- Case report
- Open Access
Giant cell tumor of the uterus: case report and response to chemotherapy
BMC Cancer volume 7, Article number: 46 (2007)
Giant cell tumor (GCT) is usually a benign but locally aggressive primary bone neoplasm in which monocytic macrophage/osteoclast precursor cells and multinucleated osteoclast-like giant cells infiltrate the tumor. The etiology of GCT is unknown, however the tumor cells of GCT have been reported to produce chemoattractants that can attract osteoclasts and osteoclast precursors. Rarely, GCT can originate at extraosseous sites. More rarely, GCT may exhibit a much more aggressive phenotype. The role of chemotherapy in metastatic GCT is not well defined.
We report a case of an aggressive GCT of the uterus with rapidly growing lung metastases, and its response to chemotherapy with pegylated-liposomal doxorubicin, ifosfamide, and bevacizumab, along with a review of the literature.
Aggressive metastasizing GCT may arise in the uterus, and may respond to combination chemotherapy.
Giant cell tumor (GCT) of bone, also known as osteoclastoma, is a primary osteolytic bone neoplasm in which monocytic macrophage/osteoclast precursor cells and multinucleated osteoclast-like giant cells infiltrate the tumor [1–3]. Walker first demonstrated that osteoclasts are derived from monocytic osteoclast precursors in blood [4, 5]. The origin of GCT is unknown, but the tumor cells of GCT have been reported to produce chemoattractants that can attract osteoclasts and their precursors [3, 6].
GCT is usually benign but locally aggressive, and most commonly occurs in the epiphysis of long bones. Rarely, GCT can originate at extraosseous sites. Metastases from GCT of bone are unusual, and often behave in an indolent manner that can be managed by surgery . More rarely, GCT may exhibit a much more aggressive phenotype. The role of chemotherapy in metastatic GCT is not well defined. We report a case of an aggressive GCT of the uterus with rapidly growing lung metastases, and its response to chemotherapy with pegylated-liposomal doxorubicin, ifosfamide, and bevacizumab, along with a review of the literature.
A 55 year old woman developed anorexia, vaginal bleeding, and a non-productive cough over one month. Her last menstrual period was 11 months earlier, and she had noted some vaginal spotting for 5 months. CT scans revealed a large uterine mass and multiple lung nodules. An endometrial curetting showed small fragments of tumor consisting of two components; aggregates of atypical plump mononuclear cells with hyperchromatic, pleomorphic nuclei were interspersed with numerous large multinucleated osteoclast-type giant cells, some of which had more than 30 benign-appearing nuclei (Figure 1, Top). Up to ten mitoses power high-power field were observed in the mononuclear cells. Immunoperoxidase stain for the histiocytic marker CD68 was positive in a subpopulation of mononuclear cells and in the osteoclast-type giant cells. These cells were negative for the epithelial marker cytokeratin (AE1/AE3) which highlighted scattered benign endometrial glands. A fine needle aspirate of the lung showed sheets of atypical mononuclear plump cells and numerous scattered benign-appearing osteoclast-type giant cells (Figure 1, Bottom). Some mononuclear cells were positive for the endometrial stromal marker CD10; all mononuclear and multinucleated cells were positive for the mesenchymal cell marker vimentin; CD117 (c-kit) was weakly positive in multinucleated cells. All cells were negative for estrogen receptors, cytokeratins (7, 20, AE1/AE3), muscle specific actin and mucin.
