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Abed Alharbi W, Mohammed Alshareef H, Hennawi YB, Munshi AA, Khalid Alzahrani A. Giant Cell Tumor in Tarsal Midfoot Bones: A Case Report. Cureus 2024; 16:e56215. [PMID: 38623116 PMCID: PMC11017238 DOI: 10.7759/cureus.56215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Diffuse tenosynovial giant cell tumor (D-TGCT), previously known as pigmented villonodular synovitis (PVNS), is a benign, aggressive, and distracting proliferative synovial lesion. D-TGCT is commonly seen in large joints such as the knee and hip. We present the case of a 57-year-old female who initially presented with swelling on the left midfoot that increased over four years. Clinically, a ganglion was suspected on the left midfoot and an MRI showed a heterogeneous lobulated soft tissue mass on the superior aspect of the tarsal midfoot measuring 5.8 x 2.4 x 4.2 cm. The mass causing remodeling and bony erosion was more appreciated at the medial aspect of the talus bone and extended to the sinus tarsi and talocalcaneal joint space. Surgical excision of the mass was performed, and pathology reports found lobulated soft tissue lesions composed of mononuclear cells, multinucleated giant cells, sheets of foamy macrophages, inflammatory cells, and hemosiderin-laden macrophages. This case represents D-TGCT without atypia or malignancy based on the findings.
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Bansal K, Singh J, Gupta P, Singh S, Kumar R, Singh S. Giant Cell Tumor: A Case Series of Seven Patients with GCT at Atypical Sites. J Orthop Case Rep 2023; 13:171-179. [PMID: 38025361 PMCID: PMC10664210 DOI: 10.13107/jocr.2023.v13.i11.4050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Giant cell tumor (GCT) represents 5% of all primary bone tumors and 20% of biopsy analyzed benign tumors. More than half of these lesions occur in the 3rd and 4th decades of life. There is no absolute treatment method selection. Techniques ranging from intralesional curettage to wide resection can be used. Goal is to eradicate the tumor, preserve limb function, and prevent local recurrence and distant metastasis. Case Report We are presenting seven cases of GCT at five different and rare sites involving tibia, calcaneum, metatarsal, proximal humerus, and clavicle with tumor being limited to bone in all seven cases not involving the soft tissue. There were three male patients and four female patients. Six patients underwent intralesional curettage using high-speed burr and curette, along with adjuvant irrigation with hydrogen peroxide and normal saline followed by polymethyl methacrylate reconstruction. One patient with GCT clavicle underwent wide resection. Results In all seven cases, we were able to able to remove the tumor completely. Six patients had a gradual and complete recovery with return to near normal activity within 6 month-1 year after surgery. One patient with proximal humerus GCT had a recurrence which got resolved with injection denosumab. All patients have been followed up for a minimum duration of 2 years. Conclusion Intervention in the early stages can avoid radical procedures such as wide local excision or amputation. We recommend aggressive surgical approach with close follow-up to detect recurrence if any, at an early stage.
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Affiliation(s)
- Kapil Bansal
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Jagdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Pranav Gupta
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Subeg Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rohit Kumar
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Supreet Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Kamal AF, Hilmy F. Giant cell tumor with secondary aneurysmal bone cyst of the left calcaneus. Int J Surg Case Rep 2022; 100:107697. [PMID: 36242890 PMCID: PMC9574781 DOI: 10.1016/j.ijscr.2022.107697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
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. A 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. Conservative curettage, followed by bone allograft application is effective and safe to manage lower Campanacci grades of giant cell tumors of the calcaneus
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fahresa Hilmy
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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Haje DDP, Silva CCD. Metatarsal Transfer Associated with Microsurgical Flap in Exposed Foot Fracture: A Case Report and 10-Year Follow-up. JBJS Case Connect 2020; 10:e1900604. [PMID: 32910572 DOI: 10.2106/jbjs.cc.19.00604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 35-year-old female patient presented with an exposed forefoot fracture with bone and dermal loss after a vehicular accident. There was a bone defect at the level of the second toe and the third metatarsal. She was treated by second toe resection and second metatarsal transfer to augment the third metatarsal diaphysis ray (nonvascularized, without any soft-tissue envelope) and a microsurgical forearm flap. CONCLUSION As one option among the reconstruction techniques available for a metatarsal segmental defect, metatarsal transfer associated with a fasciocutaneous radial forearm flap proved to be effective in this patient.
