Giant cell tumor of the clavicle: report of a case in a rare location with consideration of surgical method

BMC Musculoskeletal Disorders

Setsuro Komiya¹  Takuya Yamamoto¹  Yasuhiro Ishidou³  Shunsuke Nakamura¹  Hirofumi Shimada¹  Hiromi Sasaki¹  Takao Setoguchi²  Masahiro Yokouchi¹  Toru Tsuchimochi¹  Satoshi Nagano¹ 

[1] Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan;The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan;Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan

关键词: Shoulder function;    Pathology;    Claviculectomy;    Giant cell tumor;   

Others  :  1227753
DOI  :  10.1186/s12891-015-0604-4

 received in 2014-02-18, accepted in 2015-05-28,  发布年份 2015

【 摘 要 】

Background

Most bone tumors that occur in the clavicle are malignant. A few giant cell tumors (GCTs) of the clavicle have been reported; however, the most appropriate operative method for this tumor has never been discussed.

Case presentation

A 54-year-old man noticed enlargement of the proximal aspect of the right clavicle. A plain X-ray revealed lytic change and ballooning of the proximal end of the right clavicle. The tumor was isointense on T1-weighted magnetic resonance images and showed a mixture of low- and high-intensity areas on T2-weighted images without extension to the surrounding soft tissues. Bone scintigraphy showed strong accumulation (normal/tumor ratio, 2.31), and positron emission tomography revealed strong uptake of fluorine-18-2-fluoro-2-deoxy-d-glucose (SUVmax, 6.0) in the proximal part of the right clavicle. Because we could not completely exclude malignancy, an open biopsy was performed. Pathologically, the tumor comprised mononuclear stromal cells and multinuclear giant cells, resulting in a diagnosis of a GCT of the bone. Although curettage may be considered for such lesions (Campanacci grade II), we chose resection to minimize the chance of recurrence. The tumor was resected en-bloc with the proximal half of the clavicle. No postoperative shoulder disproportion was observed, and full range of motion of the right shoulder was maintained. The patient was satisfied with the surgical outcome (Musculoskeletal Tumor Society score of 96 %). He returned to his original job as a land and house investigator without any signs of recurrence for 1 year after surgery.

Conclusions

Although GCT of the bone rarely occurs in the clavicle, the typical X-ray findings demonstrated in the present case are helpful for a correct diagnosis. Although en-bloc resection without reconstruction is appropriate for GCTs in expendable bones, there has been much discussion about shoulder function after total claviculectomy. Considering the importance of the function of the clavicle, which is to support the scapula through the acromioclavicular joint, we preserved the muscle attachments of the deltoid, trapezius, and pectoralis major. Because both the oncological and functional outcomes were satisfactory, we recommend preservation of as much of the clavicle as possible in patients with clavicular bone tumors.

【 授权许可】

   
2015 Nagano et al.

【 图 表 】

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