The authors declare that they have no competing interests.
SaN, TT, MY, and HS participated in the surgical treatment and follow-up of the patient. SaN, TS, YI, and SK drafted and finalized the manuscript. ShN, HS, and TY performed the pathological examination and prepared the figures. All authors read and approved the final manuscript.
Most bone tumors that occur in the clavicle are malignant. A few giant cell tumors (GCTs) of the clavicle have been reported; however, the most appropriate operative method for this tumor has never been discussed.
A 54-year-old man noticed enlargement of the proximal aspect of the right clavicle. A plain X-ray revealed lytic change and ballooning of the proximal end of the right clavicle. The tumor was isointense on T1-weighted magnetic resonance images and showed a mixture of low- and high-intensity areas on T2-weighted images without extension to the surrounding soft tissues. Bone scintigraphy showed strong accumulation (normal/tumor ratio, 2.31), and positron emission tomography revealed strong uptake of fluorine-18-2-fluoro-2-deoxy-d-glucose (SUVmax, 6.0) in the proximal part of the right clavicle. Because we could not completely exclude malignancy, an open biopsy was performed. Pathologically, the tumor comprised mononuclear stromal cells and multinuclear giant cells, resulting in a diagnosis of a GCT of the bone. Although curettage may be considered for such lesions (Campanacci grade II), we chose resection to minimize the chance of recurrence. The tumor was resected en-bloc with the proximal half of the clavicle. No postoperative shoulder disproportion was observed, and full range of motion of the right shoulder was maintained. The patient was satisfied with the surgical outcome (Musculoskeletal Tumor Society score of 96 %). He returned to his original job as a land and house investigator without any signs of recurrence for 1 year after surgery.
Although GCT of the bone rarely occurs in the clavicle, the typical X-ray findings demonstrated in the present case are helpful for a correct diagnosis. Although en-bloc resection without reconstruction is appropriate for GCTs in expendable bones, there has been much discussion about shoulder function after total claviculectomy. Considering the importance of the function of the clavicle, which is to support the scapula through the acromioclavicular joint, we preserved the muscle attachments of the deltoid, trapezius, and pectoralis major. Because both the oncological and functional outcomes were satisfactory, we recommend preservation of as much of the clavicle as possible in patients with clavicular bone tumors.
Fletcher CDM, World Health Organization., International Agency for Research on Cancer. WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69:106–14. PubMed
Musculoskeletal Tumor Committee JOA: Bone tumor registry in Japan. Tokyo: National Cancer Center; 2012
Dahlin DC, Unni KK. Bone tumors : general aspects and data on 8,542 cases. U.S.A.: 4th edn. Springfield, IllThomas; 1986.
Tajima T, Takagishi N. Evaluation system for the shoulder joint disorders. J Jpn Orthop Assoc. 1987;61:623–39.
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993:286:241–246
Smith FB. Giant cell tumor of the middle third of the clavicle. An unusual location; report of a case with eight year follow-up. Portland Clin Bull. 1955;9:39–50. PubMed
Baryluk M. Giant-cell tumor of the distal end of the clavicle treated by anatomical resection. Chir Narzadow Ruchu Ortop Pol. 1967;32:73–5. PubMed
Li Z, Ye Z, Zhang M. Functional and oncological outcomes after total claviculectomy for primary malignancy. Acta Orthop Belg. 2012;78:170–4. PubMed
Krishnan SG, Schiffern SC, Pennington SD, Rimlawi M, Burkhead Jr WZ. Functional outcomes after total claviculectomy as a salvage procedure. A series of six cases. J Bone Joint Surg Am. 2007;89:1215–9. PubMed
Rockwood C, Wirth M. Don’t throw away the clavicle. Orthop Trans. 1992;16:763.
- Giant cell tumor of the clavicle: report of a case in a rare location with consideration of surgical method
- BioMed Central
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