On presenting to our clinic, her history was remarkable for anorexia, uterine bleeding, dyspnea on exertion, a non-productive cough, and a 10 pound weight loss during the previous month. Her past history was notable for treated hypertension and hypothyroidism, an episode of gout, and monoclonal gammopathy of undetermined significance. Her medications were lisinopril, L-thyroxine, and a multivitamin. Her physical examination was notable for scattered crackles and occasional wheezes, and mild lower abdominal tenderness and fullness. A repeat CT scan revealed prominent tumor progression during the preceeding month, with a 11.6 cm uterine mass and lung nodules, some >4 cm in diameter (Figure 2). Hemoglobin was 8.5 g/dl, AST, alkaline phosphatase, bilirubin, creatinine, and electrolytes were normal. Treatment was begun with pegylated-liposomal doxorubicin (45 mg/m2, day 1), ifosfamide (9 g/m2 total dose given by continuous infusion over 6 days, days 1–6) with mesna uroprotection , and bevacizumab 5 mg/kg every 2 weeks, with pegfilgrastim 6 mg given subcutaneously on day 7, with cycles repeated every 28 days. After the first cycle of chemotherapy, repeat CT imaging revealed a tumor response in the lung nodules (Figure 3), although her symptoms were unchanged. At the start of cycle 3 her cough, vaginal bleeding, and dyspnea on exertion had noticeably improved. The dose of pegylated-liposomal doxorubicin was decreased by 10% for the third and subsequent cycles due to mucositis and skin rash. A CT scan before cycle 4 showed continued tumor regression. Blood pressure remained controlled and no proteinuria was noted. After 7 cycles the tumor had stabilized by CT imaging (Figure 4). The lung nodules had largely disappeared, but the uterine mass remained at about 8.5 cm. She was given cycle 8 without bevacizumab in anticipation of hysterectomy. Repeat CT imaging showed stable disease, and she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy 8 weeks after cycle 8.
The uterus contained a poorly demarcated tumor that measured 4.8 × 4.0 × 3.5 cm arising in the left lateral wall (Figure 5, Top). Multiple leiomyomata ranging from 0.3 to 2.2 cm were also identified. Sections from the tumor (Figure 5, Bottom) showed atypical mononucleated plump to spindle shaped tumor cells diffusely infiltrating the myometrium and within dilated blood vessels. Tumor cells accounted for approximately 30 % of the cells. Vascular invasion was observed. Occasional multinucleated giant cells of osteoclastic-type were also recognized; however, these were rare and tended to form small aggregates. Extensive areas of necrosis showed dystrophic calcification. Large numbers of histiocytes with foamy cytoplasm and hemosiderin granules were observed throughout the tumor; these cells accounted for approximately 70% of the cellular population. A subpopulation of mononuclear cells was positive for CD10; osteoclastic cells were non-reactive. Some of the mononuclear plump and spindle cells were weakly positive for actin; they were negative for desmin and smooth muscle myosin. CD117 was weakly positive in the osteoclastic cells. The cell division marker Ki67 was positive in tumor cells and negative in histiocytes and osteoclasts; Stains for common leukocyte antigen (CD45) and for the histiocytic marker CD68 were positive in histiocytes and osteoclasts, but were negative in tumor cells. Stains for lysozyme were weakly positive in histiocytes and osteoclasts but were negative in tumor cells. Stains for cytokeratin (AE1/AE3), estrogen receptors, and progesterone receptors were negative. Pelvic washings were negative; the cervix, parametria, tubes, and ovaries were free of tumor.
Two months after the hysterectomy, progression of the lung nodules was noted on CT imaging and therapy with pegylated-liposomal doxorubicin and bevacizumab was begun, but progression was noted after 2 months. Gemcitabine (675 mg/m2 intravenously over 90 min given days 1 and 14 with pegfilgrastim days 2 and 15 due to neutropenia on day 8 of the first cycle, with cycles repeated every 28 days) [9, 10] with bevacizumab was begun, but progression was noted after two months. Therapy was then begun with ifosfamide and etoposide  and bevacizumab, and a partial response was observed after two months, with stabilization at 4 months. The patient received a total of 6 cycles of ifosfamide, etoposide, bevacizumab, although bevacizumab was held on day 14 of cycle 6 due to proteinuria. Two months later significant progression was noted. She received 1 cycle of dacarbazine, mitomycin c, and cisplatinum, with a very good response, but prominent toxicity including myelosuppression and fatigue. Two months later tumor progression was noted.
