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J Thorac Cardiovasc Surg 1998;116:649-651
© 1998 Mosby, Inc.
BRIEF COMMUNICATIONS |
Tokyo, Japan
From the Department of Surgery, Teikyo School of Medicine, Tokyo, Japan.
Received for publication March 19, 1998. Accepted for publication April 13, 1998. Address for reprints: Iwao Takanami, MD, Department of Surgery, Teikyo School of Medicine, 2-11, Kaga 2-Chrome, Itabashi-Ku, Tokyo, 173 Japan.
A benign giant cell tumor of the bone (BGCTB) is difficult to categorize because its clinical course cannot be predicted. Approximately 50 cases of a pulmonary metastasis from a BGCTB have been reported in the literature.
1 A pulmonary metastasis from a BGCTB does not necessarily mean a bad prognosis, but it has been the cause of death in 16% to 25% of reported cases. 2,3 Our method of managing a pulmonary metastasis of a BGCTB is that it should be treated aggressively, as long as the required operation does not impair pulmonary functioning. This article presents our results in treating 4 patients with pulmonary BGCTB metastasis.
Patients and methods
Forty-seven patients with BGCTB were treated at our facility between 1979 and 1997. Four of these patients had a documented pulmonary BGCTB metastasis (Table I). A local recurrence was manifested in all cases. The interval between the operation for local recurrence and the subsequent diagnosis of a pulmonary metastasis was 9 to 54 months (average, 37 months). Plain radiographs and computed tomography scans of the chest were used for the localization of the pulmonary nodules.
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The lung was found to be the only site of a metastatic involvement in all 4 patients, who thus underwent a complete resection their pulmonary metastasis (Table II). Two of these patients remained tumor-free after their initial bilateral thoracotomy for their pulmonary metastasis; however, the remaining 2 patients who were surgically treated (cases 1 and 2) experienced the development of a metastatic recurrence in the lung. Both patients did not stay tumor-free after their second thoracotomy and had to undergo a third thoracotomy. None of the 4 patients were given chemotherapy or radiotherapy. Each was followed up at 6-month intervals at which time computed tomography scans of the chest were performed. After undergoing the surgical interventions, all patients are still alive (24 to 76 months after the operation).
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Although the overall BGCTB survival is much higher that for other metastasized lung tumors, BGCTB pulmonary metastasis have been implicated as the cause of death. The natural history of a BGCTB with pulmonary metastasis is as unpredictable as that of the primary BGCTB. On the basis of what is presently known, lesions from BGCTB pulmonary metastasis can be divided into 3 types: (1) those that show spontaneous regression or cessation of growth; (2) those that show continuous slow growth; and (3) those that show rapid growth. It has been reported that metastatic lesions of the lung have disappeared after just a biopsy 4 and that some pulmonary lesions spontaneously regress. 1 However, of the few reported cases of an untreated pulmonary BGCTB metastasis, most patients die quite rapidly of the disease. 4
For therapy, a thoracotomy and a complete excision of the pulmonary nodules has proved successful, 4 and the literature strongly favors the surgical extirpation of all pulmonary nodules. 2 Some studies that included patients with BGCTB that was treated by operation and whose follow-ups have been pursued have reported no signs of a BGCTB recurrence at 18 or more years after a resection. 2 Another study has also found that some patients have become asymptomatic, even though they had a progressive pulmonary disease, and are alive and well. 5 Further, cases have been reported of recurring and progressive pulmonary metastasis after the surgical removal of previous pulmonary nodules. 2 In this latter regard, it has been reported that other patients who underwent a partial or a complete excision of their pulmonary nodules also died of the condition. 4 However, a thoracotomy and the complete excision of recurring, metastatic, pulmonary nodules has been found beneficial for long-term survival. 2
Our management policy for the 4 cases of this study was a complete extirpation of their pulmonary metastasis, even for the 2 patients who had repeated metastatic recurrences. The 2 patients have also remained disease free at 76 months after the third thoracotomy. As for methods of treatment for a BGCTB metastasis, radiation has been used without apparent success 5 and chemotherapy has only occasionally proved successful. 4 Therefore for cases of recurring lung metastasis from a BGCTB, we believe that an aggressive thoracotomy remains the best therapy, provided that the metastasis can be totally removed without impairing pulmonary functioning.
References
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