• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.103-106
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• 2010

Purpose: Giant cell tumors of the bone are rare, locally aggressive lesions that primarily affect the epiphysis of the long bones in young adults. These tumors occur very rarely on the skull, principally in the sphenoid and temporal bones. The occipital bone is an unusual site. We report a rare case of a giant cell tumor of the occipital bone with a review of the relevant literature. Methods: A 7-year-old boy presented with a mass of the right occipital area, which was accompanied by localized tenderness and mild swelling. The mass was first recognized approximately 1 year earlier and grew slowly. There was no significant history of trauma. The physical examination revealed a nonmobile and non-tender bony swelling on the occipital region. The neurological evaluation was normal. The serial skull radiography and CT scan showed focal osteolytic bone destruction with a bulged soft tissue mass in the right occipital bone. The patient underwent a suboccipital craniectomy and a complete resection of the epidural mass. The lesion was firm and cystic. The mass adhered firmly to the dura mater. Results: The postoperative clinical course was uneventful, and the patient was discharged 5 days later. The histopathology report revealed scattered multinucleated giant cells and mononuclear stromal cells at the tumor section, and the giant cells were distributed evenly in the specimen, indicating a giant cell tumor. Conclusion: Giant cell tumors are generally benign, locally aggressive lesions. In our case, the lesion was resected completely but a persistent long term follow up will be needed because of the high recurrence rate and the possible transformation to a malignancy.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.67-72
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• 2002

Purpose : Treatment of giant cell tumor of distal radius can be treated in several ways according to the agressiveness of the tumor. We treated 3 cases of widely involved giant cell tumor of distal radius with wide resection and proximal fibular graft and report the results with review of literatures. Material and Method : We have treated 3 cases of giant cell tumor of the distal radius since last 1990. Among 3 cases, two cases were grade III radiologically and treated by wide resection of distal radius and vascularized proximal fibular graft, and one case, grade II radiologically, treated by distal radial resection and non-vascularized proximal fibular graft. We followed up clinical results of above three cases 9 years, 12 years and 2 years. Result : In all three cases, tranplanted fibula graft showed solid union but grade III tumors recurred at 4 year and 6 year postoperatively. One of the case which recurred 4 year later was treated with secondary wide resection and wrist fusion with autogenous iliac bone graft, and didn't show any recurrent finding for these 5 years after re-operation. And another grade III, which recurred at 6th post-operative year, is under follow-up for 6 years after recur without 2nd operation. Grade II case didn't show any recurrent findings on 2 year follow-up. Conclusion : Grade III cases recurred at 4 year and 6 year follow-up. The cause of recurrence was thought to be invasion of remaining tumor cell in the soft tissue. To prevent recurrence, complete resection of primary tumor was necessary.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.796-798
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• 2007

Purpose: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. Methods: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a $1.6{\times}1.3cm$ sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. Results: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. Conclusion: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

• 대한골관절종양학회지
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• 제2권1호
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• pp.60-64
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• 1996

Giant cell tumor of tendon sheath is a slow-growing, unilateral and solitary lesion that is most commonly seen in the digits of the hand and knee, but occasionally occurs in the hips, ankles, toes and wrists. The lesion is asymptomatic or mildly painful, especially if it is diffuse and located in a major joint. The concepts concerning about the pathogenesis of these lesion have undergone constant revision, which include neoplastic process, inflammation and lipid metabolism. Authors analysized 20 patients with giant cell tumor of tendon sheath about the etiology, clinical findings, pathologic findings and treatment results. The results were as follows: 1. 13 cases were females (65%) and 7 cases were males (35%), and the range of age was from 9 years old to 60 years old. 2. The hand was most frequently involved site in which 14 cases (70%) were included, and the foot was involved in 5 cases (25%). 3. Solitary lesions were 15 cases and multiple lesions were 5 cases. 4. Radiographically, in 3 cases bony erosion was seen. 5. All cases were treated by surgical excision and presented no recurrence. In conclusion, the giant cell tumor of tendon sheath, which has been considered to be benign tumorous conditions appeared to be necessary for complete surgical excision to prevent recurrence.

