Result of the treatment of a recurrent giant cell tumour in the middle phalanx by combined bone grafting and restoration of the PIP joint: a case report.

Introduction

Giant-cell tumour of the bone is a benign, locally aggressive neoplasm, with low metastatic potential and is associated with substantial skeletal morbidity. Histologically the tumour is rich in osteoclast-like giant cells and contains mononuclear (stromal) cells that express RANK ligand, a key mediator of osteoclast activation. Overexpression of receptor activator of nuclear factor kappa-B ligand (RANKL) by mononuclear neoplastic stromal cells promotes activation of reactive multinucleated, osteoclast-like giant cells, causing lacunar bone resorption [1]. Management of small lesions is similar to bone cysts and includes curettage of the lesion followed by filling the cave with cancellous bone graft or polymethyl methacrylate. There is, however, a high rate of recurrence after most methods of local treatment. In advanced, inoperable and recurrent cases with metastases, denosumab – a human monoclonal antibody against RANK ligands was successfully tested [1].

Localization of giant-cell tumours in hand bones (phalanges and metacarpals) is very uncommon; it more frequently involves the distal end of the radius or ulna and carpal bones [2]. We present the case of a recurrent giant-cell tumour affecting proximal ¾ of the middle phalanx of the middle finger. The patient underwent resection of the involved part of the middle phalanx, followed by reconstruction of the phalanx and articular surface with combined bone grafting (iliac crest and hemihamate).

Publication History

Article published online:
12 June 2020

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