Efectividad de las variantes quirúrgicas en el manejo del tumor de cédulas gigantes óseo, según criterios radiológicos e histopatológicos
Fecha
2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El tumor óseo de células gigantes (TCG) es un tumor benigno, agresivo localmente,
poco común que afecta principalmente a la población de pacientes adultos jóvenes. Es
una lesión osteolítica que conduce a destrucción ósea progresiva, fractura y
discapacidad. La cirugía es el modo principal de tratamiento, pero el TCG tiende a
recurrir. Objetivo: Evaluar la efectividad de las variantes quirúrgicas en el manejo del
tumor de células gigantes óseo, según criterios radiológicos e histopatológicos.
Metodología: El estudio es observacional, analítico, retrospectivo y de corte
longitudinal, que incluyó a 41 pacientes con tumor óseo de células gigantes del Hospital
de especialidades Teodoro Maldonado Carbo captados desde el periodo del 1 de enero
del 2008 hasta el 31 de diciembre del 2017. Resultados: El 95,1% del tumor de células
gigantes se localizó en la región metáfisoepifisaria, de la cual, el 63,4% correspondió a
la región epífisometafisaria distal y el 31,7% a la región epífisometafisaria proximal. El
hueso afectado con mayor frecuencia fue el fémur con el 48,8%, seguido de la tibia
24,4% y el radio 7,3% en menor proporción. La manifestación clínica más importante
fue el dolor que estuvo presente en el 100% de los pacientes. El 68,3% (28) estaban
dentro de la categoría grado radiológica III de Enneking-Campanacci y el 29,3%
correspondieron al grado II, solo 1 paciente fue clasificado como grado I, lo cual
representó el 2,4% del total. La resección intralesional, curetaje, electrocauterización,
fresaje y cementación ósea (46,3%) fue la modalidad de tratamiento quirúrgico más
empleada en los pacientes del presente estudio. Se demuestra que la resección
intralesional, curetaje, electrocauterización, fresaje y cementación ósea (46,3%), se
utiliza con mayor frecuencia en pacientes con características radiográficas grado III
(26,8%) e histológicas grado II (34,1%), especialmente en miembros inferiores. Se
reporta un total de 11 pacientes con complicaciones post-operatorias (26,8%) Las más
frecuentes fueron la movilidad disminuida (24,1%), recidiva, rigidez e infección con el
7,3% respectivamente. Se evidenció diferencias significativas en las puntuaciones de la
escala de Barthel antes y después del tratamiento quirúrgico demostrando que el
tratamiento tiene impacto positivo sobre el grado de discapacidad y calidad de vida de
los pacientes (p=0,01).
Giant cell tumor (GCT) is a rare benign bone tumor that mainly affects the population of young adult patients. It is an osteolytic lesion that leads to progressive bone destruction, fracture and disability. Surgery is the main mode of treatment, but GCTs tend to recur. Objective: Evaluate the effectiveness of surgical variants in the management of bone giant cell tumor, according to radiological and histopathological criteria. Methodology: The study is observational, analytical, retrospective and longitudinal, which included 41 patients with giant cell bone tumor of the Regional Hospital IESS No. 2 Teodoro Maldonado Carbo captured from the period of January 1, 2008 to December 31 of 2017. Results: 95.1% of giant cell tumors were located in the epiphyseal region, of which 63.4% corresponded to the distal epiphysis and 31.7% corresponded to the proximal epiphysis. The most frequently affected bone was the femur with 48.8%, followed by the tibia (24.4% and the radius (7.3%) in a smaller proportion.) The most important clinical manifestation was the pain that was present in 100% of the patients: 68.3% (28) were in the radiographic category III of Enneking- Campanacci and 29.3% corresponded to grade II, only 1 patient was classified as grade I, which represented 2.4% of the total Intralesional resection, curettage, electrocautery, bone hardening and bone cementing (46.3%) was the surgical treatment modality most used in the patients of the present study, which shows that intralesional resection, curettage, Electrocautery, bone hardening and bone cementing (46.3%), is used more frequently in patients with grade III radiographic characteristics (26.8%). A total of 11 post-operative complications are reported (26.8%). frequent were decreased mobility (24.1%), recurrence VAT, stiffness and infection with 7.3% respectively. Significant differences were found in the scores of the Barthel scale before and after the surgical treatment showing that the treatment has a positive impact on the degree of disability and quality of life of the patients (p = 0.01).
Giant cell tumor (GCT) is a rare benign bone tumor that mainly affects the population of young adult patients. It is an osteolytic lesion that leads to progressive bone destruction, fracture and disability. Surgery is the main mode of treatment, but GCTs tend to recur. Objective: Evaluate the effectiveness of surgical variants in the management of bone giant cell tumor, according to radiological and histopathological criteria. Methodology: The study is observational, analytical, retrospective and longitudinal, which included 41 patients with giant cell bone tumor of the Regional Hospital IESS No. 2 Teodoro Maldonado Carbo captured from the period of January 1, 2008 to December 31 of 2017. Results: 95.1% of giant cell tumors were located in the epiphyseal region, of which 63.4% corresponded to the distal epiphysis and 31.7% corresponded to the proximal epiphysis. The most frequently affected bone was the femur with 48.8%, followed by the tibia (24.4% and the radius (7.3%) in a smaller proportion.) The most important clinical manifestation was the pain that was present in 100% of the patients: 68.3% (28) were in the radiographic category III of Enneking- Campanacci and 29.3% corresponded to grade II, only 1 patient was classified as grade I, which represented 2.4% of the total Intralesional resection, curettage, electrocautery, bone hardening and bone cementing (46.3%) was the surgical treatment modality most used in the patients of the present study, which shows that intralesional resection, curettage, Electrocautery, bone hardening and bone cementing (46.3%), is used more frequently in patients with grade III radiographic characteristics (26.8%). A total of 11 post-operative complications are reported (26.8%). frequent were decreased mobility (24.1%), recurrence VAT, stiffness and infection with 7.3% respectively. Significant differences were found in the scores of the Barthel scale before and after the surgical treatment showing that the treatment has a positive impact on the degree of disability and quality of life of the patients (p = 0.01).
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Tumor óseo de células gigantes, Tratamiento quirúrgico, Histología, Patología, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Radiología, Epidemiología analítica, Estudios retrospectivos