The current report describes an unusual case of aggressive GCT of the uterus and its response to chemotherapy with pegylated-liposomal doxorubicin, ifosfamide, and bevacizumab. The role of chemotherapy in GCT is not well defined. Pegylated-liposomal doxorubicin and ifosfamide are active in soft tissue and bone sarcomas [8, 11–15]. Angiogenic growth factor expression, including VEGF, has been previously reported in a variety of sarcomas and in GCT of bone [16–23], providing a rationale for the potential role of therapy directed against the VEGF signaling pathway, such as bevacizumab, in sarcomas, including GCT. In addition, VEGF is capable of inducing osteoclastogenesis in osteopetrotic mice (op/op) . The current case responded well to therapy with pegylated-liposomal doxorubicin, ifosfamide, and bevacizumab. It is of interest that in the first two specimens obtained before treatment (endometrial curetting and lung aspirate) there were large numbers of giant cells and these were evenly distributed. In contrast, the hysterectomy specimen after chemotherapy, showed only rare osteoclast-type giant cells, and there was extensive replacement of tumor cells by necrosis and reactive histiocytes.
Usually GCT is a primary osteolytic bone neoplasm in which monocytic macrophage/osteoclast precursor cells and multinucleated osteoclast-like giant cells infiltrate the tumor [1–3, 6]. These multinucleated giant cells have biochemical and functional characteristics of osteoclasts (reviewed in ). While usually benign, GCT is locally aggressive and most commonly occurs in the epiphysis of long bones. GCT of soft parts are very rare, but have been described [25, 26], as have GCT of the thyroid  and pancreas [28, 29].
Pulmonary metastases of GCT of bone usually grow slowly, and are often treated by surgery, though in some cases chemotherapy with various agents or radiation therapy have been used [30–39]. Two cases of rapidly progressive metastatic GCT of bone have been reported that were treated with chemotherapy with a transient response [40, 41]. Several reports have suggested the potential utility of interferon alpha in GCT of bone [30, 42–44].
Walker observed that osteoclasts are derived from monocytic progenitors found in the blood [4, 5], providing the first demonstration of the existence of stem cells in blood for non-hematopoietic tissue. The etiology of GCT is unknown, however the tumor cells of GCT have been reported to produce chemoattractants that can recruit osteoclasts and osteoclast precursors [3, 6].
Many reactive conditions and benign and malignant tumors contain osteoclast-type giant cells. An important difference between many of these entities and the "true" giant cell tumor is that the spatial relationship between the giant cells and the tumor cells is different. In giant cell tumor, the osteoclast-type giant cells are distributed regularly and uniformly throughout the tumor; in other entities, the giant cells tend to be clustered, frequently in areas of hemorrhage, that alternate with areas completely devoid of giant cells. This difference in distribution probably reflects differences in pathogenesis. It has been suggested that in the various entities with unevenly distributed giant cells, the latter are probably the result of cytokines produced that attract osteoclast precursors. In giant cell tumor, the even distribution may reflect interaction/co-dependence as in a paracrine loop between the tumor stromal cells and the reactive, osteoclast type giant cells.
We found reports of 9 other cases of GCT of the uterus [45–51]. Three patients in whom follow up was available died of their tumors. Four of the cases were thought to also have smooth muscle differentiation. Absence of desmin and myosin and only focal and weak reactivity for actin argue against true smooth muscle differentiation in our case.
The tumor cells of GCT of bone have been reported to produce chemoattractants, including both TGF beta1 and monocyte chemoattractant protein 1 (MCP-1), that can attract osteoclasts and TRAP-positive monocytic osteoclast precursors. Other growth factors indicative of an osteoclastogenic environment of potential importance in GCT, including RANKL, have been identified in GCT [6, 18, 52–54]. RANKL (OPGL) binds specific hematopoietic progenitor cells and induces osteoclast differentiation. RANKL also activates osteoclasts, and administration of RANKL to mice results in hypercalcemia . RANKL is necessary and sufficient for osteoclastogenesis . RANKL mRNA expression was recently reported to be over-expressed in the stromal-like tumor cells of GCT, while its receptor, RANK, was expressed only in the macrophage-like mononuclear cells and multinucleated giant cells [6, 52–54]. The potential role for tumor cell-osteoclast interaction/co-dependence, as in a paracrine loop between the stromal tumor cells and the osteoclast-like cells, in GCT is unknown. In this regard, it is of interest that the marked decrease in the population of viable tumor cells in the hysterectomy specimen after chemotherapy was associated with a marked reduction in the number of osteoclast-type giant cells and with loss of their spatial relationship. Thus, it is intriguing to speculate that new agents that inhibit osteoclastogenesis via the RANK/RANKL pathway, such as denosumab, could be useful in the treatment of GCT. Recent studies also suggest that bisphosphonates may induce apoptosis in both osteoclast-like giant cells and stromal tumor cells in vivo and in vitro in GCT [56, 57], possibly by interfering with an autocrine and/or paracrine loop in the tumor between stromal tumor cells and osteoclast-like giant cells.
