. Giant cell tumor of the sacrum. Clin Orthop Relat Res. 1993; 291: 215–21.
  58. Bloem J.L., Reidsma I.I. Bone and soft tissue tumors of hip and pelvis. Eur. J. Radiol. 2012; 81: 3793–801. https://doi.org/10.1016/j.ejrad.2011.03.101
  59. Синюков П.А. Гигантоклеточная опухоль костей (клиника, диагностика, лечение): Дис… канд. мед. наук. М., 1979; 248.
  60. [Sinyukov P.A. Giant cell tumor of the bones (clinic, diagnosis, treatment): Dis ... cand. med. scie. M., 1979; 248 (in Russian)]
  61. Лукьянченко А.Б. Возможности компьютерной томографии в распознавании опухолей опорно-двигательного аппарата. Дис. … докт. мед. наук. М., 1990; 294.
  62. [Lukyanchenko A.B. Possibilities of computed tomography in recognition of tumors of the musculoskeletal system. Dis. ... dokt. med. scie. M., 1990; 294 (in Russian)]
  63. Stacy G.S., Peabody T.D., Dixon L.B. Mimics on Radiography of Giant Cell tumor of Bone. AJR. 2003; 181: 1589. https://doi.org/10.2214/ajr.181.6.1811583
  64. Yu H., Shi R., Peng Z.G., Yu B.H., Cui J.L. Primary malignancy in giant cell tumor of thoracic vertebrae: A case report. Medicine. 2018; 97 (28): e11484. https://doi.org/10.1097/MD.0000000000011484
  65. Freeman J.L., Oushy S., Schowinsky J., Sillau S., Youssef A.S. Invasive giant cell tumor of the lateral skull base: a systematic review, meta-analysis, and case illustration. World Neurosurg. 2016; 96: 47–57. https://doi.org/10.1016/j.wneu.2016.05.086;
  66. Gamboa N.T., Ronna B., Gamboa C.T., Palmer C.A., Park M.S., Gurgel R.K., Couldwell W.T., Kalani M. Giant Cell Tumor of the Lateral Skull Base: Diagnostic and Management Options. Journal of neurological surgery reports. 2018; 79 (2): 41–54. https://doi.org/10.1055/s-0038-1645885
  67. Лукьянченко А.Б., Алиев М.Д., Соловьев Ю.Н., Медведева Б.М., Мусаев Э.Р. Гигантоклеточная опухоль кости: особенности проявлений при магнитно-резонансной томографии. Вестник РОНЦ им. Н. Н. Блохина РАМН. 2007; 18 (3): 50–5.
  68. [Lukyanchenko A.B., Aliyev M.D., Soloviev Yu.N., Medvedkova B.M., Musayev E.R. Giant-cell bone tumor: magnetic resonance imaging patterns. Bulletin RCRC them. N.N. Blokhin RAMS. 2007; 18 (3): 50–5 (in Russian)]