Depression and anxiety in recurrent giant cell tumor of bone

Abstract

Giant cell tumor of bone (GCTB) is a benign neoplasia more frequently encountered in young females. The pathogenic and evolutionary dynamics of the disease is strongly influenced by the presence of depression and cellular mechanisms, especially proinflammatory and immune. Although it is not a malignant tumor, it is often recurrent, which determines a high level of depression, anxiety, and fear of the patients. Cytokine mechanisms, especially through increased tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6), as well as the involvement of the receptor activator of nuclear factor-kappa B (RANK)-RANK ligand (RANK-L) system, can be correlated with the risk of malignancy. Unfavorable evolution is associated with persistent pain, difficulties of movement and body dysmorphic symptoms. The diagnosis is based mainly on histopathological (HP) assessment. The patients can be treated with pharmacological agents (Denosumab), surgery with tumor excision, reconstruction or osteosynthesis, and radiotherapy. Patients with GCTB require HP and imaging evaluations, especially of relapses, to detect the risk of metastasis or malignancy, simultaneously with psychological and psychiatric monitoring to detect depression, addictive behaviors, and suicide risk. It is necessary to evaluate in a multidisciplinary team to avoid unfavorable oncological and psychiatric developments. Through its clinical, HP, and therapeutic features, GCTB has multiple connections with the psychological and psychopathological dimension.

Figure 1

Proliferation of mononuclear cells with sporadic typical mitotic figures, including frequent large-cell nuclei with multiple nuclei (over 20/cell), sporadic intratumoral lymphocytes. Hematoxylin–Eosin (HE) staining, ×100

Figure 2

Remnants of bone lashes, marginal to tumor proliferation. HE staining, ×200

Figure 3

Tumor proliferation with multiple nucleated cells with more than 50 nuclei. HE staining, ×400

Figure 4

Bone tumor detail with mononuclear cells and multinucleated cells. HE staining, ×100

Figure 5

(A) Bone tumor detail with typical mitosis in mononuclear cells. (B) Bone tumor detail with sporadic mitosis in mononuclear cells. HE staining: (A and B) ×400

Figure 6

(A and B) Bone tumor with positive immunoreaction to α-SMA in mononucleate cells. Anti-α-SMA antibody immunomarking: (A) ×100; (B) ×200. α-SMA: Alpha-smooth muscle actin

Figure 7

(A and B) Bone tumor with negative immunoreaction to desmin. Anti-desmin antibody immunomarking: (A) ×100; (B) ×200

Figure 8

(A–C) Bone tumor with positive CD68 immunomarker in multicellular cells and dispersed mononuclear cells. Anti-CD68 antibody immunomarking: (A) ×50; (B) ×100; (C) ×200. CD68: Cluster of differentiation 68

Figure 9

(A and B) Bone tumor with p16 cytoplasmic immunoreaction in multinucleated cells; cytoplasmic and nuclear immunoreaction in dispersed mononuclear cells. Anti-p16 antibody immunomarking: (A) ×50; (B) ×200

Figure 10

(A) Bone tumor with Ki67 immunoreaction in rare mononuclear tumor cells dispersed and immunoreaction in frequent inflammatory cells. (B) Bone tumor with Ki67 immunoreaction in dispersed mononuclear tumor cells and rare inflammatory cells. Anti-Ki67 antibody immunomarking: (A and B) ×100

Figure 11

Multifactorial theoretical model of psychiatric disorders in patients with giant cell tumor of bone (GCTB)