Category Archives: Bibliographic References

Giant cell tumor, also known as TGC, is a mesenchymal neoplasm that is notable for the proliferation of large multinucleated cells, called gigantocytes. These cells resemble osteoclasts and are found within a stroma of mononucleated cells. Due to its peculiar histological morphology, accurate diagnosis often requires a thorough analysis of the clinical and radiographic picture in order to avoid confusion with other pathological processes.

The main manifestation of a giant cell tumor is intermittent local pain, often accompanied by an increase in volume in the affected region and restriction of adjacent joint movements. The evolution period varies from 6 to 12 months, depending on the affected bone, with reports of trauma as the initial trigger of symptoms being common.

This type of tumor tends to affect a single bone, mainly long bones such as the femur, tibia, humerus and radius. However, in rarer cases, it can occur in bones of the axial skeleton, with a predilection for the sacrum. The incidence is more common between the third and fourth decades of life, affecting both sexes equally.

Radiographically, TGC appears as an epiphyseal lesion characterized by bone rarefaction, initially eccentric and later compromising the cortex. Diagnostic confirmation is obtained through histological analysis, which reveals the presence of multinucleated giant cells and spindle cell stroma.

The treatment of giant cell tumors is well established and aims at segmental resection of the lesion, whenever possible, ensuring safety margins for both bone and soft tissues. In cases where segmental resection is not feasible, such as in the cervical spine, endocavitary curettage followed by adjuvant therapy is indicated. Among the adjuvant therapeutic options are the CO2 laser, phenol diluted in 4% alcohol, liquid nitrogen and electrothermia.

The electrothermal technique has been shown to be effective in complementing curettage, providing a more complete cleaning of the tumor cavity. After electrothermia, milling of the cavity using appropriate instruments such as the slow drill is performed to ensure complete removal of the remaining tumor cells.

Filling the treated cavity can be done with different materials, such as autologous bone graft, bone substitutes or methylmethacrylate, each with its advantages and disadvantages. Post-treatment follow-up is essential to monitor disease recurrence and ensure the effectiveness of the treatment performed.

In summary, giant cell tumor is a complex condition that requires a multidisciplinary approach to ensure the best therapeutic outcome and the patient’s quality of life. Advances in diagnostic and treatment techniques have contributed significantly to improving the prognosis of these patients, offering increasingly effective and safe therapeutic options.

Introduction:

Orthopedic oncological surgery encompasses the treatment of musculoskeletal lesions, including benign and malignant bone neoplasms, pseudo-tumor lesions and benign and malignant soft tissue neoplasms. Soft tissue sarcoma is a malignant neoplasm derived from the mesoderm, occurring in soft tissues, such as muscles, fascia, tendons, etc., differentiating itself from carcinomas, which have embryonic origin in the ectoderm.

Etiology:

Most soft tissue sarcomas do not have a defined cause, but some risk factors are well described, such as previous radiotherapy, lymphedema, Li-Fraumeni syndrome, type I neurofibromatosis, individual genetic propensity and HIV infection.

Incidence:

It is a rare tumor, representing approximately 12% of pediatric neoplasms and only 1% of all malignant tumors in adults. In the USA, there are an estimated 12,000 new cases per year, resulting in around 4,700 deaths. Around 60% of soft tissue sarcomas arise in the limbs, predominantly in the thigh, followed by the chest wall and retroperitoneum.

Classification:

The classification of soft tissue sarcoma is based on histological subtype such as liposarcoma, synovial sarcoma, rhabdomyosarcoma etc. Histological grade is also used, being divided into Grade 1 (well differentiated), Grade 2 (moderately differentiated) and Grade 3 (poorly differentiated).

Clinical condition:

The initial clinical picture is characterized by a palpable tumor bulge, often painless, with progressive growth, mainly in the thigh. Some patients may experience pain and paresthesia due to the compressive effect of the tumor. Fever or weight loss are exceptional symptoms.

Staging:

At diagnosis, soft tissue sarcoma rarely metastasizes, occurring more frequently as large-volume, deep-to-muscular, high-grade tumors. The pattern of dissemination is mainly hematogenous, with predominant lung metastases.

Imaging exams:

Exams include radiography, magnetic resonance imaging, tomography, PET-CT and scintigraphy. Biopsy is indicated for histological diagnosis, and can be performed in several ways, including percutaneous needle biopsy, incisional (surgical), ultrasound or tomography-guided biopsy.

Pathology:

The pathologist plays a crucial role in the diagnosis, carrying out examinations such as freezing, to ensure the representativeness of the sample, and subsequently microscopic study in paraffin, for histopathological diagnosis as well as determining the histological grade of the tumor. Immunohistochemistry is an important resource to complement the study of the sample.