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Case Reports
. 2015 Jul 30;7(7):e291.
doi: 10.7759/cureus.291. eCollection 2015 Jul.

'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab

Raju Vaishya  1 , Amit Kumar Agarwal  1 , Vipul Vijay  2
Affiliations
Case Reports

'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab

Raju Vaishya et al. Cureus. .

Abstract

Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

Keywords: denosumab; giant cell tumor of bone; rankl.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anteroposterior radiograph of the left shoulder (Case #1) showing a large lytic lesion involving the whole humeral head and proximal humerus with indistinct cortices and uniform radiolucency.
Figure 2
Figure 2. Post-denosumab therapy radiograph of the left shoulder (Case #1) showing patchy ossification and sclerotic rimming of the lesion in the proximal humerus.
Figure 3
Figure 3. Pre-denosumab histopathological picture from the left proximal humerus (Case #1) showing typical features of any giant cell tumor, including numerous multi-nucleated giant cells.
Figure 4
Figure 4. Post-denosumab histopathological picture (Case #1) showing osseo-fibrous conversion of the lesion with disappearance of multinucleated giant cells.
Figure 5
Figure 5. Computer tomography (CT scan) showing a large lytic lesion involving the sacrum (Case #2).
Figure 6
Figure 6. Anteroposterior radiograph of the pelvis showing patchy calcification and ossification with peripheral sclerosis of the tumor, indicating improvement after denosumab therapy (Case #2).
Figure 7
Figure 7. Anteroposterior radiograph of the hip (Case #3) after curettage, bone grafting and plate fixation for a histologically confirmed GCT of the proximal left femur.
Figure 8
Figure 8. Anteroposterior radiograph of the left proximal femur (Case #3) showing healing of the lesion after 6 months of denosumab therapy.
See this image and copyright information in PMC

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