Giant Cell Tumours of Hand Bones: a Report of Two Cases (original) (raw)
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A Rare Case of Giant-Cell Tumor of Hand in a Young Male
Cureus, 2022
Giant-cell tumor (GCT) of the bone affecting the hand is a rare lesion that is usually diagnosed at an advanced stage and has a high rate of recurrence. In the current literature, GCT is described as a predominantly osteoclastogenic stromal cell tumor of mesenchymal origin. It is composed of three cell types: the neoplastic GCT stromal cells; mononuclear monocyte cells; and multinucleated giant cells. Clinical imaging is basic for the diagnosis of a GCT. This tumor within the hand tends to be less eccentric and most often central. GCT of metacarpals is noted to be a rare location, with the incidence being as low as 2%. GCT on hand as compared to other sites is locally more aggressive, grows faster, and has a higher recurrence rate. A 22-year-old male patient presented with swelling over the left hand for 7 months, spontaneous in onset, gradually progressive in size, and painfully restricting the joint movement, with no history of fall or trauma. On examination, diffuse swelling of size 5 × 5 × 3 cm was tender on palpation, restricting the movement at the 4th metacarpophalangeal joint. A plain radiograph followed by an MRI scan revealed a Campanacci's Grade III GCT of the 4th metacarpal. An open biopsy showed an expanded and lytic mass with areas of hemorrhage and necrosis. There were few mitotic figures and the tumor was diagnosed to be a GCT. On surgical resection, friable tumor tissue was noted over the region of the entire 4th metacarpal except for the base. The patient was managed by surgical intralesional excision of the mass, followed by Kirschner-wire fixation and reconstruction with synthetic bone graft. The excised tissue was sent for histopathological examination. The patient was followed up at regular intervals, with initial splinting, followed by wire removal at 6-week post-op, and with adequate physiotherapy, as tolerated by the patient. On a 3-month follow-up, the range of motion had returned to a functional level, with good uptake of graft, and no other complications. GCT of the hand is a rare presentation of the disease and requires meticulous workup, including a thorough clinical exam, hematological, radiological, and pathological workup. The various treatment modalities described in the literature for GCTs are curettage alone, curettage and bone graft, en-bloc resection, amputation, and resection with reconstruction, but curettage alone or curettage with bone graft is not effective even for GCTs of long bones and hand, too. Such a procedure creates a skeletal void and hence furthers the need for a challenging reconstructive procedure requiring reconstruction using autograft, allograft, or silastic (synthetic) implant.
Giant cell tumours of the hand managed by curettage and bone grafting: A short case series
International Journal of Orthopaedics and Physiotherapy
Giant cell tumours are rare entity and the one's involving the small bones of the hand are rarer still having an incidence rate of just 2% of all giant cell tumours. These lesions are often locally aggressive and have a tendency to recur. In this short case series we present five cases of giant cell tumours of the phalanx that initially presented as slow growing swelling of small bones of the hand and later on showed signs of increased growth and mild to moderate pain. All the patients were initially investigated by fine needle aspiration cytology which gave us the diagnosis of GCT and they were then investigated by an MRI to determine the soft tissue involvement. All the cases were managed by extended curettage and bone grafting and at one year of follow up have shown more or less full functional recovery without any signs of recurrence like pain or recurrence of swelling.
The bone & joint journal, 2013
Giant cell tumours (GCTs) of the small bones of the hands and feet are rare. Small case series have been published but there is no consensus about ideal treatment. We performed a systematic review, initially screening 775 titles, and included 12 papers comprising 91 patients with GCT of the small bones of the hands and feet. The rate of recurrence across these publications was found to be 72% (18 of 25) in those treated with isolated curettage, 13% (2 of 15) in those treated with curettage plus adjuvants, 15% (6 of 41) in those treated by resection and 10% (1 of 10) in those treated by amputation.
Management of Giant Cell Tumors in Hand and Foot
Indian Journal of Surgical Oncology, 2020
The aim of this study is to determine the treatment modalities and clinical characteristics of 12 patients diagnosed with giant cell tumor (GCT) of the hand and foot. The clinical findings, treatment modalities, and treatment failures of 12 patients with giant cell tumors of the hand and foot bones between 2007 and 2018 years were evaluated retrospectively. The average age at diagnosis was 29.2 ± 14.9 std. (between 16 and 62 years old), 8 males (66.6%) and 4 females (33.3%). Tumor was more frequently located in the talus, metacarpal, and metatarsal bones. The mean tumor size was 3.1 ± 1.1 cm (between 2.2 and 5.3 cm). The mean post-operative follow-up period was 76.3 ± 42.5 (between 12 and 139 months). The most of patients' (58.3%) common complaints were pain. The most commonly used surgical method was curettage + autografting (91.7%). Infection was seen in one patient after relapse surgery. Recurrence occurred in 33.3% of the patients in the first year. Only one patient was detected to have knee and lung metastases. Swelling and pain in the hand and foot should be examined for tumor lesions. When a bone lesion is detected, the giant cell tumor of the bone should be included in the differential diagnosis. Patients with giant cell tumors should be followed closely for recurrence and metastasis after treatment.
