Giant cell tumor of talus: a case report

En bloc resection and reconstruction using a talar prosthesis for malignant talar bone tumor: a surgical technique

En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis.

Reconstruction after Talar Tumor Resection: A Systematic Review

This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases identified 156 studies, of which 20 (23 patients) were ultimately included. The mean Musculoskeletal Tumor Society scores in the groups reconstructed using tibiocalcaneal fusion (n = 17), frozen autograft (n = 1), and talar prosthesis (n = 5) were 77.6 (range 66-90), 70, and 90 (range 87-93), respectively. Regarding complications, sensory deficits were observed in one patient (6%) and venous thrombosis in two patients (12%) in the tibiocalcaneal fusion group, while osteoarthritis was observed in one patient (100%) in the frozen autograft group. No complications were observed in the talar prosthesis group. Reconstruction with talar prosthesis seems preferable to conventional tibiocalcaneal fusion after talar tumor resection because it offers better function and fewer complications. However, as this systematic review included only retrospective studies with a small number of patients, its results require re-evaluation in future randomized controlled trials with larger numbers of patients.

Giant cell tumor with secondary aneurysmal bone cyst of the left calcaneus

Introduction and importance

Giant cell tumors (GCT) of the feet bones are rare, comprising of <1 % of cases. The lack of well-documented cases and similarity with other tumors under radiologic and histological evaluation makes diagnosis difficult. Current treatment modalities for GCT still result in a relatively high recurrence rate, making the overall management of the case a challenge. We reported a 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application.

Case presentation

A 27-year-old male presented with lump on the left heel since seven months before admission. Physical examination demonstrated solid, palpable mass on the left heel region and limited ankle motion. Magnetic resonance imaging examination demonstrated expansile bone tumor at the left calcaneus with cystic components building fluid levels and hemorrhagic components, suggestive of giant cell tumors with secondary ABC. The patient is diagnosed with giant cell tumor with secondary ABC of the left calcaneus Campanacci grade 2. The patient was managed limb salvage surgery by curettage and subsequent mix of femoral head allograft and bone cement application to fill the defect.

Discussion

Conservative surgery via careful curettage is typically preferred for lower Campanacci grade lesions followed by bone reconstruction. In terms of filling bone defects, it is known that both bone cement and allografts have advantages and disadvantages. We hence decided to perform limb salvage surgery via curettage due to the size of the tumor and bone reconstruction using a mix of femoral head allograft and bone cement to fill the defect.

Conclusion

Curettage and bone allograft with bone cement reconstruction is an option for surgical management of lower Campanacci grade 2 GCT of the calcaneus.

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A 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC)

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GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application.

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Conservative curettage, followed by bone allograft application is effective and safe to manage lower Campanacci grades of giant cell tumors of the calcaneus

Management of Giant Cell Tumor of Talus With Extended Intralesional Curettage and Reconstruction Using Polymethylmethacrylate Cement

An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.Level of Evidence: Level V.

Bone Tumours of the Talus: 18-Year Cohort of Patients With Rare Osteoid Lesions

Background Bone tumours of the talus are a rare cause of ankle pain. This study aims to provide additional clinical clarity regarding the presentation and management of a minimally researched topic. Methods Sixteen patients were diagnosed with bone tumour of the talus between 2002 and 2020 following referral for ankle pain. Symptoms, diagnosis, and management were retrospectively reviewed. Patients were actively followed up until consistently symptom-free and consenting to discharge (mean of 2.9 years). An open appointment was offered to all patients to reattend the unit if symptoms recurred. Results The most common diagnosis was osteoid osteoma/osteoblastoma (nine patients), chondroblastoma (four patients), a giant cell tumour of bone, a chondral lesion in Ollier's disease and a rare metastatic renal cancer case. The mean age of onset was 29 years. Thirteen patients experienced ankle pain without a clear precipitating cause. Night pain was less common in osteoid osteoma/osteoblastoma than usually observed in the literature. The mean delay in diagnosis was two years, often due to an incorrect diagnosis of soft tissue injury. Plain radiographs are insufficient to identify most lesions. Ten patients underwent computed tomography (CT)-guided radiofrequency ablation and five patients had open surgical curettage. Ollier's disease was managed with orthotics. The five cases of recurrence across four patients were managed operatively. Conclusions Patients are usually young and healthy with benign disease, but talus tumours can cause significant functional impairment. Unexplained ankle pain should be extensively examined and be further investigated with magnetic resonance imaging (MRI) and CT scanning to avoid missing these rare tumours.

