title: Giant cell tumor of the clavicle: report of a case in a rare location with consideration of surgical method.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. naga@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagano
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. super0721mouse@yahoo.co.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Tsuchimochi
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. masahiro@m3.kufm.kagoshima-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yokouchi
authors.affiliation: The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. setoro@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Setoguchi
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. piro422@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. mac1mickmick2@yahoo.co.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shimada
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. hhxt0y@hotmail.co.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. ishidou@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishidou
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. tyamamo@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopaedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. skomiya@m3.kufm.kagoshima-u.ac.jp.
authors.forename: Setsuro
authors.initials: S
authors.lastname: Komiya
mesh_terms: D001696:Biomechanical Phenomena; D001706:Biopsy; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002968:Clavicle / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003287:Contrast Media; D019788:Fluorodeoxyglucose F18; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D049268:Positron-Emission Tomography; D016059:Range of Motion, Articular; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18