Giant cell tumor of the capitate

Giant Cell Tumor of the Capitate and Hamate: Case Report and of Literature Review

Background  In the hand, giant cell tumors (GCTs) of the bones account for 2 to 5% of all hand tumors; they are often seen in the metacarpals and phalanges, seldom in the carpal bones. In the carpal bones, GCT usually occurs as a single lesion, with multifocal involvement being extremely rare. On analysis of recent English literature, we could find out only two reports having simultaneous involvement of multiple carpal bones. Case Description  We report a case of a 29-year-old female with simultaneous involvement of two carpal bones: capitate and hamate. After confirming the diagnosis by histopathological examination, the affected carpals were resected, and the defect was filled with autologous bone graft. Follow-up at 18 months demonstrated no evidence of local recurrence or metastatic disease, and the patient is now having a reasonable hand function. Literature Review  We analyzed nine case reports on GCTs in carpal bones in the past 25 years. Seven out of nine cases that we could analyze showed single carpal bone involvement (three capitate, two scaphoid, one hamate, one triquetrum). In these, four patients had undergone resection, and five patients had undergone curettage, of whom one patient came back 5 months later with recurrence. Only two cases were there with simultaneous involvement of multiple carpal bones. Both the cases were managed with resection and reconstruction with autologous graft iliac graft. Clinical Relevance  GCTs of the carpal bones are relatively rare, and simultaneous involvement of two bones is rarer. Every attempt should be made to preserve useful wrist range of motion by excision and limited carpal fusion.

Third-Ray and Capitate Resection with Limited Midcarpal Fusion for Recurrent Giant Cell Tumor: A Case Report

CASE

We describe a 23-year-old man who had multiple recurrences of a giant cell tumor (GCT) of the third metacarpal. Initial treatments consisted of curettage without the use of an adjuvant and bone-grafting. At the time of the latest recurrence, the lesion had extended into the capitate and the trapezoid. Treatment included third-ray resection and limited midcarpal fusion. No local recurrence was identified at more than 1 year after surgery.

CONCLUSION

GCTs of the hand should be aggressively treated, but care should be taken to preserve function whenever possible.

Recurrent Adolescent Giant-Cell Tumor of the Scaphoid: Scaphoid Excision with Intracarpal Fusion after Failed Curettage and Bone Grafting

We present a case of the giant-cell tumor of bone in the scaphoid of a 17-year-old female. Imaging revealed an expansile lytic lesion of her scaphoid, and the diagnosis was confirmed with open biopsy. She was treated with curettage and iliac crest bone graft, in an effort to spare reconstruction of her wrist. After one year, she developed increasing tightness and pain. Local recurrence was apparent on radiographs, and CT revealed increased lucency with bony destruction in the area of prior excision. She was successfully treated, without recurrence to date, with complete scaphoid excision and a four-corner wrist fusion. Local recurrence of the giant-cell tumor of bone is high, especially in carpal bones. When treating patients with advanced lesions, more aggressive initial options should be considered.

Giant Cell Tumor of the Capitate Bone

This case report describes a 16-year-old female patient with a giant cell tumor in her right capitate bone. The tumor was removed by intralesional curettage. A high-speed burr was used to extend the margins of the curettage, and alcohol irrigation was used for adjuvant therapy. The cavity of the capitate was filled with allogenic bone graft. There was no recurrence after 2 years of follow-up, and the right wrist radiographs demonstrated healing of the lesion.

Giant Cell Tumor of the Capitate Treated with Excision and Midcarpal Fusion

Background  Giant cell tumor (GCT) of bone is rare in the carpus, and only 11 cases have been reported in the capitate bone. The problem with this location is the high recurrence rate due to easy extension to the adjacent joint spaces and bones. We describe a case of GCT on the capitate bone and the treatment in comparison with the previously reported cases. Case Description  The case report concerns a 48-year-old woman with a GCT of the capitate diagnosed on curettage. The treatment consisted of large resection with the lunatum and third metacarpal arthrodesis, with a successful union at 2 years follow-up, no recurrence, and an improved function of the wrist. Literature Review  When treated by curettage (alone or with adjuvant procedures), the GCT of the capitate recurred in four out of five cases. All tumors treated with large resection did not recur. Clinical Relevance  Recommended treatment of GCT of the capitate is resection with carpometacarpal arthrodesis.

An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone

A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometacarpal (CMC III) joint were carried out. Third, due to a secondary midcarpal osteoarthritis and a secondary scaphoid nonunion, the CMC III joint fusion plate was removed and the midcarpal joint completely excised. Fourth, in the absence of recurrence of GCT, a four-corner fusion (4CF) with a corticocancellous iliac crest bone graft and complete excision of the scaphoid bone had to be performed. Fifth, a total wrist arthroplasty (TWA) was performed due to hardware failure of 4CF with migration of a headless compression screw into radiocarpal joint which led to erosion of articular surface of the distal radius. At the 3-year follow-up that includes a 1-year follow-up after TWA, there was no recurrence of GCT, and the TWA was not failed. The patient reported that she would have the motion-preserving TWA again.