Pathomorphological & Radiological Changes Following Denosumab Treatment In Giant cell tumours

Abstract

Introduction:- The introduction of denosumab has significantly impacted the treatment approach for giant cell tumors (GCTs) of bone, a locally aggressive osteolytic neoplasm. This study aimed to comprehensively investigate the pathomorphological and radiological changes observed in GCT patients following neoadjuvant denosumab therapy. Material methods: - A retrospective analysis of 12 cases was conducted, encompassing primary and recurrent GCT cases treated with denosumab. Clinical, radiological, and histopathological features were thoroughly examined. All cases displayed Campanacci grade 3 lesions with ambiguous borders. Results: - Neoadjuvant denosumab treatment led to distinct clinical benefits, including reduced intraoperative bleeding and increased bone density, facilitating surgical procedures. Histopathologically, denosumab-treated cases exhibited enhanced cellularity, prominent fibroblastic proliferation, spindle cell arrangement, osteoid formation, and fibro-osseous components. The number of osteoclast-type giant cells significantly diminished, sometimes approaching absence. Immunohistochemical analysis using P63 corroborated the diagnosis. Radiologically, denosumab-induced changes included marked osteosclerosis, sclerotic rim formation, and increased intralesional osteosclerosis. Conclusion: - These findings emphasize the significance of recognizing the diverse morphological and radiological alterations in denosumab-treated GCTs.