Giant Cell Tumor of Bone in the Carpus Treated with Excision, Bonegraft and Carpometacarpal Arthrodesis Hestmo MT, Røkkum M Upper Extremity and Microsurgery Unit, Department of Orthopaedic, Rikshospitalet, Oslo University Hospital Orthopaedic Department

Tenosynovial giant cell tumor ( Formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis) Second most common tumor in the hand after ganglion cyst Involve the digits and the wrist in 85% of the cases Cystic erosion MRI exam for diagnosis Orthopaedic Department

Case Report A 27 year old man Feb.-15 Resection of tumor ulnar side of palm/wrist and palmar side of the 5th digit Sept.-16 Resection of large tumor in the Carpal Tunnel and distal in the forearm Orthopaedic Department

Tenosynovial giant cell tumor Located in the tendon sheath Orthopaedic Department

Giant Cell Tumor of Bone 5% av benign bone tumors 2% occurs in the hand Benign lesions based on histology, but aggressive local behavior Rare, but do metastasize Lesions located in the hand: Higher risk for local recurrence Greater propensity to metastasize Orthopaedic Department

Giant Cell Tumor of Bone The most common locations in the upper extremity: Distal radius Carpal bones, Metacarpals Phalanges 15-40 year old Female > male, 2.6:1 Pain ,swelling Patological fracture in affected bone Orthopaedic Department

Campanacci’s classification (GCT) Grade I (inactive): Intraosseous lesions with intact cortex Grade II (active): Exstensive intraosseous lesions with thin cortex, cortical continuity Grade III ( aggressive): Ekstraosseous lesions, frakture of the cortex, extend into soft tissue Orthopaedic Department

Case Report A 59 year old woman Swelling over the dorsum of the left hand for 2 years Slow increase in size Plain radiographs: lytic lesions in the capitate,hamatum, base of 3. and 4. CMC- joints no matrix cortical effractions DD: Aneurysmal Bone Cyst

Giant Cell Tumor of Bone CT MRI Orthopaedic Department

Giant Cell Tumor of Bone Ultrasonygraphy-guided needle biopsy Fine needle biopsy through a well-planned approach that can later be incorporated into a salvage operation or amputation. Soft tissue must be protected during biopsy GCT has a propensity to seed soft tissues, which could result in subsequent soft tissue local recurrence Orthopaedic Department

Giant Cell Tumor of Bone Orthopaedic Department

Giant Cell Tumor of Bone Orthopaedic Department

Giant Cell Tumor of Bone Orthopaedic Department

Giant Cell Tumor of Bone Postoperativ day 1 3 months postop. Orthopaedic Department

Giant Cell tumor of Bone 6 months postoperative ROM wrist flex./ext. aktive 30/26 passive 30/30 Jamar Dynamometer left 9.4 kilo right 23.4 kilo Full ROM of all digits. No pain. Orthopaedic Department

Giant Cell Tumor of Bone Summary Approached as a low-grade malignancy when it occurs in the hand Distal carpal row lesions: wide exicision, limited carpal fusion for reconstruction Proximal carpal row lesions: proximal carpal row carpectomy Metacarpal and phalangeal lesions: wide exicision, recconstruction Orthopaedic Department

Thank you Orthopaedic Department