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Review Question - QID 300

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QID 300 (Type "300" in App Search)
A 21-year-old man presents with a lytic lesion in his distal femur. A chest radiograph reveals a lung nodule. Which of the following tumors most likely to metastasize to lung ?

Non-ossifying fibroma

1%

21/2854

Giant cell tumor

94%

2674/2854

Aneurysmal bone cyst

1%

26/2854

Osteoid Osteoma

2%

43/2854

Hemangioma

3%

80/2854

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Giant cell tumors of bone are benign lesions that can be locally aggressive. These tumors are typically treated with local resection and/or curettage. Radiation therapy is selectively used for tumors in difficult to resect locations (i.e. spine).

Only about 1 to 9% of giant cell tumors metastasize to the lungs. This stands in contrast to other benign skeletal tumors, which rarely metastasize to the lungs, making giant cell tumor, along with chondroblastoma, a unique entity in this regard. Risk factors for lung mets include local recurrence, the location of the primary giant cell tumor (distal radius, proximal femur, and sacrum), Musculoskeletal Tumor Society Stage 2 or 3 and an immunocompromised state.

Treatment for giant tumor lung mets consists of surgical excision (lobectomy, wedge resection, etc...) with good survival rates (~80%) although nearly half of all patients require multiple resections. Feigenberg et al present a case report of 3 patients with giant cell tumor and associated pulmonary metastases. They were each treated with external beam radiation for the pulmonary metastases. Other treatments include intravenous denosumab, which inhibits osteoclast formation.

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