Denosumab, a relatively newer anti-osteoclastic agent that acts via the RANK-L pathway, may also be a good option, especially as a neoadjuvant to surgical intervention or in unresectable tumors. Bisphosphonates are one of the most favored agents due to their anti-osteoclastic action in particular, nitrogen containing bisphosphonates such as Zoledronic acid are especially cytotoxic to osteoclasts. Though surgery remains the mainstay of treatment, chemotherapy options are available as well. Adjuvants to curettage therapy have helped decrease recurrence rates, and modalities include cryosurgery, high-speed burring, phenol, and more. Wide resection has been found to have little to no recurrence, though rates of post-operative complications are significantly higher than in curettage. Curettage has been linked to up to 40% rates of recurrence. Radiotherapy is not recommended due to risk of malignant transformation. Larger tumors can be resected using wide resection, as in our case, or amputation if necessary. GCTB is usually treated with curettage followed by bone filling. Additionally, our patient's tumor size and location necessitated wide resection, a decision unlikely to be changed based on tumor staging. Standard of care at our patient's hospital applies the Campanacci scale only to GCTB found in the long bones of the extremities, the most typical locations of GCTB. Between the two, the Campanacci grading system is more widely used, though, ultimately, neither of the proposed grading systems have significant value in predicting prognosis, recurrence, nor in taking account various risk factors to help guide intervention. The Enneking grading system is similar to Campanacci's, and considers radiographic as well as clinical findings. used a radiographic-based approach, with grades 1 through 3, based on tumor margins and cortical involvement as seen on radiographic imaging. The Jaffe histologic grading system classified tumors as benign, aggressive, or malignant, but the system was found to be an unreliable prognostic factor. Various attempts have been made to grade and classify GCTB based on radiographic and histologic characteristics. The diagnosis of GCTB can be done based on history and physical, and radiographic and histologic findings. GCTB is usually not suspected in patients who present with a chest mass, with conditions such as metastatic tumor, lymphoma, chondrosarcoma, thymoma, and breast mass being more heavily considered as differential diagnoses. Our patient's presentation of severe shortness of breath has not been reported in other cases. GCTB in the ribs most often present with symptoms such as feelings of pain or heaviness in the chest that can radiate, or no symptoms that affect activities of daily life, ,, ,, ]. General symptoms include pain, swelling, and limited range of motion when the tumor occupies joint spaces. A review of literature by Sharma and Armstrong of 13 cases revealed that only one consisted of a tumor greater than 15cm in diameter, like the one in our report. In addition, GCTB does not usually grow to very large sizes. Of those that do arise from the ribs, the anterior aspect is a relatively rare location. The most common locations for giant cell tumors are the distal femur and proximal tibia, with a rare location in the ribs occurring in only about 1% of cases. GCTB is a rare condition that comprises about 5% of primary bone tumors in adults. Based on these findings, a primary bone tumor with low likelihood of metastasis was suspected. 1) and visible compression on the right heart border and deviation of the mediastinal structures. Upon admission to the hospital, a contrast-enhanced computed tomography (CT) scan revealed a mass occupying the 5th rib, with destruction of the normal bone structure of the rib ( Fig. Chest exam revealed a hard, non-mobile non-tender nodule located at the lower aspect of her right rib. Lung exam revealed normal chest excursion with clear lung sounds bilaterally without rhonchi, rales or wheezes. Cardiac exam revealed tachycardia without rubs or murmurs. Her respiratory rate was 18 breaths per minute and oxygen saturation was 93%. On exam, she was afebrile, normotensive with tachycardia (108 beats per minute). She reports that the shortness of breath has been present for a long time, but that over the past few months, she has experienced dyspnea even on light exertion, which severely hinders her daily life. Initially, it was the size of a coin but increased to the size of a grapefruit. The patient reports that a lump was discovered in her chest about 7 years ago, but she did not seek care at the time. A 41-year-old female presented with extreme shortness of breath and fatigue for the past half year.
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