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Affiliation(s)
- Davi de Podestá Haje
- 1Hospital de Base do Distrito Federal and Centro Clinico Orthopectus, Brasília, DF, Brazil 2Centro de Ortopedia e Traumatologia de Brasília, Brasília, DF, Brazil
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Ozcan Akcal A, Ünal K, Gorgulu T, Akif Akcal M, Bigat Z. Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases. Microsurgery 2016; 36:598-603. [DOI: 10.1002/micr.30099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Arzu Ozcan Akcal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Kerim Ünal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Tahsin Gorgulu
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Bulent Ecevit University; Zonguldak Turkey
| | - Mehmet Akif Akcal
- Department of Orthopedic and Traumatology; Ataturk State Hospital; Antalya Turkey
| | - Zekiye Bigat
- Faculty of Medicine, Department of Anesthesiology and Reanimation; Akdeniz University; Antalya Turkey
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Kamal AF, Waryudi A, Effendi Z, Kodrat E. Management of aggressive giant cell tumor of calcaneal bone: A case report. Int J Surg Case Rep 2016; 28:176-181. [PMID: 27718436 PMCID: PMC5061111 DOI: 10.1016/j.ijscr.2016.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022] Open
Abstract
This is an advanced case of aggressive GCT of calcaneus. It is not only a rare case but also an interesting diagnosis and surgical management. 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.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Agus Waryudi
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Zuhri Effendi
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Evelina Kodrat
- Department of Anatomic Pathology Cipto Mangunkusumo National Central Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Hara H, Kawamoto T, Onishi Y, Fujioka H, Nishida K, Kuroda R, Kurosaka M, Akisue T. Reconstruction of the Midfoot Using a Free Vascularized Fibular Graft After En Bloc Excision for Giant Cell Tumor of the Tarsal Bones: A Case Report. J Foot Ankle Surg 2015. [PMID: 26213165 DOI: 10.1053/j.jfas.2015.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the case of a 32-year-old Japanese female with a giant cell tumor of bone involving multiple midfoot bones. Giant cell tumors of bone account for approximately 5% of all primary bone tumors and most often arise at the ends of long bones. The small bones, such as those of the hands and feet, are rare sites for giant cell tumors. Giant cell tumors of the small bones tend to exhibit more aggressive clinical behavior than those of the long bones. The present patient underwent en bloc tumor excision involving multiple tarsals and metatarsals. We reconstructed the longitudinal arch of the foot with a free vascularized fibular graft. At the 2-year follow-up visit, bony union had been achieved, with no tumor recurrence.
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Affiliation(s)
- Hitomi Hara
- Research Associate, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Teruya Kawamoto
- Research Associate, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuo Onishi
- Orthopedist, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Fujioka
- Professor, Hyogo University of Health Sciences School of Rehabilitation, Kobe, Japan
| | - Kotaro Nishida
- Lecturer, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Associate Professor, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Professor, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Professor, Department of Rehabilitation Science, Kobe University Graduate School of Medicine, Kobe, Japan
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Makridis KG, Theocharakis S, Fragkakis EM, Giannoudis PV. Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique: a case report. Foot Ankle Surg 2014; 20:e19-22. [PMID: 24796840 DOI: 10.1016/j.fas.2013.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/10/2013] [Accepted: 11/28/2013] [Indexed: 02/04/2023]
Abstract
UNLABELLED The literature regarding reconstruction of foot bone defects is limited. The purpose of this study is to present a case report with an extensive bone defect of the first metatarsal bone which was treated with the use of the induced membrane technique. A 53-year-old man, with comminuted foot grade IIIb open fracture was treated with the Masquelet procedure. At 14 months follow-up, clinical and radiological assessment of the foot revealed osseous healing and no signs of infection, osteolysis or hardware failure. At 18 months follow-up, the patient had no pain and returned to his usual daily activities. The Masquelet procedure provides an effective method of treatment of extensive bone defects of the foot. It can restore the normal length and metatarsal arch minimizing the risk of complications that occurs with other surgical procedures. LEVEL OF EVIDENCE Level V, case report.
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Affiliation(s)
- Konstantinos G Makridis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX, Leeds, UK.
| | - Stelios Theocharakis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX, Leeds, UK.
| | - Evangelos Minas Fragkakis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX, Leeds, UK.
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX, Leeds, UK.
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Reconstruction of metatarsal bone defects with a free fibular osteomyocutaneous flap incorporating soleus muscle. J Plast Reconstr Aesthet Surg 2013; 66:277-80. [DOI: 10.1016/j.bjps.2012.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 11/20/2022]
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Chen CC, Lin CH, Lin YH. Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report. Microsurgery 2012; 32:485-8. [DOI: 10.1002/micr.22033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 04/27/2012] [Indexed: 11/11/2022]
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