[Diagnosis and surgical treatment of giant cell tumor in hand bone].

OBJECTIVE

To review the experience with clinical and imaging characteristics of giant cell tumor (GCT) of the hand as well as the surgical outcomes.

METHODS

Between 2000 and 2010,16 cases of GCT of the hand were admitted to our department. There were 10 male and 6 female patients with a mean age of 41.3 years (age range: 24 to 65 years) with Campanacci's grade I ( n = 0), Grade II (n=12), and Grade III (n=4). Eight cases occurred in metacarpal bone and 8 cases in phalanx. All patients had the symptoms of pain,swelling and restricted range of motion in the affected joint.The average time from the onset of the symptom to the first visit of the patients was 12 months( range: 5 to 15 months).Radiographic changes showed osteolytic lesions occupying at least half of the diaphyseal region in most of the cases. Four grade III patients underwent tumor resection and bone graft or serial amputation, while 12 Grade II patients extensive curettage and bone graft.

RESULTS

Twelve patients'clinical and radiographic diagnosis at admission was endochondroma, while postoperative histopathology reported all the lesions as GCT. Twelve patients were followed up for a mean of 58.8 months (range: 24 to 140 months). Immediate relief of pain was observed postoperatively in all patients. No complications, such as infection or joint stiffness, were observed in any patient. The average healing time of bone graft was 3.3 months (range: 3 to 5 months).Ten gradeII patients were followed up for at least 2 years and 3 of them had local recurrence 8 to 16 months after first resection. En bloc resection was then performed, and no second reccurence was reported. Two gradeII patients were followed up for at least 2 years and none of them had local recurrence. No malignancy, multiple center lesion or lung metastasis was reported. Active range of motion in the patients without joint arthrodesis was maintained during the follow-up period.

CONCLUSION

GCTs of the hand are relatively rare, and tend to be misdiagnosed as endochondroma. The results of the present study suggest that extensive curettage provides favorable local control and satisfactory functional outcomes.