Download PDF
Handchir Mikrochir Plast Chir 2020; 52(03): 210-212
DOI: 10.1055/a-1162-8585
Der interessante Fall

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.

Behandlung eines Riesenzelltumorrezidivs des Mittelgliedes durch Knochentransplantation vom Beckenkamm und Rekonstruktion der Mittelgliedbasis mittels Hemi-Hamatum
Andrzej Zyluk
,
Zbigniew Szlosser
› Further Information
Also available at
    Permissions and Reprints

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

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 van der Heijden L, Dijkstra PD, Blay JY. et al. Giant cell tumour of bone in the denosumab era. Eur J Cancer 2017; 77: 75-83
    CrossrefPubMedGoogle Scholar
  • 2 Harness NG, Mankin HJ. Giant-cell tumor of the distal forearm. J Hand Surg 2004; 29 A: 188-193
    PubMedGoogle Scholar
  • 3 Adulkasem N, Pruksakorn D. Giant cell tumour of the middle phalanx of the middle finger. BMJ Case Rep 2019; 25: 12 pii: e229076. doi: 10.1136/bcr-2018–229076
    PubMedGoogle Scholar
  • 4 Campanacci M, Baldini N, Boriani S. et al. Giant-cell tumor of bone. J Bone Joint Surg Am 1987; 69: 106-114
    CrossrefPubMedGoogle Scholar
  • 5 Thomas D, Henshaw R, Skubitz K. et al. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol 2010; 11: 275-280
    CrossrefPubMedGoogle Scholar
  • 6 Lau CP, Huang L, Wong KC. et al. Comparison of the anti-tumor effects of denosumab and zoledronic acid on the neoplastic stromal cells of giant cell tumor of bone. Connect Tissue Res 2013; 54: 439-449
    CrossrefPubMedGoogle Scholar
  • 7 Spiro AS, Pogoda P, Amling M. et al. Giant cell tumour of bone: reconstruction of the index metacarpophalangeal joint with an osteochondral graft from the lateral femoral condyle. J Plast Reconstr Aesthet Surg 2013; 66: 729-732
    CrossrefPubMedGoogle Scholar
  • 8 Lewallen LW, Wagner ER, Moran SL. Giant cell tumor of the metacarpal: Case report. Hand (NY) 2017; 12: 113-117
    CrossrefPubMedGoogle Scholar
  • 9 Kanaya K, Wada T, Kitajima K. et al. Vascularized metatarsophalangeal joint transfer for giant cell tumor of the proximal phalanx of the hand. Plast Reconstr Surg 2008; 121: 354-355
    CrossrefPubMedGoogle Scholar