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.

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Surgical Treatment of Giant-Cell Tumors of the Distal Epiphysis of the Radius

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2018-0030 ◽

2018 ◽

Vol 1 (Supplement) ◽

pp. 19

Author(s):

D. Rădulescu ◽

A. Bădilă ◽

O. Nuțiu ◽

R. Manolescu ◽

T. Ciobanu ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Bone Defect ◽

Distal Radius ◽

Wrist Joint ◽

Cell Tumor ◽

Segmental Resection ◽

Giant Cell Tumors ◽

Distal Epiphysis ◽

Distal Migration

Abstract Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.

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A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

The Open Orthopaedics Journal ◽

10.2174/1874325001307010103 ◽

2013 ◽

Vol 7 (1) ◽

pp. 103-108 ◽

Cited By ~ 15

Author(s):

Theresa J.C Pazionis ◽

Hussain Alradwan ◽

Benjamin M Deheshi ◽

Robert Turcotte ◽

Forough Farrokhyar ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Wrist Joint ◽

Meta Analysis ◽

En Bloc Resection ◽

Cell Tumor ◽

En Bloc ◽

Intralesional Curettage ◽

Functional Benefit

Introduction: Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR. Methods: A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR. Results: One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC. Conclusions: Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

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

Clinical surgery research communications ◽

10.31491/csrc.2021.12.084 ◽

2021 ◽

Vol 5 (4) ◽

pp. 13-18

Author(s):

Eva Campos-Pereira ◽

◽

João Vale ◽

Tiago Amorim-Barbosa ◽

Filipe Rodrigues ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Cell Tumor ◽

Giant Cell Tumors ◽

En Bloc ◽

Musculoskeletal Tumor Society ◽

En Bloc Excision ◽

Bloc Excision ◽

One Year

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

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Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius

Journal of Orthopaedic Science ◽

10.1007/s00776-015-0763-z ◽

2015 ◽

Vol 20 (6) ◽

pp. 1090-1097 ◽

Cited By ~ 3

Author(s):

Shuai Zhang ◽

Mei-tao Xu ◽

Xu-quan Wang ◽

Jia-jia Wang

Keyword(s):

Functional Outcome ◽

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Cell Tumor ◽

Prosthetic Replacement ◽

En Bloc ◽

En Bloc Excision ◽

Bloc Excision

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Giant Cell Tumor of the Talar Neck

Journal of the American Podiatric Medical Association ◽

10.7547/0970225 ◽

2007 ◽

Vol 97 (3) ◽

pp. 225-228 ◽

Cited By ~ 7

Author(s):

Hakan Selek ◽

Hamza Özer ◽

Sacit Turanli ◽

Özlem Erdem

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Clinical Signs ◽

Cell Tumor ◽

Giant Cell Tumors ◽

Radiographic Appearance ◽

Aneurysmal Bone Cysts ◽

Tumors Of Bone ◽

Brown Tumors ◽

Small Bones

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot. (J Am Podiatr Med Assoc 97(3): 225–228, 2007)

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Intramuscular Tenosynovial Giant Cell Tumor Harboring a Novel CSF1-CD96 Fusion Transcript

International Journal of Surgical Pathology ◽

10.1177/10668969211049833 ◽

2021 ◽

pp. 106689692110498

Author(s):

Haider Mejbel ◽

Gene P. Siegal ◽

Shi Wei

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Gene Rearrangement ◽

Fusion Transcript ◽

Cell Tumor ◽

Molecular Profile ◽

Small Subset ◽

Fusion Partner ◽

Giant Cell Tumors ◽

Tenosynovial Giant Cell Tumor

Tenosynovial giant cell tumors typically arise in the synovium of joints, bursae, or tendon sheaths. They may occur in an intra- or extra-articular location and can be divided into localized and diffuse types. The neoplastic nature of the lesion has been supported by a recurrent CSF1 gene rearrangement in a small subset of lesional cells, of which the most common fusion partner is COL6A3. Herein, we report a case of intramuscular localized tenosynovial giant cell tumor harboring a novel CSF1-CD96 fusion transcript, thus expanding the molecular profile of this tumor.

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Correlation between Campanacci’s radiological classification of giant cell tumor of bone and expression of Cyclin D1 and PCNA

Journal of Solid Tumors ◽

10.5430/jst.v7n1p47 ◽

2017 ◽

Vol 7 (1) ◽

pp. 47

Author(s):

Eréndira G. Estrada-Villaseñor ◽

Hidalgo Bravo Alberto ◽

C. Bandala ◽

P. De la Garza-Montano ◽

Reyes Medina Naxieli ◽

...

Keyword(s):

Cyclin D1 ◽

Giant Cell Tumor ◽

Giant Cell ◽

Descriptive Study ◽

Cell Tumor ◽

Giant Cell Tumors ◽

Radiological Classification ◽

Tumors Of Bone ◽

Made In

Giant cell tumor of bone is considered by his behavior a benign but aggressive neoplasm. The objective of our study was to determine if there is a correlation between the Campanacci’s radiological classification of giant cell tumors of bone and the expression by immunohistochemistry of Cyclin D1 and proliferation cell nuclear antibody (PCNA). A retrospective and descriptive study was made. In total, there were 27 cases. All cases showed Cyclin D1 and PCNA positivity. Rho Spearman for Campanacci and Cyclin D1 expression was 0.06 and for Campanacci and PCNA was 0.418. We conclude that there is a positive correlation between PCNA expression in giant cell tumors of Bone and the Campanacci’s radiological classification II and III, butCyclin D1 expression was no related with radiologic features.

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