Allograft Reconstruction of a Large Giant Cell Tumor of the First Metatarsal: A Case Report

Wang, Edward H. M.; Arbatin, Jose Joefrey F.

doi:10.3113/fai.2008.0097

Cited by 8 publications

(11 citation statements)

References 22 publications

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“…After resection of a tumor in the midfoot, the residual defect has typically been reconstructed with various autografts or an allograft 7,9,12 . One patient with a GCT involving the navicular, the cuboid, and all of the cuneiforms was reported to have a good result after en bloc resection and reconstruction with a massive iliac crest graft 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Following resection, we performed a reconstruction using an autogenous iliac strut bone graft, and we chose to employ rigid fixation of the graft with multiple plates and screws. Usually, fixation in metatarsal reconstruction has been achieved with Steinmann pins, so the limb has needed to be immobilized in a cast for more than three months 6,7 . In our case, a short leg cast was worn for six weeks, and full weight-bearing was allowed at four months because the rigid fixation had resulted in early union of the graft.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, eighteen of twenty-one GCTs that involved the foot were distributed in the tarsal bones, with a noteworthy number of cases in the talus 4 . Although metatarsal lesions were rare in that series, several cases of single or double metatarsal reconstruction in patients with GCT have been reported in the literature [5][6][7] .…”

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confidence: 99%

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Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

Ahn

Choy

Kim

et al. 2011

Journal of Bone and Joint Surgery

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T he occurrence of a giant-cell tumor (GCT) in the small bones of the foot is rare. Two studies have shown incidences of 1% and 2% 1,2 . The younger age of patients with a GCT in the foot, compared with those with tumor in the long bones, as well as a multifocal trend and a higher recurrence rate have been stressed in the literature 3 . In one study, eighteen of twenty-one GCTs that involved the foot were distributed in the tarsal bones, with a noteworthy number of cases in the talus 4 . Although metatarsal lesions were rare in that series, several cases of single or double metatarsal reconstruction in patients with GCT have been reported in the literature 5-7 .The proposed treatments for GCTof the foot are curettage and bone-grafting as well as marginal or wide excision; however, wide excision is usually impossible to achieve without performing an amputation 8 . Some authors have recommended that en bloc resection and bone-grafting be used as the first line of treatment for GCT in suitable sites 5 . The reconstruction techniques include the use of allografts or large autogenous grafts with fusion 6,7,9 .We present a case of a large, aggressive GCT that originated in the medial cuneiform. It destroyed the adjacent cuneiforms as well as the first, second, and third metatarsal bases. We treated the patient with a marginal en bloc resection of the medial two cuneiforms and the proximal two-thirds of the first and second metatarsals combined with a partial excision of the medial halves of the lateral cuneiform and the third metatarsal base. The resultant osseous defect was reconstructed with a large iliac strut graft and fixation with multiple plates and screws. The midterm clinical results with radiographic features are reported with a review of the literature. The patient was informed that data concerning the case would be submitted for publication, and she consented. Case ReportA twenty-five-year-old woman presented with a painful mass of the right foot, which had been gradually enlarging over a fourteen-month period. On physical examination, a 6 · 5-cm tender mass was observed on the dorsomedial aspect of the midfoot (Fig. 1). Radiographs demonstrated a large osteolytic lesion involving the medial and intermediate cuneiforms and the first and second metatarsal bases (Figs. 2-A and 2-B). A radiograph obtained at another hospital ten months earlier revealed a poorly defined osteolytic lesion within the medial cuneiform, and initially the patient had been treated nonoperatively for osteomyelitis. On presentation to our hospital, standing lateral radiographs of the feet also revealed that the patient had a moderate cavus foot deformity bilaterally. Magnetic resonance imaging (MRI) demonstrated a large expansile mass of low signal intensity on the T1-weighted images and mixed signal intensity on the T2-weighted images; the mass had infiltrated the medial two cuneiforms and the corresponding metatarsal bases Fig. 1

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

Ahn

Choy

Kim

et al. 2011

Journal of Bone and Joint Surgery

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“…The second patient had a previous resection and unspecified reconstruction, and then underwent excision and ipsilateral fibular autograft, with return to regular activities with no signs of recurrence at 1-year follow-up [31]. Another study details the use of first metatarsal allograft for reconstruction following excision of recurrent GCT of the first metatarsal [32]. None, however, have examined treatment for multiply recurrent GCT of the first metatarsal as we have in this report.…”

Section: Discussionmentioning

confidence: 99%

Wide Resection and Iliac Crest Arthrodesis for Multiply Recurrent Giant Cell Tumor of First Metatarsal

Golz

Murphy

Nystrom

et al. 2018

Case Reports in Orthopedics

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Case Giant cell tumor of bone is a benign, aggressive neoplasm commonly arising in the femur, tibia, and distal radius and less commonly in the hands and feet. We describe a 22-year-old woman who underwent wide resection of multiply recurrent first metatarsal giant cell tumor and reconstruction with iliac crest arthrodesis. Conclusion To our knowledge, there have been no previous reports of managing multiply recurrent giant cell tumor of the first metatarsal. The patient was without pain and exercising without difficulty 18 months following surgery. This method appears useful for reconstructing the foot following multiply recurrent giant cell tumor of the metatarsal.

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“…The patient with involvement of the first metatarsal underwent en bloc excision of the metatarsal and reconstruction with metatarsophalangeal fusion using a metatarsal allograft augmented with iliac crest bone graft. 11 Similarly, the patient with cuboid GCTB underwent excision and arthrodesis to surrounding bone with iliac crest bone graft. The patient with a GCTB of the calcaneus underwent a calcanectomy without further reconstruction.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Giant cell tumor of the small bones of the foot

Wang

2018

J Orthop Surg (Hong Kong)

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This study aims to determine whether giant cell tumor of bone of the foot (GCTB-F) is more aggressive than GCTB at other sites using data from a single institution. Patients and Methods: We reviewed all patients with GCTB seen by our Unit from 1993 to 2012. Patients with GCTB-F were compared with all other patients with GCTB in terms of demographics and presentation. This group of GCTB-F was then compared with patients with GCTB of the appendicular skeleton (GCTB-AS) in terms of treatment and oncologic outcome at follow-up of at least 2 years. Results and conclusion: There were seven patients with GCTB-F (2.6%), most consulted over 12 months after symptoms. Compared to other GCTB (n ¼ 262), a bigger proportion of patients (28.5%) presented as recurrent lesions. All seven patients were classified as Campanacci III but none had lung metastasis at presentation or on follow-up. Compared to the group of 124 GCTB-AS, no GCTB-F patient received intralesional surgery. The 14% recurrence rate can be explained by contaminated non-intralesional surgery due to the advanced presentation and the technically challenging architecture of the foot. It would seem the aggressive tag of GCTB-F is not due to aggressive biologic behavior but to a combination of delayed presentation, delayed diagnosis, and difficult surgery.

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Allograft Reconstruction of a Large Giant Cell Tumor of the First Metatarsal: A Case Report

Cited by 8 publications

References 22 publications

Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

Wide Resection and Iliac Crest Arthrodesis for Multiply Recurrent Giant Cell Tumor of First Metatarsal

Giant cell tumor of the small bones of the foot

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