• Archives of Reconstructive Microsurgery
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• 제1권1호
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• pp.31-38
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• 1992

The management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In certain some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. The traditional bone grafts have high incidence in recurrence rate, delayed union, bony resorption, stress fracture despite long immobilization and stiffness of adjuscent joint. We have attemped to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle as a living bone graft. From Apr. 1984 to Nov. 1990, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 4 cases, using Vascularized Fibular Graft, which occur at the distal radius in 3 cases and at the proximal tibia in 1 case. An average follow-up was 2 years 8 months, average bone defect after wide segmental resection of lesion was 11.4cm. These all cases revealed good bony union in average 6.5months, and we got the wide range of motion of adjacent joint without recurrence and serious complications.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.100-107
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• 2007

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. But the management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. We have attempted to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle or anterior tibial vessel as living bone graft. From April 1984 to July 2005, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 14 cases, using Vascularized Fibular Graft, which occur at the distal radius. VFG with peroneal vascular pedicle was in 8 cases and anterior tibial vessel was 6 cases. Recipient artery was radial artery in all cases. Method of connection was end to end anastomosis in 11 cases, and end to side in 3 cases. An average follow-up was 6 years 6 months, average bone defect after wide segmental resection of lesion was 6.8 cm. All cases revealed good bony union in average 6.5 months, and we got the wide range of motion of wrist joint without recurrence and serious complications. Grafted bone was all alive. In functional analysis, there was good in 7 cases, fair in 4 cases and bad in 1 case. Pain was decreased in all cases but there was nearly normal joint in only 4 cases. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence.

• 대한골관절종양학회지
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• 제4권1호
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• pp.37-43
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• 1998

Between 1992 and 1996, 5 patients with the giant-cell tumor of the spine were treated. Four were female and one was male. The mean age was 34 years old, and the mean follow-up time was 36 months. The locations of the lesions were the cervical spine in 1, the thoracic spine in 3, and the lumbar spine in 1. Pain was the predominant presenting symptom in all cases and four had a neurological deficit. A combined anterior and posterior surgical approach wds as performed in all cases, which were also treated with AIF(anterior interbody fusion) and anterior and/or posterior instrumentation. Adjuvant radiation therapy was performed in 1 case of cervical spine. At the final follow-up, the pain and neurologic symptoms were improved. Radiologic examination showed no evidence of local recurrence and no failure of instrumentation of the spine.

• 대한골관절종양학회지
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• 제5권1호
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• pp.23-28
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• 1999

Between Sep. 1986 and Mar. 1996, twenty four patients with recurrent giant cell tumor of their long bones were treated and followed up for more than two years. We applied three different modalities for treatment: curettage with bone graft, curettage and packing with polymethylmethacrylate, wide excision with or without reconstruction. During the average 51.5 months after operation(24-97 months), two of three patients who underwent curettage with bone graft showed recurrence. Patients who underwent wide excision showed no recurrence. Five of fifteen patients who underwent curettage and packing with polymethylmethacrylate showed recurrence. Four of seven who showed recurrence were treated with reapplication of curettage and packing with polymethylmethacrylate. All four patients showed no recurrence, and two of them have been followed up for more than two years. We suggest that the curettage and packing with polymethylmethacrylate is an effective treatment modality of the recurrent giant cell tumor.

• 대한골관절종양학회지
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• 제14권2호
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• pp.178-181
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• 2008

골막하에 발생하는 결절종은 매우 드물며, 골막 연골종, 지방종, 건초 거대 세포종, 혈종, 기타 염증 그리고 방골성 골육종 등과 감별이 필요하다. 현재까지 보고된 골막하 결절종의 발생 부위는 경골이 가장 흔하며, 요골, 척골, 대퇴골에서도 발생이 보고되었지만, 비골에 발생한 경우는 1예만 보고되어 있다. 이에 저자들은 30세 여자 환자의 우측 원위 비골 부위에 발생한 골막하 결절종을 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다.

• 대한족부족관절학회지
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• 제6권1호
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• pp.117-120
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• 2002

We experienced 1 case of the giant cell tumor of the tendon sheath penetrating the middle phalanx of the third toe. Patient had painless huge mass all around the third phalanx of the foot which made a penetrating hole through the middle phalanx of the third toe in plain radiography. The period from the onset of the symptom until operation was about several years. The mass extended to the base of the distal phalanx and compressed digital nerves and vessels. Patient presented with a chief complaint of the pain on the plantar aspect of the toe and limitation of the motion of the distal interphalangeal joint. Giant cell tumor of the tendon sheath was cured by total en block resection.