Giant cell tumor in the proximal phalanges of the hand: A report of two cases treated with a nonbiological construct

Abstract

The lesion is classically juxta-articular at the end of long bones in the age group of 20-40 years with the mean age of 32 years. On the hand, it tends to present earlier with a mean age at presentation of 22 years (that is less than the average occurrence age of conventional GCT). [3,4] The most common location for GCTs is the distal femur and the proximal tibia, which together constitute 55% of cases. Other locations include the distal radius (10%-12%), sacrum (4%-9%), proximal humerus (4%-8%), proximal femur (4%), and less frequently, the vertebral bodies (2.5%). [5] However, its occurrence in the bones of the hands is an infrequent entity, accounting for only 2% of all GCTs, [5,6] and it is even rarer in the phalanges of the hands. Biscaglia reported a 0.9% occurrence in the hands in their review of 900 cases. [7] Averill reported an incidence of 2% GCT in the hands out of 1228 cases. [4] In a review by Patel et al. of 2400 cases, fifty cases (2%) were in the phalanges of the hand. [8] Athanasian, in his data over 50 years from the Mayo Clinic, had just five patients with GCT in the phalanges. [9] From a collection of series, in Turcott's report, of 1299, only 11 (0.84%) cases occurred in the phalanges. [5] We report on two patients with GCT-B of the phalanges. The first case presented with GCT-B in the proximal phalanx of the thumb and the second case with the tumor in the proximal phalanx of the index finger. In both patients, the lesions were radiologically Campanacci III. They were treated by total resection of the involved phalanx and nonbiological reconstruction using a Kirschner (K) wire and cement spacer. Both patients remained disease-free at 9 and 7 years, respectively, post index procedure. A literature review and management options for this rare presentation site in GCT-B are discussed.