Management and retrospective analysis of tumors and tumor-like lesions localized in the talus

OBJECTIVES

This study aims to investigate the characterization and follow-up results of tumors and tumor-like lesions in the talus.

PATIENTS AND METHODS

Twenty-one patients (15 males, 6 females; mean age: 31.6±17 years; range, 4 to 67 years) with benign and malignant tumors or tumor-like lesions in the talus region treated and followed in our clinic between January 2007 and January 2019 were evaluated retrospectively. Radiological, pathological, surgical, and demographic features were scanned from the database.

RESULTS

Patients were followed for mean 80±45.1 (range, 25 to 156) months. The most common complaint was pain and antalgic gait. Benign bone tumors were found in 15 (71%) of 21 patients, while tumor-like lesions (two intraosseous ganglia, osteomyelitis, and bone infarction) were found in four patients. The remaining two were patients with lung and bladder cancer metastasis. Lesion size was mean 2.1±0.5 (range, 1.1 to 3.3) cm. Recurrence developed in 14.3% (n=3) of the patients during follow-up.

CONCLUSION

The talus is a rare location for tumors; however, benign and malignant tumors and tumor-like lesions may be localized in the talus.

Giant cell tumor of the talus: A case report

Giant cell tumor is a benign primary bone neoplasm which most often occurs in a periarticular location. Involvement of the bones of the foot and ankle is rare, and there have been a limited number of previous case reports involving the talus. Here we report a case of giant cell tumor of the talus, which was initially radiographically occult in a 43-year-old female, with emphasis on MRI imaging characteristics. The patient underwent surgical excision and curettage. Histological examination revealed the presence of spindle cells admixed with giant cells, confirming GCT. We further provide an overview of the radiological findings of GCT.

Giant cell tumor is a benign bone neoplasm of mesenchymal origin, identified by multinucleated giant cells [1]. GCT is locally aggressive and can destroy adjacent bone and articulations. The most commonly affected bones are the distal femur, proximal tibia, and distal radius, with an epiphyseal predominance in 90% of cases [2]. Presentations are mostly mono-ostotic, however multicentricity may occur in younger patients [3]. Very few cases have been reported in the bones of the feet, an incidence of 1%-2% have been previously reported [4].

GCT is seen between ages 20 and 40 years, with a 56% predominance in females [3]. Although benign, 1%-9% cases may “metastasize” to the lungs. The initial treatment is surgical removal, either en bloc, or more commonly intralesional curettage and the use of adjuvants. Even after resection, GCT has a high recurrence rate [2]. The trigger for GCT is currently unknown. However, a majority of cases have cytogenetic abnormalities of telomeric associations (tas). Involvement of the RANK pathway is also believed to contribute to the pathogenesis of GCT [2].

Reconstruction with β-tricalcium phosphate for giant cell tumor of the talus

Giant cell tumor of bone (GCTB) is a locally aggressive tumor, commonly occurs in the long bones, and is rare in the talus and the foot. The talus is a weight-bearing bone and strut reconstruction is preferred. Reconstruction with low porosity β-tricalcium phosphate (β-TCP) blocks is reported for GCTB in the knee. In the current report, a 25-year-old female suffered from GCTB in the talus extending to the subchondral bone. The tumor was treated by curettage and the bone was reconstructed with low porosity β-TCP blocks, which have strong compressive strength. The implanted β-TCP blocks were incorporated successfully. The current reconstruction method can be applied for GCTB in the talus.

Management of aggressive giant cell tumor of calcaneal bone: A case report

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This is an advanced case of aggressive GCT of calcaneus.

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It is not only a rare case but also an interesting diagnosis and surgical management.

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Limb salvage surgery which consists of wide excision-total calcaneoctomy, followed by reconstruction with femoral head allograft and soft tissue coverage with sural flap is a good option.

