Rare site giant cell tumors: report of two cases on phalanges of the finger and review of literature

Giant cell tumor (GCT) of bone arising from a phalanx of a finger is extremely rare. We report two cases of GCT arising from a phalanx of a finger. One case presented with recurrence following the amputation of the left ring finger (performed elsewhere). He was treated successfully with ray amputation. The other case was treated primarily by intralesional curettage and autogenous bone graft. At their most recent follow-ups (80 and 24 months, respectively), both were recurrence free and had returned to their previous occupational and recreational activities.     

Tuberculosis of the metacarpals and phalanges of the hand

Skeletal tuberculosis (TB) is less common than the pulmonary form. Involvements of the metacarpals and phalanges of the hand are infrequent. The authors report their experience with treatment and outcome of TB of the metacarpals and phalanges of the hand in 7 patients. There were 4 women and 3 men in the study who ranged in age from 3 to 60 years (average age, 22.7 years). The duration of complaints at presentation ranged from 4 to 17 months (average, 9 months). The most common presentation was pain and swelling. The presumptive preoperative diagnoses were bone tumor in 4 patients, spina ventosa in 2, and chronic pyogenic osteomyelitis in 1 patients. The results of the laboratory examination showed a mild increase in the erythrocyte sedimentation rate. No patient had an active tubercular lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. No patient had bony debridement or arthrodesis to control the infection. The treatment of all patients began with a 4-drug regimen for 2 months, followed by a 2-drug regimen for 10 months. The mean follow-up was 30.28 months (range, 16-52 months). At the time of the last follow-up, all lesions had healed with no recurrence. The functional results were satisfactory in all patients. One patient with thumb metacarpophalangeal TB had joint irregularity and thumb metacarpal shortening. Arthrodesis was not needed in any patient. TB of the metacarpals and phalanges of the hand can be difficult to diagnose during the early stages. TB should be suspected in cases of long-standing pain and swelling in the metacarpals and phalanges. It is necessary to keep TB in mind when making the differential diagnosis of several osseous pathologies.     

Experience with giant cell tumors

Authors describe, 64 cases of giant-cell tumour. 5 (9 per cent) was found in the latent, 32 (50 per cent) in the active and 27 (41 per cent) in the aggressive stage when first seen. The operative methods are described and these are determined first of all by the surgical stage of the giant-cell tumour, its size and localization, by the age of the patient and whether primary tumour or a recurrence is found. Based on their experiences, excochleation and filing is suggested in the latent and active stage of this tumour. In tumours in the agressive stage the so called wide resection in the healthy tissue is reasonable. In the rare malignant giant-cell tumour radical resection is suggested. Recurrence was found in 29 per cent after the first operation. Follow-up examinations show that 64 per cent of the patients is symptom free, in 33 per cent the main source of complaints is the consecutive arthrosis, 2 patients were lost in consequence of lung metastasis.     

Fractures of the phalanges of the hand in children.

Fractures of the phalanges of the hand were studied in 203 children. Fingertip fractures caused disability for three weeks but usually had good results. Comminuted fractures often took the form of longitudinal splitting. Epiphyseal fractures were mostly of the Salter type 2 and metaphyseal types and usually had good results: remodelling occurred in both planes at the base of the proximal phalanx but only in the sagittal plane at the base of the middle phalanx. Epiphyseal fractures at the base of the distal phalanx often had unsatisfactory results. Fractures of the neck of phalanx showed no remodelling at all and if deformity is not corrected it is probably permanent.     

Recurrent giant cell tumors of the tendon sheath

Seventy patients underwent surgical excision of a giant cell tumor of the tendon sheath. The patients were monitored for an average of 3 years 4 months. Nineteen of the 70 patients (27%) had a surgically and histologically documented recurrence at an average of 2 years 3 months (range, 3 months to 10 years) following the initial procedure. Eight of 19 patients (42%) with recurrence had a prior recurrence. Statistically significant risk factors for recurrence included presence of adjacent degenerative joint disease, location at the distal interphalangeal joint of the finger or interphalangeal joint of the thumb, and radiographic presence of an osseous pressure erosion. Age, gender, size, and location within the digit (volar vs. dorsal) were not risk factors for recurrence. Awareness of these associations should be reflected in the surgeon's approach and preoperative discussion with the patient.     

Vascular cell tumors of the hand in children

The diagnosis of vascular cell tumors of the upper limb in children can be extremely difficult. There is considerable variation in their presentation and natural history. In most instances, the correct diagnosis can be achieved after a careful history and examination. Almost invariably, they are benign lesions and, of these, hemangiomas and vascular malformations account for more than 90%. Worrying tumors of the intermediate and malignant grade are rare. Any atypical, rapidly growing tumor with superficial ulceration and bony destruction on radiology should be regarded as malignant. Histologic differentiation of all problematic vascular swellings requires the services of an experienced pediatric vascular pathologist. In the future, specific cellular marker profiles of individual lesions may simplify the diagnosis. Conservative, symptomatic management is the first line of treatment for almost every vascular swelling. Intervention is reserved for swellings complicated by ulceration, uncontrollable rapid growth, coagulopathies, cardiovascular compromise, or the possibility of malignancy. Small lesions may generally be simply excised, whereas larger lesions often remain a problem.     

Arthroplasty for tenosynovial giant cell tumors

Background and purpose — Tenosynovial giant cell tumors (t-GCTs) can behave aggressively locally and affect joint function and quality of life. The role of arthroplasty in the treatment of t-GCT is uncertain. We report the results of arthroplasty in t-GCT patients.

Patients and methods — t-GCT patients (12 knee, 5 hip) received an arthroplasty between 1985 and 2015. Indication for arthroplasty, recurrences, complications, quality of life, and functional scores were evaluated after a mean follow-up time of 5.5 (0.2–15) years.

Results — 2 patients had recurrent disease. 2 other patients had implant loosening. Functional scores showed poor results in almost half of the knee patients. 4 of the hip patients scored excellent and 1 scored fair. Quality of life was reduced in 1 or more subscales for 2 hip patients and for 5 knee patients.

Interpretation — In t-GCT patients with extensive disease or osteoarthritis, joint arthroplasty is an additional treatment option. However, recurrences, implant loosening, and other complications do occur, even after several years.     

Fractures of the shafts of the phalanges of the hand.

Fractures of the shafts of the phalanges are common and often disabling. Little detailed information is available as to the results of treatment, against which new methods of treatment may be compared. Thirty-nine comminuted fractures and 109 which were not comminuted were followed-up and their results are presented in detail. In both groups only about 57% obtained satisfactory results. Possible methods of improving these are discussed and the importance of accurate reduction of non comminuted fractures is emphasised.     

Metatarsal giant cell tumors and giant cell reparative granuloma are similar entities

Light and electron microscopic investigations and studies of the resorption ability in vitro of giant cells were done in two patients with giant cell osteolytic lesions of metatarsal bone. Giant cells harvested from both patients were similar in morphologic features and ability to resorb dentin. After other diagnoses of osteolytic lesions of metatarsal bone were ruled out, one lesion was considered a giant cell reparative granuloma and the other a true giant cell tumor of bone. Clinical, radiologic, ultrastructural, functional studies, and data in the literature, indicated that giant cell reparative granuloma only can be differentiated from giant cell tumor by younger age at diagnosis and the occurrence of giant cell clusters. All other features (cortical erosion, high rate of recurrence, hemorrhage areas, predominant intercellular collagenous substance) are characteristic of both lesions. If these two giant cell lesions are different entities, more accurate means are needed to distinguish them.