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Pulmonary metastasis of recurrent Giant-cell tumor

of bone in proximal humerus


(A case report)
Aris Kurniawan*, Mujaddid Idulhaq**
*Resident of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University
dr. Moewardi General Hospital Prof. DR. R. Soeharso Orthopaedic Hospital, Solo
** Staff of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University
dr. Moewardi General Prof. DR. R. Soeharso Orthopaedic Hospital, Solo
Abstract
Introduction
Giant cell tumor (GCT) of bone is a locally destructive tumor that occurs predominantly
in long bones of post-pubertal adolescents and young adults, where it occurs in the
epiphysis. Metastasis, with identical morphology to the primary tumor, occurs in a few
percent of cases, usually to the lung. The overall mortality rate in patients with pulmonary
metastases is approximately 15%.
Case Report
A 40 year-old male was diagnosed with a giant cell tumor of the left proximal humerus in
April 2014. He underwent intralesional curettage, on basis of outpatient there was no
evidence of recurrence. Eight months later, in December 2014, the patient had a local
recurrence of the tumor and was treated by wide excision. The patient presented in April
2015 with a dyspneu and recurrence in the same place. He was taken to surgery, and a
disarticulation of Glenohumeral joint was performed. On Chest x-ray, we revealed a
nodul within both lung, and suspected with a metastasis of the tumor to the lung.
Discussion
The lung was the most common site of metastasis and extrapulmonary metastasis was
rare. Patients age and sex are not risk factors for metastatic disease and there is no
predilection for the right or left side. The reported interval between diagnosis of the
primary tumor and detection of metastasis ranges from 0 to 10 years (average, 3.5 years).
Although lung metastasis may spontaneously evolve into necrosis or ossification, the
treatment of lung metastases is usually surgical resection. If removal of the lesion is
unfeasible, chemotherapy can control evolution of the disease. Radiotherapy is
contraindicated because of the risk of induced malignancy. The mortality of pulmonary
metastatic GCT is variable and uncertain, depending on the length of the follow-up and
the prognosis of a GCT with pulmonary metastasis is quite favorable.