Aggressive metastasizing GCT may arise in the uterus, and may respond to combination chemotherapy. The addition of bevacizumab is logical, though its contribution to the effect observed in this case is unclear.
giant cell tumor
vascular endothelial growth factor
transforming growth factor
tartrate-resistant acid phosphatase
receptor activator of NF-kappa B ligand
Athanasou NA, Bliss E, Gatter KC, Heryet A, Woods CG, McGee JO: An immunohistological study of giant-cell tumour of bone: evidence for an osteoclast origin of the giant cells. J Pathol. 1985, 147: 153-158. 10.1002/path.1711470302.
Goldring SR, Roelke MS, Petrison KK, Bhan AK: Human giant cell tumors of bone identification and characterization of cell types. J Clin Invest. 1987, 79: 483-491.
Zheng MH, Fan Y, Smith A, Wysocki S, Papadimitriou JM, Wood DJ: Gene expression of monocyte chemoattractant protein-1 in giant cell tumors of bone osteoclastoma: possible involvement in CD68+ macrophage-like cell migration. J Cell Biochem. 1998, 70: 121-129. 10.1002/(SICI)1097-4644(19980701)70:1<121::AID-JCB12>3.0.CO;2-S.
Walker DG: Congenital osteopetrosis in mice cured by parabiotic union with normal siblings. Endocrinology. 1972, 91: 916-920.
Walker DG: Bone resorption restored in osteopetrotic mice by transplants of normal bone marrow and spleen cells. Science. 1975, 190: 784-785. 10.1126/science.1105786.
Roux S, Amazit L, Meduri G, Guiochon-Mantel A, Milgrom E, Mariette X: RANK (receptor activator of nuclear factor kappa B) and RANK ligand are expressed in giant cell tumors of bone. Am J Clin Pathol. 2002, 117: 210-216. 10.1309/BPET-F2PE-P2BD-J3P3.
Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK: Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol. 1992, 158: 331-334.
Skubitz KM, Hamdan H, Thompson RC: Ambulatory continuous infusion ifosfamide with oral etoposide in advanced sarcomas. Cancer. 1993, 72: 2963-2969. 10.1002/1097-0142(19931115)72:10<2963::AID-CNCR2820721017>3.0.CO;2-W.
Okuno S, Edmonson J, Mahoney M, Buckner JC, Frytak S, Galanis E: Phase II trial of gemcitabine in advanced sarcomas. Cancer. 2002, 94: 3225-3229. 10.1002/cncr.10602.
Patel SR, Gandhi V, Jenkins J, Papadopolous N, Burgess MA, Plager C, Plunkett W, Benjamin RS: Phase II clinical investigation of gemcitabine in advanced soft tissue sarcomas and window evaluation of dose rate on gemcitabine triphosphate accumulation. J Clin Oncol. 2001, 19: 3483-3489.
Northfelt DW, Dezube BJ, Thommes JA, Miller BJ, Fischl MA, Friedman-Kien A, Kaplan LD, Du Mond C, Mamelok RD, Henry DH: Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi's sarcoma: results of a randomized phase III clinical trial. J Clin Oncol. 1998, 16: 2445-2451.
Skubitz KM: Phase II trial of pegylated-liposomal doxorubicin (Doxil) in sarcoma. Cancer Invest. 2003, 21: 167-176. 10.1081/CNV-120016412.
Skubitz KM, Haddad PA: Paclitaxel and pegylated-liposomal doxorubicin are both active in angiosarcoma. Cancer. 2005, 104: 361-366. 10.1002/cncr.21140.
