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.

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