Surreal illustration of connected bone and adrenal tumors.

Rare Case Connection: When Bone Tumors and Adrenal Gland Tumors Collide

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"Unveiling the Unusual Link Between Multicentric Giant Cell Tumors of Bone and Paraganglioma: A Case Report Analysis."

Giant cell tumors (GCTs) of bone, while relatively uncommon, typically account for a small percentage of primary bone tumors. These tumors occasionally metastasize, most frequently to the lungs. Recent research highlights the role of the RANKL pathway in GCT development, yet the precise mechanisms remain unclear.

Multicentric giant cell tumors (MGCTs), where tumors appear in multiple locations within the bone, are an even rarer occurrence. A recent case involving a young man diagnosed with both MGCT and a paraganglioma, a tumor of the adrenal glands, has presented an unusual opportunity to study the potential connections between these rare conditions.

This article delves into the details of this unique case report, exploring the clinical presentation, diagnostic process, treatment strategies, and potential underlying mechanisms that may link MGCT and paraganglioma. It offers insights into the complexities of rare tumor occurrences and emphasizes the importance of considering unusual associations in diagnosis and treatment planning.

The Case: A Young Man's Journey with MGCT and Paraganglioma

Surreal illustration of connected bone and adrenal tumors.

A 20-year-old male presented with recurrent pain in his left knee. Initial radiographs revealed lytic lesions with trabeculation and cortical thinning in the distal femur, proximal tibia and fibula, and distal ipsilateral tibia. These findings suggested multiple tumor sites, leading to a diagnosis of MGCT.

Further investigation revealed a retroperitoneal tumor, and the patient experienced alternating episodes of hypertension and hypotension. This prompted suspicion of a pheochromocytoma, which was later confirmed. A solitary pulmonary metastasis was also discovered. This complex presentation raised questions about potential links between the MGCT and the paraganglioma.

Initial Presentation: Knee pain and multiple bone lesions.
Diagnosis: MGCT confirmed, along with retroperitoneal paraganglioma and lung metastasis.
Treatment: Surgical interventions for bone lesions and retroperitoneal tumor.
Complications: Development of liver metastasis from the paraganglioma and further spread of GCT.

Interestingly, the activity of the GCT lesion in the fibula seemed to correlate with the status of the paraganglioma. Resection of the paraganglioma led to temporary improvement of the fibular GCT, while recurrence of the paraganglioma was associated with worsening of the GCT lesion. This observation suggests a potential functional relationship between the two tumors, possibly mediated by factors such as norepinephrine.

Unraveling the Connection and Implications for Future Research

The co-occurrence of MGCT and paraganglioma in this case is exceptionally rare, with limited existing literature on the topic. While a causal relationship cannot be definitively established, the observed correlation between the activity of the fibular GCT lesion and the status of the paraganglioma suggests a potential functional link.

The case highlights the importance of considering unusual associations in patients presenting with rare tumors. Further research is needed to investigate the potential underlying mechanisms that may connect MGCT and paraganglioma. One possible mechanism involves the role of beta-adrenoreceptor agonists, such as norepinephrine, in stimulating RANKL expression and promoting osteoclast differentiation.

This unique case report contributes to the growing body of knowledge on rare tumor occurrences and emphasizes the need for continued research to improve our understanding of these complex conditions. Further investigation into the potential link between MGCT and paraganglioma may lead to improved diagnostic and therapeutic strategies for patients with these rare tumors.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2106/jbjs.cc.l.00155, Alternate LINK

Title: Multicentric Giant Cell Tumor Of Bone And Paraganglioma

Subject: Orthopedics and Sports Medicine

Journal: JBJS Case Connector

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Shintaro Iwata, Tsukasa Yonemoto, Takeshi Ishii, Akinobu Araki, Yoko Hagiwara, Shin-Ichiro Tatezaki

Published: 2013-03-13

Everything You Need To Know

What exactly are multicentric giant cell tumors of bone, and how do they differ from typical giant cell tumors?

Multicentric giant cell tumors of bone, or MGCTs, are rare instances where giant cell tumors appear in multiple locations within the bone. This contrasts with typical giant cell tumors, which usually occur in a single location. The recent case study highlights the co-occurrence of MGCT with paraganglioma, which is an even rarer presentation. The presence of multiple bone tumors, as opposed to a solitary one, complicates diagnosis and treatment, potentially requiring a more comprehensive approach.

What are the potential underlying mechanisms that could explain the co-occurrence of multicentric giant cell tumors of bone and paraganglioma?

The unusual co-occurrence of multicentric giant cell tumors of bone (MGCT) and paraganglioma raises important questions about potential underlying mechanisms. While the precise nature of their connection is not fully understood, one hypothesis involves factors such as norepinephrine, a hormone produced by the adrenal glands. The case study observed a correlation between the activity of the MGCT lesion in the fibula and the status of the paraganglioma, suggesting a potential functional relationship. Further research is needed to explore these mechanisms and their implications for diagnosis and treatment.

What treatment strategies were employed in the presented case, and what do the outcomes suggest about the relationship between the tumors?

In this specific case, the patient underwent surgical interventions for both the bone lesions associated with multicentric giant cell tumors of bone (MGCT) and the retroperitoneal tumor identified as a paraganglioma. The surgical removal, or resection, of the paraganglioma led to a temporary improvement in the fibular MGCT, while recurrence of the paraganglioma coincided with the worsening of the MGCT lesion. This suggests that treatment strategies should consider the potential interaction between these tumors.

How does the RANKL pathway relate to this case, and what further research is needed to understand its role in connecting multicentric giant cell tumors of bone and paraganglioma?

The RANKL pathway is known to play a significant role in the development of giant cell tumors (GCTs) of bone, however, the specific mechanisms are not fully understood. While the case study doesn't explicitly detail how the RANKL pathway might connect multicentric giant cell tumors of bone (MGCT) and paraganglioma, it opens the door to further investigation. Future research could explore whether any shared signaling pathways or genetic factors influence the development and progression of both tumor types. It is not clear in the text how the RANKL pathway and norepinephrine are related, if at all.

What complications arose in the case, and what implications do they have for managing similar cases in the future?

The liver metastasis from the paraganglioma and the further spread of multicentric giant cell tumors of bone (MGCT) highlight the challenges in managing such complex cases. The liver metastasis indicates the potential for paragangliomas to become aggressive and spread to distant sites. The further spread of MGCT suggests the need for continued monitoring and potentially more aggressive treatment strategies. These complications underscore the importance of considering the systemic nature of these rare tumor occurrences and the potential for long-term follow-up.