Background

Giant cell tumors (GTC) of bone are benign, locally aggressive tumors generally occurring in young people with a female predominance during reproductive age. Considering their worsening during pregnancy it has been suggested that pregnancy can accelerate GCT progression or favor recurrence but correlation between tumor growth and pregnancy has not yet been clarified. Aim of this study was to clarify clinical characteristics, timing and type of treatment through a literature review on GTCs occurring during pregnancy.

Patients and methods

An electronic search was performed in December 2020 in PubMed, Scopus, Embase, Medline, Cochrane Register using the keywords “giant cell tumor” AND “pregnancy” looking for papers reporting cases of giant cell tumors of the bone onset or recurred during pregnancy. The electronic search identified 212 papers; sixteen studies were selected, for a total of 32 cases.

Results

The diagnosis was made during pregnancy in 24 cases and after the partum in 8 cases. 27 cases were new diagnoses while 5 cases were recurrences. Pulmonary metastases were reported in 3 patients. The treatment was performed during the pregnancy in 7 out of 32 cases; in the remaining 27 cases treatment was performed after delivery. The hormone receptor status was reported in 14 patients. Data regarding follow-up was reported for 26 out of 32 patients; three patients had local recurrences that were treated with wide resection and amputation in 2 and 1 case, respectively; at the last follow-up all patients were apparently without any evidence of disease except for three patients who had stable lung metastases.

Discussion

In case of GCT during pregnancy, a multidisciplinary approach is necessary to offer the patients the best treatment in terms of mother and child's health. A correct diagnosis is necessary and not confusing tumor symptoms with ones of pregnancy is mandatory in order not to delay the diagnosis and let the tumor progress. Actually, even though pregnancy would seem to promote GCT growth and aggressiveness, the relationship is not clear. More studies are necessary to clarify this interesting aspect.

Level of Evidence

IV, systematic review.

中文翻译：

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妊娠期巨细胞瘤：文献复习

背景

骨巨细胞瘤 (GTC) 是一种良性的局部侵袭性肿瘤，通常发生在处于育龄期的年轻人中，女性居多。考虑到它们在怀孕期间恶化，有人提出怀孕可以加速 GCT 进展或有利于复发，但肿瘤生长与怀孕之间的相关性尚未阐明。本研究的目的是通过对妊娠期间发生的 GTC 的文献回顾来阐明临床特征、时机和治疗类型。

患者和方法

2020 年 12 月，使用关键词“巨细胞瘤”和“妊娠”在 PubMed、Scopus、Embase、Medline、Cochrane Register 中进行了电子搜索，寻找报告妊娠期间发生或复发的骨巨细胞瘤病例的论文。电子检索确定了 212 篇论文；共选择了 16 项研究，共 32 个案例。

结果

孕期确诊24例，产后确诊8例。新发27例，复发5例。3 例患者报告肺转移。32 例中有 7 例在妊娠期间进行治疗；其余 27 例在分娩后进行治疗。报告了 14 名患者的激素受体状态。32 名患者中有 26 名报告了随访数据；局部复发3例，分别行广泛切除和截肢2例，截肢1例。在最后一次随访时，除了三名肺转移稳定的患者外，所有患者显然都没有任何疾病迹象。

讨论

如果在怀孕期间发生 GCT，就母子健康而言，需要采用多学科方法为患者提供最佳治疗。正确的诊断是必要的，不要将肿瘤症状与妊娠症状混淆是强制性的，以免延误诊断并让肿瘤进展。实际上，尽管怀孕似乎会促进 GCT 的生长和攻击性，但两者之间的关系尚不清楚。需要更多的研究来阐明这个有趣的方面。

证据等级

四、系统评价。