Unusual Histopathological Challenges in Diagnosis of Giant Cell Tumor Cases Treated with Neoadjuvant Denosumab Chemotherapy: A Rare Case Report.

Autor:	Mohapatro M; Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India., Rana R; Department of Orthopaedics, SCB Medical College and Hospital, Cuttack, Odisha, India., Priyadarshini P; Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India., Sabyasachi S; Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India., Gouda K; Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India., Mohanty L; Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic case reports [J Orthop Case Rep] 2024 Sep; Vol. 14 (9), pp. 147-151.
DOI:	10.13107/jocr.2024.v14.i09.4760
Abstrakt:	Introduction: Giant cell tumor of bone (GCTB) is a rare yet locally aggressive neoplasm primarily affecting young adults. Its hallmark features include multinucleated osteoclast-type giant cells and mononuclear tumor cells. Treatment with denosumab, an anti-RANK ligand antibody, has shown efficacy, but it alters histomorphology, posing diagnostic challenges. Co-occurrence with achondroplasia, though rare, warrants consideration in bone lesion evaluations. Case Report: A 30-year-old male with achondroplasia presented with a proximal femur GCT, a rare association. Neoadjuvant denosumab was administered due to thin tumor cortex and cortical breech. Surgical excision with bone cement filling and Philo's plate supplementation was performed. Histopathological examination post-treatment revealed the absence of osteoclast-type giant cells, extensive necrosis, hyalinization, and mononuclear infiltrates. Discussion: Denosumab induces a reduction in osteoclast numbers, causing tumor shrinkage and sclerosis, while altering typical GCT histology. Similar findings were noted in the literature, including stromal changes like spindle-shaped cells, inflammation, vascular proliferation, and hemosiderin-laden foamy macrophages. Recognition of these alterations is crucial for accurate diagnosis. Conclusion: GCT, though rare, presents distinct histopathological features aiding diagnosis. Denosumab treatment modifies tumor morphology, necessitating thorough clinical evaluation for accurate diagnosis post-treatment. Understanding, these challenges is essential for optimal management of GCT cases. Competing Interests: Conflict of Interest: Nil (Copyright: © Indian Orthopaedic Research Group.)
Databáze:	MEDLINE
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