Jeremy J Reynolds1, Dominique A Rothenfluh1, Nick Athanasou1, Shaun Wilson1, David C Kieser2,3. 1. Division of Spinal Surgery, University of Oxford, Oxford, England, UK. 2. Division of Spinal Surgery, University of Oxford, Oxford, England, UK. kieserdavid@gmail.com. 3. Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch, 8011, New Zealand. kieserdavid@gmail.com.
Abstract
PURPOSE: To present a case of aggressive sacral osteoblastoma (OB) treated with neoadjuvant denosumab therapy and en bloc resection. METHODS: Case report of a 14-year-old male with an aggressive OB affecting the superior articular process of the left first sacral segment. The lesion was lytic and metabolically active and involved the left-sided posterior elements of S1-S3 with extension into the spinal canal, affecting the left S1, S2, S3, S4 and S5 nerve roots. He was treated for 1 month with neoadjuvant denosumab followed by en bloc resection. RESULTS: Denosumab therapy caused regression of the tumour and converted the diffuse infiltrative mass into a well-defined solid (osteoma-like) structure, aiding surgical resection and preserving the S1, S4 and S5 nerve roots. Histologically, the treated lesion showed abundant sclerotic woven bone and osteoblasts with absence of osteoclasts. CONCLUSIONS: A short course of denosumab caused tumour regression, ossification and conversion of an aggressive OB into a sclerotic, well-defined lesion thus aiding surgical resection and preservation of neural structures. Neoadjuvant therapy reduced osteoclast numbers but PET showed that the lesion remained FDG avid post-therapy.
PURPOSE: To present a case of aggressive sacral osteoblastoma (OB) treated with neoadjuvant denosumab therapy and en bloc resection. METHODS: Case report of a 14-year-old male with an aggressive OB affecting the superior articular process of the left first sacral segment. The lesion was lytic and metabolically active and involved the left-sided posterior elements of S1-S3 with extension into the spinal canal, affecting the left S1, S2, S3, S4 and S5 nerve roots. He was treated for 1 month with neoadjuvant denosumab followed by en bloc resection. RESULTS:Denosumab therapy caused regression of the tumour and converted the diffuse infiltrative mass into a well-defined solid (osteoma-like) structure, aiding surgical resection and preserving the S1, S4 and S5 nerve roots. Histologically, the treated lesion showed abundant sclerotic woven bone and osteoblasts with absence of osteoclasts. CONCLUSIONS: A short course of denosumab caused tumour regression, ossification and conversion of an aggressive OB into a sclerotic, well-defined lesion thus aiding surgical resection and preservation of neural structures. Neoadjuvant therapy reduced osteoclast numbers but PET showed that the lesion remained FDG avid post-therapy.
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Authors: S Papapoulos; K Lippuner; C Roux; C J F Lin; D L Kendler; E M Lewiecki; M L Brandi; E Czerwiński; E Franek; P Lakatos; C Mautalen; S Minisola; J Y Reginster; S Jensen; N S Daizadeh; A Wang; M Gavin; C Libanati; R B Wagman; H G Bone Journal: Osteoporos Int Date: 2015-07-23 Impact factor: 4.507
Authors: David C Kieser; Scheherezade Soltani; Niels Hammer; Amir Koutp; Eleanor Hughes; Jeremy J Reynolds Journal: J Neurosurg Case Lessons Date: 2021-11-29