Soft tissue recurrence of giant cell tumor of the bone: Prevalence and radiographic features

Abstract

Aim: Recurrence of giant cell tumor of bone (GCTB) in the soft tissue is rarely seen in the clinical practice. This study aims to determine the prevalence of soft tissue recurrence of GCTB, and to characterize its radiographic features.

Methods: A total of 291 patients treated by intralesional curettage for histologically diagnosed GCTB were reviewed. 6 patients were identified to have the recurrence of GCTB in the soft tissue, all of whom had undergone marginal resection of the lesion. Based on the x-ray, CT and MRI imaging, the radiographic features of soft tissue recurrence were classified into 3 types. Type I was defined as soft tissue recurrence with peripheral ossification, type II was defined as soft tissue recurrence with central ossification, and type III was defined as pure soft tissue recurrence without ossification. Demographic data including period of recurrence and follow-up duration after the second surgery were recorded for these 6 patients. Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate functional outcomes.

Results: The overall recurrence rate was 2.1% (6/291). The mean interval between initial surgery and recurrence was 11.3 ± 4.1 months (range, 5-17). The recurrence lesions were located in the thigh of 2 patients, in the forearm of 2 patients and in the leg of the other 2 patients. According to the classification system mentioned above, 2 patients were classified with type I, 1 as type II and 3 as type III. After the marginal excision surgery, all patients were consistently followed up for a mean period of 13.4 ± 5.3 months (range, 6-19), with no recurrence observed at the final visit. All the patients were satisfied with the surgical outcome. According to the MSTS scale, the mean postoperative functional score was 28.0 ± 1.2 (range, 26-29).

Conclusions: The classification of soft tissue recurrence of GCTB may be helpful for the surgeon to select the appropriate imaging procedure to detect the recurrence. In addition, the marginal resection can produce a favorable outcome for the patients.

Keywords: Giant cell tumor of bone; Prevalence; Radiographic features; Recurrence.

Fig. 1

A 44-year-old female patient with giant cell tumor in the proximal left fibula. (a–c) CT scan of the left leg at the 17th month after surgery showed soft tissue nodular lesions with eggshell-like peripheral hyperdense rim. (d) On the cross-sectional fat-suppressed T2-weighted MR image, soft tissue masses revealed inhomogeneous high signal intensity.

Fig. 2

A 37-year-old male patient with giant cell tumor in the right ischium. (a–b) A centrally located ossification could be observed on both plain radiography and CT scan at the 9th month after surgery.

Fig. 3

A 34-year-old female patient with giant cell tumor in the distal right femur. (a) There was no evidence of ossification in the soft tissue on plain radiography (b) The coronal T2-weighted MR image showed inhomogenous intermediate to high signal intensity.