Some patients present with either mild or severe cases of DtGCT but experience only mild symptoms. Do we present them with a better functional outcome in the short and long term if we would just wait and follow-up?
Although I agree DtGCT or PVNS can be locally aggressive this is not always the case.
We tend to evaluate the natural course of the disease in the individual patients before we plan surgery
So far we can result promising results just doing nothing, although some patients do progress and need surgery as planned.
Staged treatment is therefore legitimate in individual cases with only mild complaints and normal anatomical locations
Dr Van de Sande,
There is a paper out, authored by Stevenson, Jaiswal, Gregory et al. in which the authors state that "asymptomatic Dt-GCT lesions may dissapear without ever presenting to the orthopaedic surgeon."
I have done some research on PVNS and this is the first time I have read a statement like this (and in a very respectable Journal), and I was taken aback. My impression of PVNS was always that of a very aggressive lesion which, if left untreated, would spread in and out of the joint, causing destruction of nearby soft tissues and bones. This is especially true in the ankle (this paper talks about the pathology in the ankle joint), due to limited space and a large number of joints.
Hopefully, this is true and we can relax in certain cases. Although, if it were me with DPVNS, I'd want it removed.
Kind regards,
Ozren
http://www.ncbi.nlm.nih.gov/pubmed/?term=stevenson%2C+jairwal%2C+gregory
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