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

Treatment of a Carpal Giant Cell Tumor of Bone With Curettage and Cemented Capitohamate Fusion

Carpal giant cell tumor of bone spanning multiple bones is a rare condition. We present a case of a man in his fifth decade with wrist pain who was found to have giant cell tumor of bone involving his capitate and hamate bones. This condition was successfully treated with intralesional curettage, argon beam coagulation, chemical cauterization and a cemented limited carpal fusion with satisfactory outcomes and no recurrence at 1-year postoperative follow-up.

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

Various pathologies of the adult carpus result in clinical scenarios where excision can be considered and even recommended. In the appropriate patient population, isolated carpal excision can alleviate pain and improve mobility. Excisions of the pisiform, trapezium, and trapezoid have abundant literature evidence to support positive long-term functional outcomes. In contrast, isolated excision of the capitate, hamate, and triquetrum has limited support in the literature secondary to compromise of carpal mechanics and lead to recurrent pain. Additionally, isolated scaphoid and lunate excision are best avoided secondary to carpal collapse and should be paired with concomitant stabilizing procedures in the carpus. This article provides a comprehensive literature review of isolated excision of each osseous carpal bone, their indications, and previously assessed outcomes.

Multifocal giant cell tumor of the carpus: Unusual presentation. Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Giant cell tumors (GCTs) of bone in the carpus are rare. Carpal GCTs are usually solitary lesions; multifocal involvement is exceptional. These lesions have a higher risk of local recurrence after intralesional curettage than those in other body areas.

CASE PRESENTATION

We present a case of a 28-year-old male with a six-month history of a palpable mass in the dorsal aspect of the left wrist. Physical examination revealed a 2 cm, mildly tender mass. Magnetic resonance revealed a large intermediate signal lesion involving completely hamate bone and the distal portion of the triquetrum. Histological examination confirmed a giant cell tumor of the carpus. The patient underwent en-bloc resection of the hamate bone extending to the distal part of the pyramidal. The defect was reconstructed using polymethylmethacrylate cement (PMMA), and intercarpal arthrodesis with the capitate was achieved. Follow-up at 18 months revealed a good clinical evolution, wrist range of motion of 30° of extension, 30° of flexion, and 10° of ulnar and radial deviation without evidence of tumoral recurrence.

CLINICAL DISCUSSION

The current literature suggests a high incidence of local recurrence in carpal GCT, so wide excision with carpal arthrodesis is recommended, especially in Campanacci III and multifocal involvement.

CONCLUSION

Carpal GCT is exceptional, mainly affecting the hamate, capitate, and scaphoid. Most literature supports wide excision of carpal GCT owing to the high recurrence rate with intralesional procedures.