Judson I, Radford JA, Harris M, Blay JY, van Hoesel Q, le Cesne A, van Oosterom AT, Clemons MJ, Kamby C, Hermans C, Whittaker J, Donato di Paola E, Verweij J, Nielsen S: Randomised phase II trial of pegylated liposomal doxorubicin (DOXIL/CAELYX) versus doxorubicin in the treatment of advanced or metastatic soft tissue sarcoma: a study by the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer. 2001, 37: 870-877. 10.1016/S0959-8049(01)00050-8.
Patel SR, Vadhan-Raj S, Papadopolous N, Plager C, Burgess MA, Hays C, Benjamin RS: High-dose ifosfamide in bone and soft tissue sarcomas: results of phase II and pilot studies--dose-response and schedule dependence. J Clin Oncol. 1997, 15: 2378-2384.
Zheng MH, Xu J, Robbins P, Pavlos N, Wysocki S, Kumta SM, Wood DJ, Papadimitriou JM: Gene expression of vascular endothelial growth factor in giant cell tumors of bone. Hum Pathol. 2000, 31: 804-812. 10.1053/hupa.2000.8441.
Skubitz KM, Skubitz AP: Characterization of sarcomas by means of gene expression. J Lab Clin Med. 2004, 144: 78-91. 10.1016/j.lab.2004.04.005.
Skubitz KM, Cheng EY, Clohisy DR, Thompson RC, Skubitz AP: Gene expression in giant-cell tumors. J Lab Clin Med. 2004, 144: 193-200. 10.1016/j.lab.2004.06.005.
Kumta SM, Huang L, Cheng YY, Chow LT, Lee KM, Zheng MH: Expression of VEGF and MMP-9 in giant cell tumor of bone and other osteolytic lesions. Life Sci. 2003, 73: 1427-1436. 10.1016/S0024-3205(03)00434-X.
Hoang BH, Dyke JP, Koutcher JA, Huvos AG, Mizobuchi H, Mazza BA, Gorlick R, Healey JH: VEGF expression in osteosarcoma correlates with vascular permeability by dynamic MRI. Clin Orthop Relat Res. 2004, 32-38. 10.1097/01.blo.0000141492.52166.20.
Heymach JV, Desai J, Manola J, Davis DW, McConkey DJ, Harmon D, Ryan DP, Goss G, Quigley T, Van den Abbeele AD, Silverman SG, Connors S, Folkman J, Fletcher CD, Demetri GD: Phase II study of the antiangiogenic agent SU5416 in patients with advanced soft tissue sarcomas. Clin Cancer Res. 2004, 10: 5732-5740. 10.1158/1078-0432.CCR-04-0157.
Hayes AJ, Mostyn-Jones A, Koban MU, A'Hern R, Burton P, Thomas JM: Serum vascular endothelial growth factor as a tumour marker in soft tissue sarcoma. Br J Surg. 2004, 91: 242-247. 10.1002/bjs.4398.
Graeven U, Andre N, Achilles E, Zornig C, Schmiegel W: Serum levels of vascular endothelial growth factor and basic fibroblast growth factor in patients with soft-tissue sarcoma. J Cancer Res Clin Oncol. 1999, 125: 577-581. 10.1007/s004320050319.
Niida S, Kaku M, Amano H, Yoshida H, Kataoka H, Nishikawa S, Tanne K, Maeda N, Kodama H: Vascular endothelial growth factor can substitute for macrophage colony-stimulating factor in the support of osteoclastic bone resorption. J Exp Med. 1999, 190: 293-298. 10.1084/jem.190.2.293.
van Haelst UJ, de Haas van Dorsser AH: Giant cell tumor of soft parts. An ultrastructural study. Virchows Arch A Pathol Anat Histol. 1976, 371: 199-217. 10.1007/BF00433068.
Dodd LG, Major N, Brigman B: Malignant giant cell tumor of soft parts. Skeletal Radiol. 2004, 33: 295-299. 10.1007/s00256-003-0744-8.
Silverberg SG, DeGiorgi LS: Osteoclastoma-like giant cell tumor of the thyroid. Report of a case with prolonged survival following partial excision and radiotherapy. Cancer. 1973, 31: 621-625. 10.1002/1097-0142(197303)31:3<621::AID-CNCR2820310319>3.0.CO;2-N.
