Denosumab for an inoperable giant cell tumour of the ischial bone

BMJ Case Rep. 2023 Dec 18;16(12):e257619. doi: 10.1136/bcr-2023-257619.

Abstract

Giant cell tumour of bone is a benign, locally aggressive osteolytic tumour that typically affects skeletally mature young individuals. It predominantly emerges within the metaphysis, extending towards the epiphysis of long bones, while occurrences in flat bones are exceptionally rare. We present a case of a woman in her late 20s who presented with a large right ischial mass. A biopsy confirmed the mass as a giant cell tumour. The tumour extended to the acetabulum, and due to the potential risk of significant bleeding and contamination during en bloc excision, a prudent approach involved initiating denosumab therapy, a monoclonal antibody targeting receptor activator of nuclear factor-κB ligand therapy, before proceeding with radical surgery. Denosumab therapy successfully rendered a previously inoperable tumour favourable for surgical intervention. We went on to perform a type 2 and 3 internal hemipelvectomy, followed by a reconstruction with a hip endoprosthesis replacement.

Keywords: Drug therapy related to surgery; Orthopaedic and trauma surgery; Surgical oncology.

Publication types

  • Case Reports

MeSH terms

  • Biopsy
  • Bone Density Conservation Agents* / therapeutic use
  • Bone Neoplasms* / diagnostic imaging
  • Bone Neoplasms* / drug therapy
  • Bone Neoplasms* / surgery
  • Denosumab / therapeutic use
  • Female
  • Giant Cell Tumor of Bone* / diagnostic imaging
  • Giant Cell Tumor of Bone* / drug therapy
  • Giant Cell Tumor of Bone* / surgery
  • Humans
  • Spinal Neoplasms* / pathology

Substances

  • Denosumab
  • Bone Density Conservation Agents