title: Recurrence potential of diffuse-type giant cell tumor in the foot: radiologic and pathologic features.
abstract: BACKGROUND
  Aggressive musculoskeletal tumors in the foot, such as diffuse-type giant cell tumors or extra-abdominal desmoid tumors, are difficult to treat because the foot does not have enough soft tissue to allow wide tumor resection. We reviewed the clinical behavior of diffuse-type giant cell tumor in the foot and evaluated the recurrence potential of these tumors from radiologic and pathologic perspectives.
  
  
  METHODS
  Six patients with a mean age of 37.6 years were included in this study. Radiologic studies, including sonography, computed tomography (CT), magnetic resonance imaging (MRI), and bone and gallium citrate scintigraphy, were obtained followed by surgical treatment and histologic evaluation of the tumor.
  
  
  RESULTS
  Recurrence occurred in three patients. Although CT and MRI findings were similar in the recurrent and nonrecurrent tumors, marked differences were found between the two by scintigraphy; positive radiotracer uptake to the affected foot with gallium citrate scintigraphy was noted only in recurrent tumors, although positive accumulation was seen in all patients with bone scintigraphy. Histologically, the necrotic area and mitotic activity were more apparent in recurrent than in the nonrecurrent tumors, and tumor cell dyscohesion was noted in the former, (the intercellular space was increased).
  
  
  CONCLUSIONS
  Repeated recurrence with tumor invasion into tarsal bone resulted in breakage of the tarsal arch that supports the body's weight. Amputation would be necessary for patients in whom the disease had progressed to obtain local cure and relief of pain. In the present study, we found two features of the recurrence potential of diffuse-type giant cell tumors: sparse cell to cell contact on pathologic examination and positive accumulation in the tumor on gallium citrate scintigraphy. We concluded that giant cell tumors with these two features have a strong potential for local recurrence, and thus require intensive followup.
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Nagano, Japan. tshimiz@hsp.md.shinshu-u.ac.jp
authors.forename: Tominaga
authors.initials: T
authors.lastname: Shimizu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uehara
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Akahane
authors.forename: Kenichi
authors.initials: K
authors.lastname: Isobe
authors.forename: Hideki
authors.initials: H
authors.lastname: Arai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005529:Foot Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011859:Radiography; D011877:Radionuclide Imaging