1. 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

2. 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

3. 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

4. Tenosynovial giant cell tumor Located in the tendon sheath
Orthopaedic Department

5. 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

6. 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

7. 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

8. 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

9. Giant Cell Tumor of Bone CT MRI
Orthopaedic Department

10. 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

11. Giant Cell Tumor of Bone
Orthopaedic Department

12. Giant Cell Tumor of Bone
Orthopaedic Department

13. Giant Cell Tumor of Bone
Orthopaedic Department

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

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

16. 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

17. Thank you
Orthopaedic Department