Tumor de células gigantes de hueso: serie de casos durante 64 años en un único centro
Resumen
Introducción: el tumor de células gigantes de hueso es una lesión localmente agresiva que tiende a la recurrencia local y ocasionalmente presenta metástasis a distancia. Objetivo: describir la presentación clínica e histológica y la frecuencia relativa del tumor de células gigantes de hueso en un único centro, Medellín-Colombia. Materiales y métodos: estudio descriptivo; se revisaron todos los casos diagnosticados como tumor de células gigantes de hueso entre 1944 y 2008 en el Departamento de Patología de la Universidad de Antioquia, y para cada uno se revisaron las principales características clínicas e histológicas. Resultados: entre 1944 y 2008 se diagnosticaron 2.185 tumores óseos; de éstos, 302 tenían diagnóstico de tumor de células gigantes del hueso y se confirmó el diagnóstico en 117, correspondiente al 5,3% de todos los tumores óseos. La relación mujer: hombre fue de 1,1:1. Las localizaciones más frecuentes fueron fémur distal (19,7%), tibia proximal (25,6%), manos y pies (11,1%), radio distal (9,4%) y húmero proximal (8,5%). Las características histológicas atípicas que se observaron fueron áreas fusocelulares, invasión de tejidos blandos, necrosis, hemorragia, áreas de quiste óseo aneurismático secundario, áreas de células mononucleadas con escasas células gigantes y formación de osteoide dentro del tumor. Conclusión: el tumor de células gigantes del hueso es una lesión heterogénea en su presentación clínica e histológica, que se puede localizar en casi cualquier hueso. La frecuencia relativa observada en el presente estudio es similar a la de otros grandes centros del mundo.
Descargas
Referencias bibliográficas
Karpik M. Giant Cell Tumor (tumor gigantocellularis, osteoclastoma) - epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil 2010; 12: 207-215.
Dorfman HD, Czerniak B. Bone tumors. 1998. St. Louis. Mosby. pp 559-606.
Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, et al. Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 2012; 94: 461-467.
https://doi.org/10.2106/JBJS.J.01922
Kremen TJ Jr, Bernthal NM, Eckardt MA, Eckardt JJ. Giant cell tumor of bone: are we stratifying results appropriately? Clin Orthop Relat Res 2012; 470: 677-683.
https://doi.org/10.1007/s11999-011-2172-8
Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008; 134: 969-978.
https://doi.org/10.1007/s00432-008-0370-x
Cheng JC, Johnston JO. Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res 1997; 338: 205-214.
https://doi.org/10.1097/00003086-199705000-00027
Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol 1992; 158: 331-334.
https://doi.org/10.2214/ajr.158.2.1729794
Reid R, Banerjee SS, Sciot R. Giant Cell Tumor. En. Fletcher DM, Unni KK, Mertens F (Eds.). WHO Classification of Tumors. Pathology & Genetics. Tumors of Soft Tissue and Bone. 2002. Lyon, France. IARCPress. pp 310-312.
Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006; 37: 35-51.
https://doi.org/10.1016/j.ocl.2005.08.005
Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant-cell tumor of bone: analysis of two hundred and eight cases in Chines patients. J Bone Joint Surg 1982; 64A: 755-761.
https://doi.org/10.2106/00004623-198264050-00015
Ghert M, Simunovic N, Cowan RW, Colterjohn N, Singh G. Properties of the stromal cell in giant cell tumor of bone. Clin Orthop Relat Res 2007; 459: 8-13.
https://doi.org/10.1097/BLO.0b013e31804856a1
Husain J, Jarial MS, Muller J, Kocoshis TA. Giant-cell tumor of bone arising from the falx cerebri. A case report. J Submicrosc Cytol Pathol 2002; 34: 67-76.
Masui F, Ushigome S, Fujii K. Giant cell tumor of bone: an immunohistochemical comparative study. Pathol Int 1998; 48: 355-361.
https://doi.org/10.1111/j.1440-1827.1998.tb03918.x
Salerno M, Avnet S, Alberghini M, Giunti A, Baldini N. Histogenetic characterization of giant cell tumor of bone. Clin Orthop Relat Res 2008; 466: 2081-2091.
https://doi.org/10.1007/s11999-008-0327-z
Wülling M, Delling G, Kaiser E. The origin of the neoplastic stromal cell in giant cell tumor of bone. Hum Pathol 2003; 34: 983-993.
https://doi.org/10.1053/S0046-8177(03)00413-1
Huang L, Teng XY, Cheng YY, Lee KM, Kumta SM. Expression of preosteoblast markers and Cbfa-1 and Osterix gene transcripts in stromal tumour cells of giant cell tumour of bone. Bone 2004; 34: 393-401.
https://doi.org/10.1016/j.bone.2003.10.013
Cowan RW, Singh G. Giant cell tumor of bone: A basic science perspective. Bone. 2012; 52: 238-246.
https://doi.org/10.1016/j.bone.2012.10.002
Murata A, Fujita T, Kawahara N, Tsuchiya H, Tomita K. Osteoblast lineage properties in giant cell tumors of bone. J Orthop Sci 2005; 10: 581-588.
https://doi.org/10.1007/s00776-005-0946-0
Kim Y, Nizami S, Goto H, Lee FY. Modern interpretation of giant cell tumor of bone: predominantly osteoclastogenic stromal tumor. Clin Orthop Surg 2012; 4: 107-116.
https://doi.org/10.4055/cios.2012.4.2.107
Goldring SR, Roelke MS, Petrison KK, Bhan AK. Human giant cell tumors of bone identification and characterization of cell types. J Clin Invest 1987; 79: 483-491.
https://doi.org/10.1172/JCI112838
Byers VS, Levin AS, Johnston JO, Hackett AJ. Quantitative immunofluorescence studies of the tumor antigen-bearing cell in giant cell tumor of bone and osteogenic sarcoma. Cancer Res 1975; 35: 2520-2531.
