Commentary on: #x0201c;L4 and L5 Spondylectomy for En Bloc Resection of Giant Cell Tumor and Review of the Literature#x0201d;

摘要

Giant cell tumor (GCT; also known as osteoclastoma) is a locally aggressive, intermediate primary bone tumor characterized by osteoclast-like, multinucleated giant cells and the overexpression of receptor activator of nuclear factor kB ligand (RANKL) produced by stromal tumor cells. The tumorigenesis seemed to be associated with mutations of a histone (H3F3A) gene. Prevalence of GCT can be different in different regions/ethnical groups; e.g., GCT is rare in the United States#x02014;approximately 4 to 5 of primary bone tumors#x02014;but more often occurs in China where it is 10 to 20.1 Local recurrence is common in surgically treated cases. Globally, malignant transformation has been described in 10 of cases, and lung metastases have been described in 1 to 4 of cases. Metastasizing can occur in benign, primary lesions as well and more frequently in recurrent GCTs and in spinal lesions.23 According to the Enneking surgical staging system, GCT is rarely S1 (latent); in 90 of cases, it is S2 (active with extensive cortical thinning and bulging) or S3 (aggressive with soft-tissue component). Management of GCT is often challenging and requires a multidisciplinary approach. In the spine, the osteolytic lesion can result in pathological fracture and consequential instability. Furthermore, the locally aggressive expansion of the tumor can cause neurological symptoms even in its early stage. The Enneking appropriate, en bloc resection of an S3 spinal lesion is a technically challenging surgery with high risk for perioperative complications and functional loss.