Imaging Diagnosis And Treatment Strategy Of Giant Cell Tumor Of The Sacrum

AimBased on review and analysis of medical records of sacrum tumor patients, we studied the differences between images of giant cell tumor and other tumors related to the sacrum and analyzed them by the statistics method. Our results are informative to the early diagnosis of giant cell tumor by the imaging method and evaluation of the feasibility of curettage of the tumor. It is also critical to the observation of tumor morphology before radiotherapy, so that the psychiatrist is able to identify pathological changes before and after therapy in order to analyze the effectiveness of radiotherapy. Hence, our research is significant and provides scientific proof for the early diagnosis and options of therapeutic approach to patients of giant cell tumor of the sacrum.MethodsEcollected data from 40 cases of sacrum tumors from our institute between January 1991 and August 2008, including 20 males and 20 females of an average age of 45.75 years (total range from 4 to 72 years), that comprised of 10 cases of giant cell tumor, 7 cases of notochordoma and 9 cases of metastatic tumor, all of which were final diagnosed by imaging and tissue pathology diagnosis. First, we collected medical records containing full imaging results for image analysis: we took 7 cases of sacrum giant cell tumor as our experiment group, 7 cases of sacrum notochordoma as control group A, and 7 cases of sacrum metastatic tumor as control group B. We collected the imaging results from corresponding groups and analyzed the site of tumorigenesis, growing conditions of tumor, peripheral conditions of tumor, and the density of tumor growth. Second, we collected medical records and imaging results and pathological data from 10 cases of sacrum giant cell tumor patients, who underwent aspiration biopsy diagnosis, and were scored according to Campanicci's system by radio-imaging. Among these cases, 7 patients underwent operation therapy, all of which were curettage of the tumor, where S1-2 of the sacrum and S3 of at least one side of the sacrum were retained by internal fixation during operation (the previous 3 cases were performed by iliac bar enlarged bone graft while the recent 7 cases were done by screw-rod system). 2 patients underwent radiotherapy before operation, the radiation dose of which were 4000cGy and 4500cGy respectively. We took aspiration biopsy and operative pathology data from 2 patients for CD34 and Ki67 imm unohisto chemistry staining respectively, and counted the microvessel density (MVD) and proliferation index (PI) respectively. We studied the feasibility of curettage of the tumor during operation as well as the feasibility and different outcomes of performing radiotherapy before operation for patients of giant cell tumor of the sacrum.ResultFirst, we compared the imaging data of the experiment group and the control groups. We found out that: in the experiment group, all 7 cases occurred in the epistasis of the sacrum, given 6 cases occurred on the peripherals of the sacrum and 1 case in the center of the sacrum, with 5 cases showing a neat line and 2 cases showing eclipse on the border of tumor, and all but 1 case showed even density in the center of the tumor;in control group A,1 case occurred in the epistasis of the sacrum and 6 cases occurred in the hypostasy of the sacrum, given all 7 cases occurred in the center of the sacrum, with 4 cases showing a neat border and 3 cases showing a vague border, and all but 2 cases showed uneven density in the center of the tumor; in control group B, 5 cases occurred in the epistasis of the sacrum and 2 cases throughout the sacrum, given 2 cases on the peripherals of the sacrum and 5 cases in the center of the sacrum, with all 7 cases showing a vague border, and all but 1 case showed uneven density in the center of the tumor. We analyzed the results and concluded that sacrum giant cell tumor and sacrum notochordoma has similar tumor peripheral conditions but different predilection sites, tumor growth conditions and tumor density; while sacrum metastatic tumor has different tumor peripheral conditions, tumor growth conditions and tumor density, but similar predilection sites as sacrum giant cell tumor. Second, 10 cases were final diagnosed by aspiration biopsy diagnosis and scored according to Campanicci's system, wherein 7 patients underwent curettage of the tumor. Among these patients, 5 cases were lost of visit and 2 cases were followed-up by return visit or telephone. 1 case out of the 5 cases experienced recurrence 6 months after operation and subsequently underwent another operation. Follow-up time was 34.2 months in average (in a range of 5 to 67 months). 4 cases recovered their excretion function after operation, 1 case had difficulty in urination and recovered in 4 months. 1 case had fractured sacral rod 2 years after operation, so the patient underwent overhauling and recovered extremity function thereafter. 2 cases were provided radiotherapy before operation, and reduced microvessel density (MVD) and proliferation index (PI) after radiotherapy were perceived.Conclusion1. Sacrum giant cell tumor patients could be diagnosed by imaging diagnosis in early diagnosis.2. The imaging data of giant cell tumor of the sacrum revealed that its predilection site is in the epistasis of the sacrum, resulting in decenter osteolysis, together with tumor with a neat border and even density.3. Sacrum giant cell tumor and sacrum notochordoma has similar tumor peripheral conditions but different predilection sites, tumor growth conditions and tumor density; while sacrum metastatic tumor has different tumor peripheral conditions, tumor growth conditions and tumor density, but similar predilection sites as sacrum giant cell tumor.4. Curettage of the tumor is appropriate for giant cell tumor of the sacrum. Patients undergone operation therapy recovered well and had low recurrence.5. Retaining S1-2 of the sacrum and S3 of at least one side of the sacrum during operation facilitated proficient recovery of the nervous system.6. Good internal fixation during operation enabled patients to exercise soon after operation and facilitated the recovery of extremity functions, resulting in a higher quality of post-operative life.7. Performing radiotherapy before operation reduced tumor cell proliferation and microvessel density. It is thus considered a good adjunctive therapy.