Gorunova L, Vult von Steyern F, Storlazzi CT, Bjerkehagen B, Follerås G, Heim S, et al. Cytogenetic analysis of 101 giant cell tumors of bone: nonrandom patterns of telomeric associations and other structural aberrations. Genes Chromosomes Cancer 2009; 48: 583-602.
https://doi.org/10.1002/gcc.20667
Bardi G, Pandis N, Mandahl N, Heim S, Sfikas K, Willén H, et al. Chromosomal abnormalities in giant cell tumors of bone. Cancer Genet Cytogenet 1991; 57: 161-167.
https://doi.org/10.1016/0165-4608(91)90147-M
Bridge JA, Neff JR, Bhatia PS, Sanger WG, Murphey MD. Cytogenetic findings and biologic behavior of giant cell tumors of bone. Cancer 1990; 65: 2697-2703.
https://doi.org/10.1002/1097-0142(19900615)65:12<2697::AID-CNCR2820651217>3.0.CO;2-3
Moskovszky L, Szuhai K, Krenács T, Hogendoorn PC, Szendröi M, Benassi MS, et al. Genomic instability in giant cell tumor of bone. A study of 52 cases using DNA ploidy, relocalization FISH, and array-CGH analysis. Genes Chromosomes Cancer 2009; 48: 468-479.
https://doi.org/10.1002/gcc.20656
Atkins GJ, Kostakis P, Vincent C, Farrugia AN, Houchins JP, Findlay DM, et al. RANK expression as a cell surface marker of human osteoclast precursors in peripheral blood, bone marrow, and giant cell tumors of bone. J Bone Miner Res 2006; 21: 1339-1349.
https://doi.org/10.1359/jbmr.060604
Roux S, Amazit L, Meduri G, Guiochon-Mantel A, Milgrom E, Mariette X. RANK (receptor activator of nuclear factor kappa B) and RANK ligand are expressed in giant cell tumors of bone. Am J Clin Pathol 2002; 117: 210-216.
https://doi.org/10.1309/BPET-F2PE-P2BD-J3P3
Nicholson GC, Horton MA, Sexton PM, D'Santos CS, Moseley JM, Kemp BE, et al. Calcitonin receptors of human osteoclastoma. Horm Metab Res 1987; 19: 585-589.
https://doi.org/10.1055/s-2007-1011887
Lau YS, Sabokbar A, Gibbons CL, Giele H, Athanasou N. Phenotypic and molecular studies of giant-cell tumors of bone and soft tissue. Hum Pathol 2005; 36: 945-954.
https://doi.org/10.1016/j.humpath.2005.07.005
Zheng MH, Robbins P, Xu J, Huang L, Wood DJ, Papadimitriou JM. The histogenesis of giant cell tumour of bone: a model of interaction between neoplastic cells and osteoclasts. Histol Histopathol 2001; 16: 297-307.
Nakashima M, Nakayama T, Ohtsuru A, Fukada E, Niino D, Yamazumi K, et al. Expression of parathyroid hormone (PTH)-related peptide (PthrP) and PTH/PTHrP receptor in osteoclast-like giant cells. Pathol Res Pract 2003; 199: 85-92.
https://doi.org/10.1078/0344-0338-00359
Cowan RW, Singh G, Ghert M. PTHrP increases RANKL expression by stromal cells from giant cell tumor of bone. J Orthop Res 2012; 30: 877-884.
https://doi.org/10.1002/jor.22020
Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer 2003; 97: 2520-2529.
https://doi.org/10.1002/cncr.11359
Hoch B, Inwards C, Sundaram M, Rosenberg AE. Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am 2006; 88: 1998-2008.
https://doi.org/10.2106/JBJS.E.01111
Cummins CA, Scarborough MT, Enneking WF. Multicentric giant cell tumor of bone. Clin Orthop Relat Res 1996; 322: 245-252.
https://doi.org/10.1097/00003086-199601000-00029
Viswanathan S, Jambhekar NA. Metastatic giant cell tumor of bone: are there associated factors and best treatment modalities? Clin Orthop Relat Res 2010; 468: 827-833.
https://doi.org/10.1007/s11999-009-0966-8
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 1970; 52: 619-664.
https://doi.org/10.2106/00004623-197052040-00001
Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am 1984; 66: 269-274.
https://doi.org/10.2106/00004623-198466020-00014
Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res 1994; 302: 219-230.
https://doi.org/10.1097/00003086-199405000-00034
Bertoni F, Present D, Enneking WF. Giant-cell tumor of bone with pulmonary metastases. J Bone Joint Surg Am 1985; 67:890-900.
https://doi.org/10.2106/00004623-198567060-00011
Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M. Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res 1988; 237: 275-285.
https://doi.org/10.1097/00003086-198812000-00040
Siebenrock KA, Unni KK, Rock MG. Giant-cell tumour of bone metastasising to the lungs. A long-term follow-up. J Bone Joint Surg Br 1998; 80: 43-47.
https://doi.org/10.1302/0301-620X.80B1.0800043
Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol 2004; 15: 375-381.
https://doi.org/10.1093/annonc/mdh086
Alacacioğlu A, Bengi G, Oztop I, Canda T, Balci P, Osma E, et al. Metastasis of giant cell tumor to the breast: case report and review of the literature. Tumori 2006; 92: 351-353.