Introduction

Prevalence of giant cell tumor (GCT) at atypical locations like bones of the feet are rare, seen in <1% of cases. GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Difficult diagnosis most often followed with complicated management and high recurrence rate remains a challenge that is rarely reported.

Presentation of case

We presented a case of forty-six-year-old male patient with giant cell tumor of the right calcaneus Campanacci 3 with secondary aneurysmal bone cyst (ABC). Wide excision total calcaneoctomy, followed by reconstruction bone defect using femoral head allograft and soft tissue coverage with sural flap had been done.

Discussion

Conservative surgery with careful curettage and placement of bone cement should be considered the treatment of choice when feasible. However, aggressive GCTs may require wide excision and reconstruction or may be amputation. We decided to do salvage surgery since: traditionally curettage is not possible, adequately wide resection of local tumor could be achieved, neurovascular bundle was not involved, and also bone and soft tissue reconstructions could be done. In addition, he refused for amputation.

Conclusion

Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation.

Imaging findings of various talus bone tumors-clinico-radiologic features of talus bone tumors

Osseous neoplasms of the foot are uncommon, accounting for only 3.3% of all primary bone tumors. Bone tumors of the talus are even rarer, and there are not many publications that comprehensively evaluate the imaging findings of talus tumors. The purpose of this article is to review the benign and malignant bone tumors affecting this uncommon site and to describe the clinical and radiologic features of each tumor.

Giant Cell Tumor of the Talus: 19-Year Follow-Up of a Patient

Giant cell tumor in small bones is a rare condition characterized by extensive bony destruction and a high recurrence rate. Intralesional excision with curettage and autologous bone grafting has been used as a standard treatment method for giant cell tumor of the bones. We report the case of a 30-year-old female with giant cell tumor of the talar body. She was followed up for 19 years after intralesional curettage and autologous bone grafting treatment.

Extended curettage and adjuvant therapy for benign tumors of the talus

PURPOSE

Benign tumors of the talus are rare, and their management is controversial. Recent efforts have extended the safety margin of intralesional excision and curettage by chemical and physical means. Cryotherapy as adjuvant therapy is associated with risks of local wound and bony complications (delayed healing, potential for pathological fractures).

METHODS

We retrospectively reviewed six cases of benign talar tumors (three giant cell tumors, two aneurysmal bone cysts, one osteoblastoma) treated by extended curettage and adjuvant cryotherapy. Talar bone stock was restored by bone grafting the residual cavity with fibular strut grafts and/or cancellous bone grafts. Patients were followed for a mean of 40 months.

RESULTS

At latest follow-up, each patient had a mobile painless ankle and good functional outcome. No patient experienced recurrence or complications related to cryotherapy.

CONCLUSIONS

Intralesional extended curettage with bone grafting and cryotherapy is a successful, safe, and efficient treatment of benign tumors of the talus.

Aggressive giant cell tumour of talus with pulmonary metastasis-a rare presentation

Giant cell tumour (GCT) is a primary benign neoplasm of bone. It is classically described as a locally invasive tumour that occurs close to the joint of a mature bone. It accounts for 5% of all skeletal tumours. It usually originates from long bones. Giant Cell Tumour of the small bones of the hand and foot are relatively uncommon. Giant Cell Tumour of talus is a rare occurrence. We report a rare presentation of giant cell tumour of the talus in a 62-year-old farmer treated by talectomy and tibiocalcaneal fusion, who later presented with features suggestive of recurrence and secondaries in chest within six months following surgical resection of the primary. Below knee amputation was performed to manage the recurrence. At two years follow-up the patient showed no further progression of pulmonary metastasis or local recurrence.

Primary aneurysmal bone cyst of talus

Aneurysmal bone cyst (ABC) of the talus is an extremely rare lesion; less than 20 cases have been reported in PubMed till 2012. We report a primary ABC of the talus in a 20-year-old male that was managed by extended intralesional curettage with phenol as an adjuvant and autologous cancellous iliac crest bone grafting. The patient had excellent functional outcome and there was no recurrence at 2 years of follow-up.