Giant cell tumor of the thumb proximal phalanx: resection-iliac graft and double arthrodesis

Giant cell tumours (GCT) of bone are frequent, with variable behaviour, high risk of recurrence and an often benign histological appearance. Their location in the hand is uncommon, and there are few publications on the subject. Surgical treatment as described in the literature is very variable. We report a case of recurrent grade II GCT, arising in the proximal phalanx of the thumb, aggressive and causing a pathological fracture. After a surgical biopsy, we performed an "en bloc" resection of the first phalanx, with an iliac crest graft reconstruction and a double arthrodesis of the metacarpophalangeal and interphalangeal joint. No recurrence or lung metastasis was seen at 18 months follow-up.     

Giant cell tumor of distal phalanx of great toe. A case report

Giant cell tumors are locally aggressive benign osseous neoplasms of unknown origin. They mostly occur after skeletal maturity in 3rd or 4th decade and commonly involve long bones although occasional occurrence at other sites has been reported. It is rare to see these tumors involving the phalangeal bone of foot. We report a case of giant cell tumor involving the distal phalanx of great toe in a 27 year old female who presented with swelling of great toe of right foot. Radiography showed an expansile lesion in distal phalanx of great toe. En bloc resection of phalanx was done. Biopsy showed giant cell tumor and regular follow up of this patient for two years showed no recurrence of tumor. Giant cell tumor at such a location is unusually aggressive and needs regular follow up to detect local recurrence.     

Giant cell tumour of the distal phalanx of the hand.

Giant cell tumour of bone in the phalanx of the hand is extremely rare. A case of giant cell tumour of distal phalanx treated with a ray amputation is presented.     

Giant cell tumor of the rib

We experienced a rare case of giant cell tumor (GCT) arising in the 5^th rib involving the 5^th vertebral body and transverse process. A 57-year-old man presented with a well-defined mass in the left thoracic cavity on chest x ray examination. Chest computed tomography showed a heterogeneous 7cm-diameter mass originating in the posterior segment of the left 5^th rib. The tumor had spread to the 5^th thoracic vertebra destroying the left half of the body and transverse process. Magnetic resonance imaging showed a heterogeneous-intensity mass involving the 4^th to 6^th ribs. A radical excision of the tumor followed by a 50 Gy radiotherapy was performed after embolization of the feeding arteries. The pathological diagnosis was a GCT. The patient remains well without evidence of recurrence for 6 years following surgery. The present case is only the 14^th case of GCT arising in the rib to have been reported in Japan.     

Giant cell tumor of the skull

A 23 year-old female had a giant cell tumor originating in the right temporal bone. A diagnosis was maed by biopsy. Microscopically it was sarcomatous in part. Two courses of radiation therapy, each total dose being 6000 rads and 3000 rads in air, were employed with good subjective response for a short duration. However, the tumor involving the petrous bone and the mastoid process extended, invading the epipharynx and the clivus. The patient died one year after onset.     

Giant cell tumor of the spine

Giant cell tumors are benign but locally aggressive neoplasms that typically affect the extremities. When involving the spine, the tumors occur predominantly in the sacrum. Gross total resection of the tumor with wide margins yields good results in terms of survival. However, it carries a significant potential for morbidity and disability. Subtotal resection with adjuvant radiation carries a risk for recurrence or, more concerning, sarcomatous malignant transformation. Endovascular tumor embolizations have also been attempted to control unresectable tumors, and have been performed with moderate degrees of success. Outcomes are analyzed outcomes following surgery, radiation therapy, and tumor embolization.     

Giant cell tumor of the sternum

A primary giant cell tumor (GCT) originating from the sternum is extremely rare. We report a case of a GCT originating from the sternum in a 45-year-old man who was referred to us for a mass in the anterior chest wall that had been growing slowly. Computed tomography revealed a soft tissue mass involving a large osteolytic and destructive lesion of the sternum body. Subtotal sternectomy and reconstruction with methylmethacrylate were performed. The tumor was 8.5 × 4.5 × 2.5?cm, and the histopathological examination confirmed GCT. Radical wide resection of primary sternum tumors and reconstruction with an appropriately rigid prosthetic material are necessary to minimize local recurrence.     

