A Surgical Approach to Giant Cell Tumor of Lower End of Tibia with Curettage and Reconstruction by Bone Grafting Harvested from Left Iliac Crest and K-wire Fixation: A Case Report

Introduction: Giant cell tumor (GCT) is a distinctive lesion characterized by the proliferation of multinucleate giant cells in a stroma of mononuclear cells; it is generally seen in skeletally mature individuals. GCT is usually found in the long bones around the knee or in the distal radius but distal end of tibia, proximal humerus, vertebrae of young adults are unusual location. We report a case of GCT of the distal end of tibia, with a secondary aneurysmal bone cyst, in a 26-year-old female. Based on our review of the medical literature, it appears that the occurrence of a GCT along with a secondary aneurysmal bone cyst (ABC) in distal end of tibia is less typical with challenging task for full tumor resection and restoration of ankle function to normal. Case Summary: 26 year old female presented with pain&swelling over left ankle since last six month. Biopsy was suggestive of GCT with ABC of lower third tibia. We managed this case with intralesional curettage using phenol and burr and bone graft harvested from left iliac crest for reconstruction of defect along with kwire fixation to achieve optimum anatomical restoration. Conclusion: In cases of GCT, the management depends upon the various factors such as site, age, involvement of the bone, extent of bone involvement and whether there is articular involvement or not. Here Intra-articular GCT is managed with extended intralesional curettage with phenol. Bone graft plays a role of agent for reconstruction of the defect and kwire for anatomical reduction.

Development of Deep Learning Algorithms to Discriminate Giant Cell Tumor of Bone from Adjacent Normal Tissues by Confocal Raman Spectroscopy

Raman spectroscopy is a non-destructive analysis technique that provides detailed information about the chemical structure of the tumor. Raman spectra of 52 giant cell tumor of bone (GCTB), and 21...

The proximal fibular free flap - an ideal material for reconstructing distal radius defect after Giant tumor cell resection. A case report

Giant cell tumors (GCT) of the distal end of radius are relatively common tumors, representing approximately 5% of all primary bone tumors. It is the third most common location for GCT following distal femur and proximal tibia. In general, treatment includes thorough tumor excision, reconstruction of the defect, and wrist joint rehabilitation. The proximal fibular free flap is an ideal material for distal radius reconstruction after giant cell tumor excision. We present a case of a 57-year-old female, admitted to the hospital due to painful and limited proper wrist movement. Based on X-ray and Magnetic resonance imaging (MRI) images and histopathology findings, the patient was diagnosed with a stage 3 giant cell tumor of the distal radius. The patient underwent a one-step surgery of tumor excision and distal radius reconstruction by a vascularized proximal fibular free flap. 2 years follow-up post-surgery showed that the patient had no pain of the wrist, improved wrist joint function, no sign of recurrence, and good flap vitality and the knee joint remains normal. In conclusion, the surgery was successful with no further prolonged pain, improvement of the wrist joint function and overall improvement of the patient quality of life.

Wrist Arthrodesis with Vascularized Fibular Graft after Failed Allograft Replacement for Giant-Cell Tumor Resection

Giant-cell tumor (GCT) is locally aggressive bone neoplasm, with an unpredictable pattern of biological aggressiveness. The optimal treatment had to achieve a negligible local recurrence rate while maximizing musculoskeletal function. Numerous options for reconstruction are available, but in the literature there is a lack of salvage surgery data. We present a case of a 67-year-old woman who underwent complete wrist arthrodesis with vascularized fibular graft as salvage procedure for allograft necrosis, after excision of a distal radius GCT. The patient did not complain of any impairment in daily use, and the functional score was 22 points (73%) at latest follow-up of 14 months. Despite joint salvage remains the most favorable treatment with regard to functional outcome for aggressive tumors of the distal radius, vascularized fibular grafts is a valuable alternative especially in salvage procedures, where the use of another allograft could lead to higher complications rate. Keywords: Vascularized fibular graft, Wrist arthrodesis, Giant-Cell Tumor, Fibula free flap.

En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis

Giant cell tumor of the tenosynovial type in the prevertebral space with a cervical approach

<p class="abstract">The complex anatomy of the neck makes surgical interventions of cervical neoplasms a very complex process. The aforementioned challenges the surgeon to find a surgical approach with the least morbidity and cosmetic sequelae. This is particularly true in tumoral occupation of the prevertebral space (PVS), most frequently due to the extension of neoplasms from naso and oropharynx; whereas primary tumors of the PVS are extremely rare. There are a number of surgical approaches to access the skull base and the anterior region of the upper cervical spine, such as the transcervical-transtemporal approach, retraction and dissection of the soft palate, mandibular osteotomy, medial glossotomy, among others. The following article presents a case report in which a less invasive combined transcervical-transoral approach was performed on a tenosynovial giant cell tumor of the PVS. As an alternative in the treatment of these type of lesions, it is in our opinion equally effective and less morbid.</p>