|Year : 2017 | Volume
| Issue : 3 | Page : 586-588
Giant cell tumour of distal ulna
Shreedhar Archik1, Sanjay Kumar Tripathi2, Saurav Narayan Nanda2, Ashlesh Choudhari3
1 Department of Orthopaedics and Trauma, Lilavati Shushrusha Hinduja Healthcare, Global Hospitals, Khar, Mumbai, Maharashtra, India
2 Department of Orthopaedics and Trauma, Lilavati Hospital, Shushrusha Hospital, Hinduja Healthcare, Global Hospitals, Mumbai, Maharashtra, India
3 Department of Orthopaedics and Trauma, Fellow in Trauma and Arthroplasty Under Dr. Shreedhar Archik, Mumbai, Maharashtra, India
|Date of Web Publication||31-Aug-2017|
Sanjay Kumar Tripathi
Department of Orthopaedics and Trauma, Lilavati Hospital and Research Centre, Bandra West, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Giant cell tumor (GCT) of distal end epiphysis ulna is a rare presentation, and only few cases are reported in the scientific literature. We report a case of GCT of distal end epiphysis ulna treated at our Tertiary Care Hospital, Mumbai.
Keywords: En bloc excision of distal ulna, giant cell tumor of distal end epiphysis ulna, primary bone tumor
|How to cite this article:|
Archik S, Tripathi SK, Nanda SN, Choudhari A. Giant cell tumour of distal ulna. J Can Res Ther 2017;13:586-8
| > Introduction|| |
Most common site for giant cell tumor (GCT) is at the long bone meta-epiphysis, especially the distal radius and femur, proximal humerus, and tibia. Distal end epiphysis of the ulna is an uncommon site for primary bone tumors. GCT of bone is a rare, benign, locally invasive tumor, accounting for approximately 3–5% of all primary bone tumors., GCT at distal end epiphysis of the ulna is very rare, with a reported incidence from 0.45% to 3.2%.,, It generally occurs in adults between the ages of 20 and 40 years. GCT of bone is very rarely seen in children or in adults older than 65 years of age. We here report a case of GCT of distal end epiphysis ulna treated by en bloc excision of the distal ulna. The goal of treatment is the adequate removal of the tumor to lower the risk of recurrence.
| > Case Report|| |
A 24-year-old male patient came to hospital with painful progressive swelling of the right wrist since 1 month. There was no history of injury, pain, and fever.
On examination, the diffuse swelling was present over the wrist, more over distal aspect of ulna [Figure 1]. The skin over the swelling was normal with no evidence of dilated or engorged veins, stretch mark, or sinuses. On palpation, there was tenderness over the swelling, but temperature was not raised. The swelling was about 4 cm × 2 cm in dimension, arising from the distal end of ulna. It was soft to firm in consistency, not fixed to the overlying skin. Supination, pronation and ulnar deviation were painfully restricted. Radial pulse was palpable.
|Figure 1: Diffuse swelling was present over wrist, more over distal aspect of ulna|
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Routine blood investigations and serum biochemistry studies were within normal limits.
X-ray of right wrist anterior-posterior and lateral showed expansile, osteolytic, multiloculated lesion in the distal end of right ulna without any periosteal reaction [Figure 2]. It was showing characteristic soap bobble appearance suggestive of GCT of the distal ulna.
|Figure 2: X-ray of right wrist anterior-posterior and lateral showed expansile, osteolytic, multiloculated lesion in the distal end of right ulna without any periosteal reaction|
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No evidence of lung metastases was seen on the chest radiograph [Figure 3].
|Figure 3: No evidence of lung metastases was seen on the chest radiograph|
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Fine-needle aspiration cytology was done which further lead to a diagnosis of GCT of distal end epiphysis of ulna.
The patient was managed with an operative procedure involving en bloc excision of distal end ulna [Figure 4] under general anesthesia. The intraoperative specimen was sent for a biopsy, which further confirmed the diagnosis of GCT of distal end epiphysis of ulna.
|Figure 4: Operative procedure involving en bloc excision of distal end ulna|
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Postoperatively, patient was comfortable and previous severe and continuous pain was relieved except for surgical site pain which was reducing gradually. At the day of suture removal on the postoperative day 14, patients were absolutely pain-free. After 3 weeks of follow-up, physiotherapy was started, and the patient was gaining continuous increase mobility at wrist joint and at 6-week patient was fully recovered [Figure 5].
| > Discussion|| |
Usually, the tumor is located at the long bone meta-epiphysis, especially the distal radius and femur, proximal humerus, and tibia. Distal end epiphysis of the ulna is an uncommon site for primary bone tumors. The incidence of GCT of bone is higher in Asian compared to the West populations. In Malaysia, Ng et al. reported 34 (24%) out of 141 cases of primary bone tumors were GCT and 1 (2.9%) out of the 34 GCT cases involved the end of the distal ulna. Therefore, there are no clear-cut guidelines about the preferred modality of treatment of GCT of distal end epiphysis of ulna. Depending on surgeon and preference and setup, primary goal of treatment is wide resection of the tumor to minimize recurrences with optional other procedures as intralesional curetage with adjuvants such as cryotherapy, phenol, burring, bone grafting, and polymethylmethacrylate cement or wide resection with or without stabilization or reconstruction of ulnar stump.
Simple curettage has high recurrence rate as compared to curettage with adjuvant therapy as per Campanacci et al., Sung et al., As per literature, adequate removal of the tumor is more important for decrease incidence of recurrence rate. It seems that recurrence rates correlate better with the inadequacy of tumor tissue removal rather than the type of specific adjuvant treatment used. Kayias et al. found a high failure rate without stabilization of the ulna stump, due to the dorsal translation of the stump at the resection site which tends to converge toward the radius. This inevitably leads to a limitation of forearm rotation, persistent pain due to instability and impingement on the radius. Cooney et al. reported good functional outcome after distal ulna resection without any stabilization and concluded that reconstruction is notroutinely indicated.
GCT of the distal end epiphysis of ulna is an extremely rare entity; a literature review of reported cases with a resection of the distal ulna for primary bone tumors, is inconclusive as to (a) whether stabilization or reconstruction is required or not and (b) as to the optimal method of stabilization or reconstruction, if chosen.
Therefore, there are no clear-cut guidelines about the preferred modality of treatment. There is not enough evidence to recommend one ulnar stump stabilization procedure over the other. The authors also feel that the treatment should be individualized, taking into consideration the patient's age, the length of the ulnar resection and patient's expectation about postoperative function.
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Conflicts of interest
There are no conflicts of interest.
| > References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]