Kapoor Rajat, Pal Chandra Prakash, Dinkar Karuna Shankar, Sharma Yajuvendra Kumar
Department of Orthopaedic Surgery, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
J Orthop Case Rep. 2020;10(2):62-65. doi: 10.13107/jocr.2020.v10.i02.1698.
Giant cell tumor (GCT) at Distal End Radius (DER) have relatively aggressive nature and higher recurrence rate and malignant transformation than their other counterparts. There is no case reported till now of GCT recurrence in grafted fibula used for reconstruction in managing primary DER-GCT. The purpose of the study is to report the recurrence of GCTin fibular graft used for treatment in primary GCT of DER.
A 40-year-old female was diagnosed with Campanacci Type 3 GCT-DER 7-year back. The patient was operated and treated by excision of tumor and reconstruction with contralateral fibular grafting with K-wire fixation of DER7-year back and biopsy of growth was sent. After 7 years, the patient again developed swelling over the right wrist and radiological diagnosis of GCT Campanacci Grade 3 is made. She is managed by resection of tumor tissue by volar approach to DER with proximal row carpectomy with ulnocarpal fusion with retrograde K-wire fixation of the 3rd metacarpal resulting in centralization of ulna.
Recurrence in GCT also occurs at donor fibula used in reconstruction for primary treatment and could be safely managed by wide excision and centralization of ulna with good results.
桡骨远端的骨巨细胞瘤(GCT)相较于其他部位的骨巨细胞瘤,具有相对侵袭性的本质、更高的复发率和恶性转化率。迄今为止,尚无关于用于原发性桡骨远端骨巨细胞瘤重建的腓骨移植后骨巨细胞瘤复发的病例报道。本研究的目的是报告用于治疗原发性桡骨远端骨巨细胞瘤的腓骨移植中骨巨细胞瘤的复发情况。
一名40岁女性7年前被诊断为坎帕纳奇3型桡骨远端骨巨细胞瘤。患者接受了手术,手术方式为切除肿瘤并采用对侧腓骨移植重建,同时用克氏针固定桡骨远端,术后7年送检生长组织活检。7年后,患者右腕再次出现肿胀,经放射学诊断为坎帕纳奇3级骨巨细胞瘤。通过掌侧入路切除桡骨远端肿瘤组织,近端排腕骨切除术,尺腕融合术,同时对第三掌骨进行逆行克氏针固定,使尺骨中心化,以此对患者进行治疗。
原发性治疗重建中使用的供体腓骨也会出现骨巨细胞瘤复发,通过广泛切除和尺骨中心化可安全治疗,效果良好。