Recurrent Giant Cell Tumor of Distal Radius with Pulmonary Metastasis: A Case Report.

Abstract

Introduction:Giant cell tumor (GCT) is a rare, locally aggressive tumor of bone characterised by the presence of abundant giant cells. GCT has a tendency for recurrence, occurring in approximately a quarter of cases. GCT very rarely metastasize, with metastasis to lungs being reported in approximately 1% of GCTs.Case Presentation:A 48 year -year-old gentleman noticed a swelling around his left wrist. Radiograph showed a lytic lesion in the distal radius having typical soap bubble appearance. He underwent left distal radius curettage and bone cement placement. The histopathological examination of excised tissue confirmed the diagnosis of GCT. Patient then had recurrence of the tumor 6 months after the surgery. He underwent left distal radius resection, fibular grafting, and wrist arthrodesis. Resected tissue on histopathological examination showed features consistent with GCT. One year later, patient noticed multiple swellings in the region of his left wrist. On examination, there were multiple bony hard, non-tender swellings over the distal forearm. Radiographs revealed a lytic lesion in the fibular strut graft with breach of the cortex. Patient was diagnosed to have recurrence for GCT for the second time. Chest radiograph and Computed Tomography (CT) scan of the thorax revealed multiple canon ball lesions in bilateral lungs, suggesting a metastasis of GCT. The patient, however, did not have any respiratory complaints. We then performed an excision of the tumor, removal of plate and k-wire, and applied a wrist spanning external fixator. Histopathological examination confirmed a recurrence of GCT. The patient was not willing for metastasectomy. The patient was followed up for a period of 18 months. We found no clinical, radiological evidence of recurrence. The metastatic lesions in the lungs were not found to have increased in number or size, while the patient remained asymptomatic.Conclusion:Giant cell tumours are benign, however, they have a propensity for recurrence. Recurrent GCT are more likely to lead to pulmonary metastasis, and thus warrant pulmonary evaluation. Pulmonary metastasis has a favourable outcome with only half the cases having progression.