Cases reported "Giant Cell Tumor of Bone"

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1/149. Pseudoanaplastic giant cell tumor of bone.

    Marked nuclear atypia can be found in a variety of benign mesenchymal tumors, including ancient schwannomas, symplastic leiomyomas, osteoblastomas, and chondromyxoid fibromas. Such nuclear atypia is believed to represent a degenerative phenomenon and does not indicate aggressive behavior. Separation of these pleomorphic but benign lesions from true sarcomas may be difficult. We are aware of only one prior description of such degenerative atypia in benign giant cell tumor of bone. We report a benign giant cell tumor of bone arising in the sacrum of a 21-year-old white female. Preoperative embolization of this lesion had been performed, and subsequent curetting revealed marked atypia suggestive of an anaplastic malignancy. However, only very rare mitotic figures were present, and the radiographs were consistent with a benign giant cell tumor. A diagnosis of benign giant cell tumor was made, and no recurrence or metastases have been observed during the 4-year postoperative period.
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2/149. Bone giant cell tumour in neuropathological practice. A fifty year overview.

    We report a case of a 29-year-old female patient who suffered from visual disturbance, resulting from a lesion in the sphenoid bone which, histologically, proved to be a giant cell tumour. Reviewing our laboratory practice over a 50 year period, only 7 cases of true giant cell tumour were found and they were in two major locations, i.e. the skull and vertebrae. These few cases led us to focus on the problem raised by the lack of histological patterns of malignancy. In agreement with Mazabraud's theory, it seems that a vertebral location is associated with a good prognosis and that gene mapping of chromosome 17 in relation to p53 mutations could be a valuable tool in the diagnosis of potential malignant behaviour.
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3/149. Chronic renal failure causing brown tumors and myelopathy. Case report and review of pathophysiology and treatment.

    Brown tumors (osteoclastomas) are histologically benign lesions that are caused by primary or secondary hyperparathyroidism. Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Skeletal brown tumors are relatively uncommon, and brown tumors that involve the spine are considered very rare. The authors present the case of a 37-year-old woman with systemic lupus erythematosus and hemodialysis-dependent anuric renal failure, in whom spinal cord compression developed due to a brown tumor and pathological fracture at T-9. The patient underwent transthoracic decompressive surgery and spinal reconstruction in which cadaveric femoral allograft and instrumentation were used. Brown tumors of the vertebral column require surgical treatment if medical therapy and parathyroidectomy fail to halt their progression or if acute neurological deterioration occurs. In patients with renal failure bone healing is delayed and there is an increased risk that healing will fail because the metabolic derangements can result in severe osteoporosis. Surgical reconstruction of the spine may require the use of augmentation with instrumentation and aggressive treatment of hyperparathyroidism to achieve successful outcomes.
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4/149. Giant cell tumor of the foot phalanges in children: a case report.

    Giant cell tumor of the bone is infrequent in the phalanges of the toes and is extremely rare in children. A case of giant cell tumor of the proximal phalanx of the big toe on the left foot in a 12-year-old boy is reported. The tumor was treated by partial resection of the phalanx and repair of the osseous defect with an autologous iliac crest graft. A literature review showed few cases of giant cell tumor at this site.
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5/149. giant cell tumors of the jugular foramen.

    PURPOSE: To review the diagnosis and treatment of giant cell tumors of the jugular foramen. MATERIALS AND methods: A typical case is reported. Symptoms, signs, and diagnostic studies are reviewed. Photomicrographs and angiographic studies showing the differences between these and glomus jugulare tumors are provided. A coherent approach to their management is presented. RESULTS: These hypervascular, traditionally radioresistant tumors may cause pulsatile tinnitus, conductive hearing loss, and lower cranial nerve paresis. Angiographic studies showed a hypervascular lesion supplied by numerous small branches of the external carotid artery, making embolization difficult. Complete resection was achieved by an infratemporal fossa approach with preoperative embolization. CONCLUSION: giant cell tumors of the temporal bone may mimic glomus jugulare tumors with respect to anatomic location, cranial nerve deficits, and vascularity.
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6/149. Giant-cell tumor of the skull base.

