Multiple Pulmonary Metastases of Recurrent Giant Cell Tumor of Bone with Expression of VEGFR-2 Successfully Controlled by Denosumab and Apatinib: A Case Report and Literature Review

Figures & data

Figure 1 Radiological images of the proximal right tibia. Radiograph (A and B) and CT (C and D) showed osteolytic bony destruction. SPECT (E) images were negative for metastatic lesions.

Figure 2 CT of the chest. (A) Local recurrence but without pulmonary metastasis. (B) Multiple pulmonary metastases were found and denosumab initiated. (C) 4 months after denosumab therapy. (D) 3 months after denosumab and apatinib therapy. (E) 15 months after denosumab and apatinib therapy. (F) 33 months after denosumab and apatinib therapy.

Figure 3 Pathological features of the local lesions. (A) High-magnification observation of numerous multinucleated giant cells (Hematoxylin and eosin stain, 200x). (B) High-magnification observation of local recurrence but without sarcomatous change (Hematoxylin and eosin stain, 200x). (C) Presence of multinucleated giant cells indicates a recurrence of GCTB (Immunohistochemical staining, 100x). (D) Expression of VEGFR-2 as assessed by immunohistochemistry (Immunohistochemical staining, 100x).

Figure 4 Radiological images of the proximal right tibia. Radiograph (A and B), postoperative films following the curettage and packing with cement; Radiograph (C and D), and CT (E, bone window) showed a circumferential lucency around the bone cement and local cortical bone destruction. MRI (F, T1-weight) showed a soft tissue mass.

Table 1 Literature Review of Therapy After Progression of GCTB

Report	Patient (NO.)	Age	Sex	Primary Site	Pulmonary Metastases	Local Recurrence	Follow-Up Time (Year)	Therapy Before Progression	Therapy After Progression	Therapeutic Response
Wang et al^Citation19	1	16	M	Spine	Yes	Yes	4	Wide resection +denosumab	Sunitinib	SD
Tsukamoto et al^Citation17	1	29	F	Left pelvis	Yes	Yes	10	Curettage+denosumab	Chemotherapy	Died
Broehm et al^Citation16	2	59	M	Right pelvis	Yes	Yes	12	Wide resection+ denosumab	Chemotherapy	NM
		56	M	Left femur	No	Yes	7	Curettage+denosumab+ wide resection	Chemotherapy	Died
Aponte-Tinao et al^Citation18	1	15	F	Right tibia	No	Yes	5	Curettage+denosumab+ wide resection	Amputation	Disease-free
Thomas et al^Citation1	1	NM	F	NM	Yes	Yes	NM	Denosumab+ resection	NM	Died
Current study	1	26	F	Right tibia	Yes	Yes	3	Wide resection+ denosumab	Apatinib	PR

Abbreviations: GCTB, giant cell tumor of bone; M, male; F, female; SD, stable disease; PR, partial response; NM, not mentioned.

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