A Case of Recurrent Giant-cell Tumor of the Lower Right Radius

Abstract

The patient whose case is reported, Miss L. Y., aged 37 years, stenographer, first consulted me on April 13, 1928. Her family history was negative for malignancy. The patient's general health had been good except for two fairly severe attacks of influenza, and paratyphoid about 1924. She had been extremely nervous and had had three or four “nervous breakdowns.” She had gained weight during the past year. Wassermann tests were consistently negative, and other laboratory examinations were negative. She had noticed a tumor at the lower end of the right radius for at least two years before I first saw her (Figs. 1, 2, and 3). The growth had been treated with X-rays and finally was operated upon elsewhere about the first of April, 1927, the growth being thoroughly curetted. Roentgenologic examination on October 21, 1927, seemed to show a recurrence (Fig. 4). When I saw her there was a tumor of the lower end of the right radius, appearing chiefly on the palmar surface (Figs. 5 and 6). The skin over it was stretched rather tightly and seemed to be quite vascular, though it was not definitely adherent to the growth. No axillary lymph nodes were palpable. On April 25, 1928, I operated, under local anesthesia, resecting the lower end of the right radius, with the immediately surrounding soft tissue, doing all of the dissection with the endotherm knife except that the bone was divided with bone forceps. The block dissection included the adjacent tendons around the lower end of the radius. After removing this mass there appeared to be a small amount of tumor tissue between the tendons. This was dissected away with the endotherm knife. The head of the metacarpal bone of the thumb was removed with forceps. The bone after division was immediately cauterized with the coagulation current. Histologic examination showed a typical giant-cell bone tumor. There were many giant cells and a stroma of spindle cells and connective tissue. The tumor was rather cellular. There were no mitotic figures (Fig. 7). The patient made a satisfactory recovery, the wound healing without infection. Roentgenologic examination May 15, 1929, showed no evidence of recurrence (Fig. 8). On May 16, 1929, I operated upon her again for reconstruction of the right wrist, the operation being done under ethylene anesthesia. The stump of the radius was exposed, and the tip of it cut off with bone forceps. The lower ulna was exposed for about four inches, and divided with bone forceps about one and one-half inches from its end. With the electric drill the distal end was hollowed out, and the proximal end of the radius was drilled. A bone peg was cut with the electric saw from the ulna and made to fit into the distal fragment of the ulna and the proximal end of the radius as a medullary graft.