Roy Mainak, Reddy Harsha Vardhan, Bhikshavarthimath Suhas Aradhya, Dwidmuthe Samir Chandrakant, Tiwari Vivek
Department of Orthopedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Department of Orthopedics, Apollo sage hospitals, Bhopal, Madhya Pradesh, India.
J Orthop Case Rep. 2025 Jan;15(1):26-30. doi: 10.13107/jocr.2025.v15.i01.5112.
Giant cell tumor of bone (GCTB) ranks among the most prevalent locally aggressive tumor lesions, displaying a diverse range of biological behaviors. Recurrence of GCTB is well-documented, often attributed to microscopic tumour remnants remaining after intralesional curettage, with increased concern when infection occurs postoperatively. Studies suggest the limited effectiveness of adjuvants in preventing giant cell tumour recurrence, emphasizing the necessity of complete removal of malignant cells. We describe our experience with a rare presentation of recurrence together with infection in an operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization.
A 28 year-old female who was operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization in 2020 presented to our outpatient department with complaints pain in right leg while walking for 3 months in October 2021. Plain radiography of the right knee suggestive of lytic lesion over medial aspect of the right tibia around cement with plate in situ and magnetic resonance imaging right knee suggestive of recurrence of the tumor with no breach in joint line and no involvement of neurovascular structures. The patient was planned for implant removal with extended curettage and plate stabilization and cementing with antibiotics (vancomycin and gentamycin) after sending tissues for culture sensitivity and histopathology. Intraoperative cultures showed growth of methicillin-sensitive staphylococcus aureus which was sensitive to cefoxitin, gentamicin, cotrimoxazole, and doxycycline following which pt received 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics as per culture sensitivity with no post-operative wound complications and had satisfactory functional outcome. The patient was followed at regular intervals till 2-year follow-up did not show any signs of recurrence and infection.
The manifestation of GCTB recurrence alongside infection is exceedingly rare with limited literature evidence. Our case illustrates a method to address both issues concurrently during a single procedure, utilizing antibiotic bone cement to tackle infection and extended curettage for thorough removal of neoplastic cells from the surrounding bone.
骨巨细胞瘤（GCTB）是最常见的局部侵袭性肿瘤病变之一，表现出多种生物学行为。GCTB复发的情况已有充分记录，通常归因于病灶内刮除术后残留的微小肿瘤组织，术后发生感染时则更令人担忧。研究表明辅助治疗在预防骨巨细胞瘤复发方面效果有限，强调彻底清除恶性细胞的必要性。我们描述了一例罕见的右胫骨近端GCTB手术病例，该病例在病灶内刮除、骨水泥填充和钢板固定后出现复发并伴有感染的情况。
一名28岁女性，2020年接受了右胫骨近端GCTB病灶内刮除、骨水泥填充和钢板固定手术。2021年10月，她因行走时右腿疼痛3个月前来我院门诊就诊。右膝X线平片显示右胫骨内侧靠近骨水泥和原位钢板处有溶骨性病变，右膝磁共振成像提示肿瘤复发，关节线未破坏，神经血管结构未受累。在将组织送去进行培养药敏和组织病理学检查后，计划为患者取出植入物，进行扩大刮除、钢板固定，并使用含抗生素（万古霉素和庆大霉素）的骨水泥。术中培养显示有对甲氧西林敏感的金黄色葡萄球菌生长，该菌对头孢西丁、庆大霉素、复方新诺明和强力霉素敏感，之后患者根据培养药敏结果接受了2周的静脉抗生素治疗和4周的口服抗生素治疗，术后伤口无并发症，功能恢复良好。对患者进行定期随访，直至2年随访期未发现任何复发和感染迹象。
GCTB复发伴感染的表现极为罕见，文献证据有限。我们的病例展示了一种在单一手术中同时解决这两个问题的方法，即利用抗生素骨水泥治疗感染，并通过扩大刮除术从周围骨组织中彻底清除肿瘤细胞。