Giant cell tumours of the hand
Journal of Hand Surgery-british and European Volume, 1996
A study of seven cases of giant cell tumours of the hand is reported. All tumours were treated by an en bloc excision of the tumour or by whole ray resection. En bloc resection of the tumour and reconstruction with a fibular graft where necessary should be considered as the treatment of choice in giant cell turnout of the hand.
Giant cell tumor of the hand: Superior results with curettage, cryosurgery, and cementation
The Journal of Hand Surgery, 2001
At our institution giant cell tumors arising in all locations are treated with curettage, cryosurgery, and cementation to avoid resection or amputation, increase local tumor control over curettage alone, and avoid the morbidity associated with immobilization. We report the oncologic and functional results of 3 patients with giant cell tumors arising from the tubular bones of the hand who were treated in this manner. At a mean follow-up period of 54 months there were no local recurrences. No patient complained of pain. Digital range of motion and grip strength were within normal limits for all 3 patients. All patients returned to their previous occupational and recreational activities. One instance of minor wound necrosis was successfully treated conservatively. There were no other complications (fractures, infections, neuropraxias, or vascular damage). Curettage, cryosurgery, and cementation performed by experienced surgeons appears to be a safe, effective, and reliable method for treating selected giant cell tumors of the hand. (J Hand Surg 2001;26A:546 -555.
Giant Cell Tumor of Tendon Sheath of the Hand: Experience With Forty-Seven Cases
Shafa Orthopedic Journal, 2015
Background: Giant cell tumor of the tendon sheath (GCTTS) is the most common benign tumor of the hand following the ganglion cyst. It is more prevalent in women in third through fifth decades of life. Objectives: The aim of the study was to investigate the demographic and clinical characteristics as well as the rate of recurrence of GCTTS in an Iranian population. Patients and Methods: Medical records of 47 patients with GCTTS were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Plain X-rays, magnetic resonance, and ultrasonographic images were observed. Patients were asked about the recurrence of the GCTTS after mean interval of 4.9 ± 2.6 years. Results: Females were predominantly involved (70.2%). Patients aged 38.5 ± 16.2 years at the time of surgery. The middle finger was the most common site of the lesion (27.6%) followed by index finger (25.5%) and thumb (21.3%). The volume of the lesions averaged 3.9 ± 5.5 cm 3. The GCTTS had invaded the skin (1 patient), bone (1 patient), tendon pulley (6 patients), tendon (4 patients), and digital nerve (2 patients). Osseous erosion was found in two patients. After exact excision, the tumor recurred in four patients (8.5%). None of the variables affected the risk of recurrence. Conclusions: The characteristics of our patients were greatly similar to the previous studies. Exact and complete excision of the lesion under magnification was the keystone of decreased rate of GCTTS recurrence.
2015
Introduction: GCT is a bone tumor involving epiphyseal area of bone abutting the subchondral bone. Commonly found in long bones like proximal tibia and distal femur. We report a case of GCT of proximal phalanx of thumb in a 42 year old male patient. Case report: A 42 years old male presented to us with a swelling in lt thumb region which was gradually progressive for last 6 months. There was no associated trauma. On examination, it was fusiform in appearance and was located over proximal phalanx. X rays showed an expansile lytic lesion involving whole of proximal phalanx with an articular breakage. We went for a surgical procedure and proximal phalanx along with whole mass was disarticulated and double arthrodesis of distal interphalangeal joints and metacarpophalangeal joints with iliac crest tricortical graft was done. Conclusion: GCT is an aggressive tumour and potentially malignant lesion. Usually it presents as a solitary lesion but when GCT occur in hand it frequently cause se...
Giant Cell Tumor of Bone: Six Years Institutional Retrospective Review, 2020
Introduction Surgery is the cornerstone for the management of giant cell tumors (GCTs). There are no definite guidelines for the management. The purpose of this series was to study the patient demography and results of the surgical intervention for skeletal GCTs in our population. Methods All the histologically diagnosed cases of GCT of bone from year 2012 to 2018 were retrospectively analyzed for patient demographics, site, and grade of the lesion, type of biopsy taken (if any), nature of surgical intervention, and final outcome with respect to complications. Results Seventeen cases of skeletal GCT were diagnosed on histopathology. The mean age at presentation was 31.5 ± 10.9 years with females affected 1.4 times more. Proximal tibia was the most common site (29.4%) followed by distal radius and dis-tal femur in that order. About 58.8% of the lesions were of Campanacci grade 2 and remaining were grade 3 lesions. Ten patients had extended curettage, five had en bloc resection, and one had amputation as the primary treatment. Twenty percent patients (n = 3) had local recurrence of the pathology and one patient developed distant recurrence (lung metastasis). Conclusion Proximal tibia followed by distal radius was the most common site of GCT in our population. The tumor behavior and recurrence cannot be predicted with any grading system. The goal should be salvage of the joint by intralesional curettage, with resection reserved for distal radius GCTs, cases with extensive soft tissue extension or those with destruction of the articular cartilage and joint involvement.
Giant cell tumor of the metacarpal bones
Indian Journal of Orthopaedics, 2011
Giant cell tumor (GCT) of hand bones is rare. We present two cases of GCT of metacarpal bone. One case was treated successfully with ray amputation. The second patient underwent wide resection and tricortical iliac crest bone grafting. Till the last follow-up (at 26 and 70 months respectively) both patients have been recurrence free and have returned to their previous occupational activities.