Jemds.com Case Report J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 5/ Issue 100/ Dec. 15, 2016 Page 7394 GIANT CELL TUMOUR OF BONE – A RARE SITE WITH RECURRENCE Anupam Saha 1 , Mala Mukherjee 2 1 Professor, Department of Pathology, MGM Medical College & LSK Hospital, Kishanganj, Bihar. 2 Assistant Professor, Department of Pathology, MGM Medical College & LSK Hospital, Kishanganj, Bihar. ABSTRACT BACKGROUND Occurrence of Giant cell tumour of bone (GCT) in phalanx of a finger is very rare. We here report a case of Giant cell tumour of middle phalanx of right ring finger in an 18 years-old female with evidence of recurrence after primary treatment and subsequent management. During clinical and radiological evaluation one should give proper importance to the fact that giant cell tumour can occur in extremely rare location and it has aggressive behaviour and potential of local recurrence. KEYWORDS Giant Cell Tumour, Middle Phalanx, Recurrence. HOW TO CITE THIS ARTICLE: Saha A, Mukherjee M. Giant cell tumour of bone– a rare site with recurrence. J. Evolution Med. Dent. Sci. 2016;5(100): 7394-7396, DOI: 10.14260/jemds/2016/1673 BACKGROUND Giant cell tumour (GCT) of bone usually occurs in epiphysis of long bones like distal femur, proximal tibia and distal radius etc. 1,2,3 However, it is extremely rare in phalanx of finger. The incidence of GCT in hand (including phalanges and metacarpals) is ranging from 1.7% to 2%. Though most cases of GCT in these sites are benign, it shows high recurrence rate 4,5 with local aggressiveness after simple curettage and often needs en block excision. 4 The recurrence of GCT of hand, especially of phalanx is significantly higher than that of other location. In 90% of cases, the local recurrence has been reported after curettage and bone grafting. 4,67,8,9 Even after wide resection and reconstruction with structural bone grafting, high local recurrence rate is noted. 4,5 Multiple surgical procedures like local and wide excision and amputation including ray amputation are used to cure the disease completely. Here, we report a case of GCT of middle phalanx of right ring finger due to its rare location as well as local recurrence after 10 months of primary curettage and bone grafting. The recurrence of tumour was treated by amputation of affected phalanx, iliac crest bone grafting and arthrodesis. CASE REPORT An 18 years old female attended our institution reporting a history of trivial accident in December 2009 following which she had pain and soft tissue swelling of middle phalanx of right ring finger. As per advice of orthopaedic surgeon, digital x-ray was done. Radiological evaluation revealed aneurysmal bone cyst with the description of expansile subarticular osteolytic lesion of middle phalanx of right ring finger. [Figure - 1]. Financial or Other, Competing Interest: None. Submission 09-11-2016, Peer Review 01-12-2016, Acceptance 09-12-2016, Published 15-12-2016. Corresponding Author: Dr. Anupam Saha, Professor, Department of Pathology, MGM Medical College & LSK Hospital, Kishanganj-855107, Bihar. E-mail: dranupamsaha@yahoo.co.in DOI: 10.14260/jemds/2016/1673 Just after one and half month she underwent curettage of lesion and bone graft. Tissue from lesion sent for histopathological examination. Microscopical examination showed classical features of Giant cell tumour of bone with round or oval mononuclear stromal cells interspersed with many multinucleated osteoclastic type of giant cells. [Figure–2]. After 10 months of surgery, she again noticed pain and soft tissue swelling of that area. She underwent repeat digital x-ray along with MRI and spiral CT scan. All the investigations were suggestive of Giant cell tumour of bone. [Figure–3, 4, 5]. Bone scan was done. No other lesion detected. Ultimately, excision of middle phalanx of right ring finger was done along with iliac crest bone grafting and arthrodesis of Proximal Interphalangeal (PIP) and Distal Interphalangeal (DIP) Joint (Performed elsewhere). Bone graft stabilised proximally with two wires at right angles and distally with stainless wire and K wire (four stairs technique) in functional position. [Figure–6]. Histopathological examination of amputated middle phalanx proved the recurrence of Giant cell tumour. [Figure–7]. Figure 1. Report of first X-ray: Aneurysmal bone cyst of middle phalanx of right ring finger