Rosai J: Carcinoma of pancreas simulating giant cell tumor of bone. Electron-microscopic evidence of its acinar cell origin. Cancer. 1968, 22: 333-344. 10.1002/1097-0142(196808)22:2<333::AID-CNCR2820220210>3.0.CO;2-A.
Trepeta RW, Mathur B, Lagin S, LiVolsi VA: Giant cell tumor ("osteoclastoma") of the pancreas: a tumor of epithelial origin. Cancer. 1981, 48: 2022-2028. 10.1002/1097-0142(19811101)48:9<2022::AID-CNCR2820480919>3.0.CO;2-I.
Caudell JJ, Ballo MT, Zagars GK, Lewis VO, Weber KL, Lin PP, Marco RA, El-Naggar AK, Benjamin RS, Yasko AW: Radiotherapy in the management of giant cell tumor of bone. Int J Radiat Oncol Biol Phys. 2003, 57: 158-165. 10.1016/S0360-3016(03)00416-4.
Feigenberg SJ, Marcus RB, Zlotecki RA, Scarborough MT, Enneking WF: Whole-lung radiotherapy for giant cell tumors of bone with pulmonary metastases. Clin Orthop Relat Res. 2002, 202-208. 10.1097/00003086-200208000-00023.
Osaka S, Toriyama M, Taira K, Sano S, Saotome K: Analysis of giant cell tumor of bone with pulmonary metastases. Clin Orthop Relat Res. 1997, 253-261.
Maloney WJ, Vaughan LM, Jones HH, Ross J, Nagel DA: Benign metastasizing giant-cell tumor of bone. Report of three cases and review of the literature. Clin Orthop Relat Res. 1989, 208-215.
Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M: Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res. 1988, 275-285.
Bertoni F, Present D, Enneking WF: Giant-cell tumor of bone with pulmonary metastases. J Bone Joint Surg Am. 1985, 67: 890-900.
Sanjay BK, Kadhi SM: Giant cell tumour of bone with pulmonary metastases. A report of three cases. Int Orthop. 1998, 22: 200-204. 10.1007/s002640050242.
Stewart DJ, Belanger R, Benjamin RS: Prolonged disease-free survival following surgical debulking and high-dose cisplatin/doxorubicin in a patient with bulky metastases from giant cell tumor of bone refractory to "standard" chemotherapy. Am J Clin Oncol. 1995, 18: 144-148.
Yamamoto M, Fukushima T, Sakamoto S, Tomonaga M: Giant cell tumor of the sphenoid bone: long-term follow-up of two cases after chemotherapy. Surg Neurol. 1998, 49: 547-552. 10.1016/S0090-3019(97)00219-X.
Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ: Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994, 219-230.
Lachat MR, Weber M, Cserhati MD, Honegger HP, von Hochstetter AR: [Giant cell tumor of bone with rapid malignant course]. Orthopade. 2004, 33: 344-348. 10.1007/s00132-003-0554-7.
De Smedt M, Copin G, Boeri C, Dosch JC, Dupuis M, Marcellin L: [A case of a aggressive giant-cell tumor with multiple bone metastases]. Rev Chir Orthop Reparatrice Appar Mot. 1999, 85: 293-296.
Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB: Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg. 2002, 60: 1103-11; discussion 1111-3. 10.1053/joms.2002.34975.
Kaiser U, Neumann K, Havemann K: Generalised giant-cell tumour of bone: successful treatment of pulmonary metastases with interferon alpha, a case report. J Cancer Res Clin Oncol. 1993, 119: 301-303. 10.1007/BF01212729.
Dickerman JD: Interferon and giant cell tumors. Pediatrics. 1999, 103: 1282-1283. 10.1542/peds.103.6.1282.
Magni E, Lauritzen AF, Wilken-Jensen C, Horn T: Malignant giant cell tumour of the uterus. APMIS Suppl. 1991, 23: 113-118.
Sieinski W: Malignant giant cell tumor associated with leiomyosarcoma of the uterus. Cancer. 1990, 65: 1838-1842. 10.1002/1097-0142(19900415)65:8<1838::AID-CNCR2820650829>3.0.CO;2-1.
