Riesenzelltumor des Stammskeletts. Aktuelle Diagnostik und Therapie

Zusammenfassung

Riesenzelltumore des Knochens gehören zu den Tumoren mit intermediärer Dignität, deren biologisches Verhalten aus dem histologischen Bild nicht sicher prognostiziert werden kann. Häufig zeigen sie ein lokal aggressives, destruierendes Ausbreitungsverhalten und neigen bei unvollständiger Entfernung zu Lokalrezidiven. Auch pulmonale Fernmetastasen kommen vereinzelt vor. Die Diagnostik erfordert bei spinaler Manifestation neben Anamnese, klinischen Befunden und Laborbefunden eine Schnittbildgebung mit CT und MRT, die Sicherung der Diagnose sollte mittels Biopsie erfolgen. Die histologische Beurteilung sollte von Pathologen mit Erfahrung in der Knochentumordiagnostik durchgeführt werden. Aufgrund der Rezidivneigung ist chirurgisch die extraläsionale, weite Exzision des Tumors notwendig, in der Regel mit einer suffizienten Fixation und Fusion. Enge postoperative Verlaufskontrollen sind erforderlich. Neue Aspekte in der begleitenden Therapie ermöglicht der humane monoklonale Antikörper Denosumab.

In diesem Artikel zu Riesenzelltumoren der Wirbelsäule berichten wir über Erfahrungen in den letzten 20 Jahren in unserer Klinik, beschreiben 2 Fälle beispielhaft und gehen auf die Diagnostik und neue Aspekte der Therapie mit Denosumab ein.

Abstract

Giant cell tumors of the bone are tumors with intermediate dignity. Their biological behavior cannot be reliably predicted histologically. They often show a locally aggressive, destructive behavior and a tendency to local recurrence in case of incomplete removal. Pulmonary distant metastases occur occasionally. In addition to anamnesis, clinical findings and laboratory findings in the case of spinal manifestation, diagnosis requires cross-sectional imaging (CT, MRT); a biopsy of the tumor is indispensable. The histological assessment should be performed by pathologists with experience in bone tumor diagnostics. Because of the tendency to recur, surgically extralesional, wide excision of the tumor is necessary, usually with adequate fixation and fusion. Close postoperative follow-up checks are required. The human monoclonal antibody denosumab enables new aspects in adjuvant treatment.

Here, we describe our experiences with spinal giant cell tumors of the spine in our hospital between 2000 and 2020. Moreover, we present two clinical cases in detail, illuminate diagnosis and current aspects of treatment - with special emphasis on Denosumab for this tumor entity.