    giant cell tumors are uncommon primary bone tumors. They primarily occur in the long bones. giant cell tumors are extremely rare in the skull and head and neck. When it does occur, the maxilla and mandible are the common sites to be involved. We described two cases of giant cell tumor in the temporal bone. In the noncontrast enhanced CT, the lesion presents as a soft tissue density mass with expansion of the bone. The bony cortex is usually intact. The adjacent soft tissues and cerebral parenchyma show no infiltration or edema. The post contrast scan reveals homogenous enhancement of the mass.
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7/149. Use of polymethylmethacrylate in large osseous defects in the foot and ankle following tumor excision.

    foot and ankle surgeons are occasionally confronted with having to fill large defects following excision of osseous lesions. This can prove to be quite challenging to the surgeon in regards to the requirement of large amounts of autogenous, allographic, or synthetic bone graft material. The amount of time spent nonweightbearing postoperatively can be quite prolonged, and the evaluation for tumor recurrence at the graft--host interface is difficult to ascertain. Polymethylmethacrylate has been used extensively in orthopedic surgery for many years in a safe manner for total joint replacement. It has also been used to fill large defects following tumor excision (i.e., giant cell tumor) and as an alternative to bone graft. This article briefly reviews the concepts of using polymethylmethacrylate in this manner and presents the use of polymethylmethacrylate in the treatment of foot and ankle lesions with three case presentations. The authors' purpose for this paper is to simply expand on the current medical literature available regarding the use of polymethylmethacrylate in the foot and ankle and to increase the awareness of foot and ankle surgeons regarding its use as a treatment alternative. A follow-up to this article is planned to present a larger patient population, longer term follow-up, and outcomes data.
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8/149. Assessment of vascularized fibular graft one year after reconstruction of the wrist after excision of a giant-cell tumour.

    We report a patient in whom the distal radius was resected for a giant cell tumour and the bone defect was replaced using a vascularized proximal fibular graft. The graft was viable and hypertrophied and normal callus formed on the distal radius. Due to chronic instability of the wrist the patient underwent revision arthrodesis 1 year after resection. Microscopic studies of the epishyseal region of the fibula showed wide necrosis of the graft with active creeping substitution. Despite the good technical result of the vascularized fibular graft, the vascularization was incomplete in the proximal epiphysis. We discuss possible reasons for this.
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9/149. Giant cell tumor of the thoracic spine simulating mediastinal neoplasm.

    A case of giant cell tumor of the thoracic spine simulating mediastinal neoplasm was identified on plain films, CT scans, MR images, and with scintigraphy. CT showed a hypervascular soft-tissue mass with shell-like calcification in the right upper mediastinum. MR imaging showed a collapse of the T1 vertebral body and a mass extending to the mediastinum. The mass had a low signal on T1-weighted MR images and a predominantly high signal on T2-weighted images with heterogeneity. technetium-99m methylene diphosphonate bone scintigraphy showed intense uptake in both the T1 and marginal parts of the mediastinal mass. There was no accumulation of gallium-67 citrate, but 18-fluorine fluorodeoxyglucose positron emission tomography showed marked uptake. The variation in these imaging findings played an important role in the differential diagnosis of this uncommon mediastinal mass.
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10/149. Free vascularized fibula grafts in surgery of the upper limb.

    Twenty patients with intractable diseases in the upper extremity were treated using free vascularized fibula grafts. There were 13 men and seven women. Three patients had traumatic bone defects, five had post-traumatic nonunions, two had congenital pseudoarthroses, seven had defects after tumor resection, and three had other lesions. The reconstructed sites were the humerus in two patients, the radius and/or ulna in 17, and the metacarpal and phalangeal bones in one. The length of the bone defect ranged from 3 to 18 cm (mean: 8.4 cm). Follow-up periods ranged from 6 to 204 months. No patient required additional bone grafts. The mean period required to obtain radiographic bone union was 4.4 months. There were no cases with fractures of the grafted bone, but malunion occurred in four cases. The vascularized fibula graft is indicated in patients with large bone defects or intractable nonunions in the humerus, radius, and/or ulna.
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