The giant cell tumor during pregnancy: A review of literature

Virginia M Formica; Valentina Bruno; Alessandra Scotto Di Uccio; Emilio Cocca; Barbara Rossi; Carmine Zoccali

doi:10.1016/j.otsr.2022.103396

The giant cell tumor during pregnancy: A review of literature

Orthop Traumatol Surg Res. 2023 May;109(3):103396. doi: 10.1016/j.otsr.2022.103396. Epub 2022 Sep 7.

Authors

Virginia M Formica¹, Valentina Bruno², Alessandra Scotto Di Uccio³, Emilio Cocca⁴, Barbara Rossi⁵, Carmine Zoccali⁶

Affiliations

¹ Hand and Microsurgery Unit, Jewish Hospital, Via Fulda, 14, 00148 Rome, Italy.
² Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
³ School of General Surgery, General Surgery and Organ Transplantation Unit, Umberto I Polyclinic of Rome, Sapienza University, Viale del Policlinico, 155, 00161 Rome, Italy.
⁴ Orthopaedic and Traumatology Unit, Department of General Surgery, Plastic Surgery, Orthopedics, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro 3, 00185 Rome, Italy.
⁵ Oncological Orthopaedics Department. IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
⁶ Orthopaedic and Traumatology Unit, Department of General Surgery, Plastic Surgery, Orthopedics, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro 3, 00185 Rome, Italy; Oncological Orthopaedics Department. IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. Electronic address: carminezoccali@libero.it.

PMID: 36087835
DOI: 10.1016/j.otsr.2022.103396

Abstract

Background: Giant cell tumors (GTC) of bone are benign, locally aggressive tumors generally occurring in young people with a female predominance during reproductive age. Considering their worsening during pregnancy it has been suggested that pregnancy can accelerate GCT progression or favor recurrence but correlation between tumor growth and pregnancy has not yet been clarified. Aim of this study was to clarify clinical characteristics, timing and type of treatment through a literature review on GTCs occurring during pregnancy.

Patients and methods: An electronic search was performed in December 2020 in PubMed, Scopus, Embase, Medline, Cochrane Register using the keywords "giant cell tumor" AND "pregnancy" looking for papers reporting cases of giant cell tumors of the bone onset or recurred during pregnancy. The electronic search identified 212 papers; sixteen studies were selected, for a total of 32 cases.

Results: The diagnosis was made during pregnancy in 24 cases and after the partum in 8 cases. 27 cases were new diagnoses while 5 cases were recurrences. Pulmonary metastases were reported in 3 patients. The treatment was performed during the pregnancy in 7 out of 32 cases; in the remaining 27 cases treatment was performed after delivery. The hormone receptor status was reported in 14 patients. Data regarding follow-up was reported for 26 out of 32 patients; three patients had local recurrences that were treated with wide resection and amputation in 2 and 1 case, respectively; at the last follow-up all patients were apparently without any evidence of disease except for three patients who had stable lung metastases.

Discussion: In case of GCT during pregnancy, a multidisciplinary approach is necessary to offer the patients the best treatment in terms of mother and child's health. A correct diagnosis is necessary and not confusing tumor symptoms with ones of pregnancy is mandatory in order not to delay the diagnosis and let the tumor progress. Actually, even though pregnancy would seem to promote GCT growth and aggressiveness, the relationship is not clear. More studies are necessary to clarify this interesting aspect.

Level of evidence: IV, systematic review.

Keywords: Delivery; Estrogen receptors; GCT; Pregnancy; Progesterone receptors.

Publication types

Systematic Review
Review

MeSH terms

Adolescent
Amputation, Surgical
Bone Neoplasms* / surgery
Bone and Bones
Child
Female
Giant Cell Tumor of Bone* / surgery
Giant Cells / pathology
Humans
Male
Neoplasm Recurrence, Local / surgery