Publikationsverlauf

Artikel online veröffentlicht:
03. November 2021

• Literatur

• 1 Soft tissue and bone tumours, WHO classification of tumours, 5. Ed. Lyon: IARC; 2020
• 2 Liede A, Bach BA, Stryker S. et al. Regional variation and challenges in estimating the incidence of giant cell tumor of bone. J Bone Joint Surg Am 2014; 96: 1999-2007
• 3 Balke M, Henrichs MP, Gosheger G. et al. Giant cell tumors of the axial skeleton. Sarcoma 2012;
• 4 Breitenseher M, Dominkus M, Scharitzer M. et al. Riesenzelltumoren in der Bildgebung. Radiologe 2001; 41: 568-76
• 5 Randall RL. Giant cell tumor of the sacrum. Neurosurg Focus 2003; 15: E13
• 6 He SH, Xu W, Sun ZW. et al. Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review. Orthop Surg 2017; 9: 139-144
• 7 Wang J, Liu X, Yang Y. et al. Pulmonary metastasis of giant cell tumour: a retrospective study of three hundred and ten cases. Int Orthop 2021; 45: 769-778
• 8 Atkins GJ, Haynes DR, Graves SE. et al. Expression of osteoclast differentiation signals by stromal elements of giant cell tumors. J Bone Miner Res 2000; 15: 640-649
• 9 Morgan T, Atkins GJ, Trivett MK. et al. Molecular Profiling of Giant Cell Tumor of Bone and the Osteoclastic Localization of Ligand for Receptor Activator of Nuclear Factor kappa B. Am J Pathol 2005; 167: 117-128
• 10 Thomas DM, Skubitz KM. Giant cell tumour of bone. Curr Opin Oncol 2009; 21: 338-344
• 11 Balke M, Hardes J. Denosumab: a breakthrough in treatment of giant-cell tumour of bone?. Lancet Oncol 2010; 11: 218-219
• 12 Branstetter DG, Nelson SD, Manivel JC. et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res 2012; 18: 4415-4424
• 13 Mattei TA, Ramos E, Rehman AA. et al. Sustained long-term complete regression of a giant cell tumor of the spine after treatment with denosumab. Spine J 2014; 14: e15-21
• 14 Luke J, Hasenfratz M, Moller P. et al. Neue Aspekte zum Riesenzelltumor des Knochens. Pathologe 2018; 39: 125-131
• 15 Behjati S, Tarpey PS, Presneau N. et al. Distinct H3F3A and H3F3B driver mutations define chondroblastoma and giant cell tumor of bone. Nat Genet 2013; 45: 1479-1482
• 16 Cleven AH, Hocker S, Briaire-de Bruijn I. et al. Mutation Analysis of H3F3A and H3F3B as a Diagnostic Tool for Giant Cell Tumor of Bone and Chondroblastoma. Am J Surg Pathol 2015; 39: 1576-1583
• 17 Shikata J, Yamamuro T, Shimizu K. et al. Surgical treatment of giant-cell tumors of the spine. Clin Orthop Relat Res 1992; 278: 29-36
• 18 Martin C, McCarthy EF. Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature. Iowa Orthop J 2010; 30: 69-75
• 19 Boriani S, Bandiera S, Casadei R. et al. Giant cell tumor of the mobile spine: a review of 49 cases. Spine 2012; 37: E37-45
• 20 Bullmann V, Liljenqvist U. Benigne und semimaligne Tumoren der Wirbelsäule. Besonderheiten im Kindes- und Erwachsenenalter. Orthopäde 2013; 42: 700-8
• 21 Yokogawa N, Murakami H, Demura S. et al. Total spondylectomy for Enneking stage III giant cell tumor of the mobile spine. Eur Spine J 2018; 27: 3084-3091
• 22 Kinoshita H, Orita S, Yonemoto T. et al. Successful total en bloc spondylectomy of the L3 vertebra with a paravertebral giant cell tumor following preoperative treatment with denosumab: a case report. J Med Case Rep 2019; 13: 116
• 23 Ouyang HQ, Jiang L, Liu XG. et al. Recurrence factors in giant cell tumors of the Spine. Chin Med J 2017; 130: 1557-1563
• 24 Gasbarrini A, Cappuccio M, Donthineni R. et al. Management of benign tumors of the mobile spine. Spine Oncology 2009; 40: 1
• 25 Boriani S, Cecchinato R, Cuzzocrea F. et al. Denosumab in the treatment of giant cell tumor of the spine. Preliminary report, review of the literature and protocol proposal. . Eur Spine J 2020; 29: 257-271
• 26 Chawla S, Blay JY, Rutkowski P. et al. Denosumab in patients with giant-cell tumour of bone: a multicentre, open-label, phase 2 study. Lancet Oncol 2019; 20: 1719-1729
• 27 Abu-Zaid A, Alaqaili SI, Ahmad SO. et al. Preoperative denosumab plus surgery in the management of giant cell tumor of bone: a comprehensive narrative literature review. . Gulf J Oncolog 2019; 1: 67-75
• 28 Bukata SV, Blay JY, Rutkowski P. et al. Denosumab treatment for giant cell tumor of the spine including the sacrum. Spine 2021; 46: 277-284
• 29 Branstetter DG, Nelson SD, Manivel JC. et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res 2012; 18: 4415-24