[A case of a aggressive giant-cell tumor with multiple bone metastases]

Giant-cell tumor are known for local recurrence. Metastases are rare (2 p. 100), and generally located in the lung. We present a case with multiple bone metastases and rapid course.

A 45-year-old man presented a 5 cm giant-cell tumor of his right distal tibia and two other localisation in the fifth and sixth cervical vertebral bodies. He underwent a resection of the distal tibia and reconstruction with a controlateral free vascularized fibula. The bodies of the fifth and sixth cervical vertebral were resected and replaced by an iliac crest graft. Other localisations appeared in iliac right crest, in the posterior wall of the cotyle and in the second, third and fourth cervical vertebral bodies. Chemotherapy was administered and clinical signs regressed but eight months later the patient presented a recurrence of his tumor in the distal tibia with new localisation in the left fifth rib, in the right clavicle, in the frontal bone, in right ischio-pubal branch and in the right proximal femur. A new chemotherapy was performed but had little effect and probably hasved dubic death 13 month after the first symptom.

The present observation is characterised by the large number of localisations (13; the highest number found in the literature was 11 localisations) and by the rapidity of the clinical course. Low grade giant-cell tumors generally give benign metastase with a course lasting several years. The chemotherapy helpt us to slow the progression of the lesions but was unable to prevent the development of new localisation and the recurrence in the distal tibia. More over, its toxicity could have caused the death of the patient.

We present the case of one patient who presented a giant-cell tumor with unusual presentation: multiple bony metastases with rapidly fatal outcome.