Giant cell tumor of the skull

Two cases of giant cell tumor of the skull are reported. The first patient had a radical operation for a giant cell tumor of the temporal base followed by radiation therapy. The second patient had a partial removal of a giant cell tumor of the occipital bone followed by radiation therapy. The pertinent literature on giant cell tumors originating from the cranial bones other than the sphenoid bone is reviewed.     

Giant cell tumor of the rib

In a rare case of a giant cell tumor of rib origin, a 25-year-old woman to be evaluated for an abnormal mass shadow in chest radiography was strongly positive in a tuberculin skin test, but showed no evidence of active tuberculosis. Chest computed tomography showed a heterogeneous mass originating in the posterior end of the right fourth rib and containing multiple calcifications and cystic lesions. Magnetic resonance imaging showed a high signal intensity with low signal intensity areas. Bone scintigraphy showed an abnormal marked accumulation at the tumor site. A thoracoscopic examination was conducted prior to complete tumor resection, including the fourth rib and related muscles. The pathological diagnosis returned was a giant cell tumor of the bone. The patient did not undergo chemotherapy or radiotherapy, and remains well, and tumor-free at 6 months after surgery.     

Giant cell tumor of the rib

In a rare case of a giant cell tumor of rib origin, a 25-year-old woman to be evaluated for an abnormal mass shadow in chest radiography was strongly positive in a tuberculin skin test, but showed no evidence of active tuberculosis. Chest computed tomography showed a heterogeneous mass originating in the posterior end of the right fourth rib and containing multiple calcifications and cystic lesions. Magnetic resonance imaging showed a high signal intensity with low signal intensity areas. Bone scintigraphy showed an abnormal marked accumulation at the tumor site. A thoracoscopic examination was conducted prior to complete tumor resection, including the fourth rib and related muscles. The pathological diagnosis returned was a giant cell tumor of the bone. The patient did not undergo chemotherapy or radiotherapy, and remains well, and tumor-free at 6 months after surgery.     

Giant cell tumor of the capitate

A case of giant cell tumor of the capitate is presented. Its recurrence and the problem of reconstruction after resection are discussed. Recommended treatment of this tumor if it occurs within the carpals is resection of the carpus with intercarpal arthrodesis if the distal row is involved or proximal row carpectomy if the scaphoid or lunate is involved.     

Giant cell tumor of the spine

Six patients with giant cell tumor of the spine had surgery between 1981 and 1995. Three lesions were located in the scrum, two lesions were in the thoracic spine, and one lesion was in the lumbar spine. Preoperatively, all patients had local pain and neurologic symptoms. Two patients had cement implanted after curettage or intralesional excision of the sacral tumor; one patient had a local relapse. After the second curettage and cement implantation, the tumor was controlled. One patient with a sacral lesion had marginal excision and spondylodesis; no relapse developed. Two patients with thoracic lesions had planned marginal excision and spondylodesis; the margins finally became intralesional, but no relapse developed. One patient with a lumbar lesion had incomplete removal of the tumor and received postoperative irradiation. At the final followup (median, 69 months), five of six patients were disease-free and one patient died of disease progression. Two of the five surviving patients had pain after standing or neurologic problems. Although some contamination occurred, planning a marginal excision of the lesion seems beneficial for vertebral lesions above the sacrum. Total sacrectomy of a sacral lesion seems to be too invasive when cement implantation can control the lesion.     

Giant cell tumor of the capitate

Giant cell tumors are primary bone tumors most often observed in the metaepiphyses of long bones; location in the hand, especially the carpal bones, is rare. We report a patient with recurrent giant cell tumor of the capitate and discuss treatment and prognosis in this rare site.     

Giant cell tumor of the rib

We experienced a rare case of giant cell tumor (GCT) arising in the 5^th rib involving the 5^th vertebral body and transverse process. A 57-year-old man presented with a well-defined mass in the left thoracic cavity on chest x ray examination. Chest computed tomography showed a heterogeneous 7cm-diameter mass originating in the posterior segment of the left 5^th rib. The tumor had spread to the 5^th thoracic vertebra destroying the left half of the body and transverse process. Magnetic resonance imaging showed a heterogeneous-intensity mass involving the 4^th to 6^th ribs. A radical excision of the tumor followed by a 50 Gy radiotherapy was performed after embolization of the feeding arteries. The pathological diagnosis was a GCT. The patient remains well without evidence of recurrence for 6 years following surgery. The present case is only the 14^th case of GCT arising in the rib to have been reported in Japan.