J Korean Bone Joint Tumor Soc.  2013 Dec;19(2):43-49. 10.5292/jkbjts.2013.19.2.43.

Treatment Outcomes of Sacral Giant Cell Tumor

• Kong CB
• Lee KY
• Song WS
• Cho WH
• Koh JS
• Jeon DG
• Lee SY

• KMID: 1961756
• DOI: http://doi.org/10.5292/jkbjts.2013.19.2.43

Abstract

PURPOSE
We analyzed the treatment outcomes of patients with sacral giant cell tumor.
MATERIALS AND METHODS
We retrospectively reviewed 7 patients with giant cell tumor of the sacrum who were treated at out institution between 1990 and 2012.
RESULTS
There were 2 men and 5 women with mean age of 23.6 years. The average follow up was 52.3 months (range, 15-73 months). Six patients received surgical treatment. Intralesional curettage was performed for the 5 patients and marginal resection for another one patient. The remaining one patient was received radiation only. The patients who received radiation therapy and marginal excision had no residual or recurrent tumors. Of 5 patients with intra-lesional excision, one patient needs one more operation; two patients need two more operation for local control of the giant cell tumor. The remaining two patients failed to gain local control in spite of additional treatments.
CONCLUSION
For the treatment of sacral giant cell tumor, intralesional resection can be one of the treatments option with minimal neurologic injury. Furthermore, radiation therapy can be recommended when complete excision or curettage is impractical.

Keyword

giant cell tumor; sacrum; treatment

MeSH Terms

Curettage
Female
Follow-Up Studies
Giant Cell Tumors*
Giant Cells*
Humans
Male
Retrospective Studies
Sacrum

Figure

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  Figure 1. Fourteen-year-old woman suffered from a perianal numbness and defecation difficulty. (A, B) Initial simple lateral X-ray and T2 weighted sagittal MRI shows a giant cell tumor at S2-S3. (C, D) 5 years later after the radiation treatment, Simple lateral X-ray and T2 weighted sagittal MRI shows sclerotic change and stationary lesion.

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  Figure 2. Twenty five-year-old woman complained about her right hip pain for two years. (A) Pre-operative plain radiograph, (B) CT, (C) Pre-operative T2 weighted MRI, and (D) Post-operative X-ray. There was no recurrence of giant cell tumor until last follow up.

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  Figure 3. Thirty one-year-old woman suffered from radiating pain for four months. (A) Pre-operative lateral X-ray and (B) pre-operative T2 weighted MRI show giant cell tumor at S2-S4 level. (C) Immediate post-operative X-ray shows packed gauzes due to massive intra-operative bleeding. (D) 4 years later after the operation, MRI shows excised coccyx at first operation and remnant tumors. So, re-curettage was performed. (E) 5 years after the first operation, T2 weighted MRI shows no residual or recurrent tumor.

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  Figure 4. Eighteen year-old women developed pelvic pain about two years ago. Three months ago, weakness of lower extremity was developed. (A) Pre-operative T2 weighted MRI shows giant cell tumor at S2-S3 level. (B) 3 months later after the operation, T2 weighted MRI shows recurrent lesions. She received radiation therapy twice. (C) T1 fat suppression enhanced MRI after the radiation treatment shows aggravated lesions. Re-curettage was performed. (D) 6 months later the reoperation, follow-up T2 weighted MRI shows aggravated lesions. (E) The lesion aggravated gradually and last follow-up pelvis CT shows huge pre-sacral mass. She has difficulties in the urination and the defecation.

Reference

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