Watanabe K, Hiraki H, Ohishi M, Mashiko K, Saginoya H, Suzuki T: Uterine leiomyosarcoma with osteoclast-like giant cells: histopathological and cytological observations. Pathol Int. 1996, 46: 656-660.
Egorov VP, Naumov VN: [Malignant giant cell uterine tumors]. Arkh Patol. 1983, 45: 78-82.
Kindblom LG, Seidal T: Malignant giant cell tumor of the uterus. A clinico-pathologic, light- and electron-microscopic study of a case. Acta Pathol Microbiol Scand [A]. 1981, 89: 179-184.
Darby AJ, Papadaki L, Beilby JO: An unusual leiomyosarcoma of the uterus containing osteoclast-like giant cells. Cancer. 1975, 36: 495-504. 10.1002/1097-0142(197508)36:2<495::AID-CNCR2820360228>3.0.CO;2-I.
Pilon VA, Parikh N, Maccera J: Malignant osteoclast-like giant cell tumor associated with a uterine leiomyosarcoma. Gynecol Oncol. 1986, 23: 381-386. 10.1016/0090-8258(86)90142-3.
Huang L, Xu J, Wood DJ, Zheng MH: Gene expression of osteoprotegerin ligand, osteoprotegerin, and receptor activator of NF-kappaB in giant cell tumor of bone: possible involvement in tumor cell-induced osteoclast-like cell formation. Am J Pathol. 2000, 156: 761-767.
Kong YY, Feige U, Sarosi I, Bolon B, Tafuri A, Morony S, Capparelli C, Li J, Elliott R, McCabe S, Wong T, Campagnuolo G, Moran E, Bogoch ER, Van G, Nguyen LT, Ohashi PS, Lacey DL, Fish E, Boyle WJ, Penninger JM: Activated T cells regulate bone loss and joint destruction in adjuvant arthritis through osteoprotegerin ligand. Nature. 1999, 402: 304-309. 10.1038/46303.
Atkins GJ, Haynes DR, Graves SE, Evdokiou A, Hay S, Bouralexis S, Findlay DM: Expression of osteoclast differentiation signals by stromal elements of giant cell tumors. J Bone Miner Res. 2000, 15: 640-649. 10.1359/jbmr.2000.15.4.640.
Lacey DL, Timms E, Tan HL, Kelley MJ, Dunstan CR, Burgess T, Elliott R, Colombero A, Elliott G, Scully S, Hsu H, Sullivan J, Hawkins N, Davy E, Capparelli C, Eli A, Qian YX, Kaufman S, Sarosi I, Shalhoub V, Senaldi G, Guo J, Delaney J, Boyle WJ: Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell. 1998, 93: 165-176. 10.1016/S0092-8674(00)81569-X.
Chang SS, Suratwala SJ, Jung KM, Doppelt JD, Zhang HZ, Blaine TA, Kim TW, Winchester RJ, Lee FY: Bisphosphonates may reduce recurrence in giant cell tumor by inducing apoptosis. Clin Orthop Relat Res. 2004, 103-109. 10.1097/01.blo.0000141372.54456.80.
Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM: Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Calcif Tissue Int. 2004, 75: 71-77. 10.1007/s00223-004-0120-2.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/7/46/prepub
We thank the nurses of the Masonic Cancer Center for skilled and compassionate patient care, and the patient who gave written consent for publication of this case. There was no funding for this study.
KMS owns publicly traded stock in Genentech, and Johnson & Johnson, is on speakers bureaus for Johnson & Johnson, is taking part in a trial using a drug made by Amgen (denosumab) for the treatment of GCT, and has taken part in trials with drugs made or marketed by Amgen, Johnson & Johnson, Bristol Myers, and Genentech.
KMS participated in care of the patient, data analysis, and helped draft the manuscript.
JCM helped analyze data, performed the pathologic examination, and helped draft the manuscript. Both authors read and approved the final manuscript.
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Skubitz, K.M., Manivel, J.C. Giant cell tumor of the uterus: case report and response to chemotherapy. BMC Cancer 7, 46 (2007). https://doi.org/10.1186/1471-2407-7-46
- Giant Cell
- Lung Nodule
- Giant Cell Tumor