Giant Cell Tumor of the Capitate and Hamate: Case Report and of Literature Review

Abstract

Background In the hand, giant cell tumors (GCTs) of the bones account for 2 to 5% of all hand tumors; they are often seen in the metacarpals and phalanges, seldom in the carpal bones. In the carpal bones, GCT usually occurs as a single lesion, with multifocal involvement being extremely rare. On analysis of recent English literature, we could find out only two reports having simultaneous involvement of multiple carpal bones. Case Description We report a case of a 29-year-old female with simultaneous involvement of two carpal bones: capitate and hamate. After confirming the diagnosis by histopathological examination, the affected carpals were resected, and the defect was filled with autologous bone graft. Follow-up at 18 months demonstrated no evidence of local recurrence or metastatic disease, and the patient is now having a reasonable hand function. Literature Review We analyzed nine case reports on GCTs in carpal bones in the past 25 years. Seven out of nine cases that we could analyze showed single carpal bone involvement (three capitate, two scaphoid, one hamate, one triquetrum). In these, four patients had undergone resection, and five patients had undergone curettage, of whom one patient came back 5 months later with recurrence. Only two cases were there with simultaneous involvement of multiple carpal bones. Both the cases were managed with resection and reconstruction with autologous graft iliac graft. Clinical Relevance GCTs of the carpal bones are relatively rare, and simultaneous involvement of two bones is rarer. Every attempt should be made to preserve useful wrist range of motion by excision and limited carpal fusion.

Distribution and Characteristics of Carpal Bone Tumors: A Systematic Review

“…Three independent reviewers collected data for inclusion, blinded from the decisions of other reviewers. Inclusion criteria for articles were: (1) tumors involving a carpal bone that were not locally aggressive extensions of the other tumors (i.e., distal radius giant cell tumors); (2) full-text publication in the English language; (3) reports or literature searches presenting cases not yet included by the reviewers. Exclusion criteria were: (1) tumors involving a carpal bone that were locally aggressive extensions of the other tumors (i.e., distal radius giant cell tumors); (2) full-text publication not in the English language; and (3) reports or literature searches with duplicate cases already included by the reviewers.…”

“…When encountered clinically, establishing a differential diagnosis can be challenging due to their rarity and the paucity literature, which are largely limited to case series and reports. 2,3 Currently, the largest study of carpal bone tumors was a case review series of 44 patients, which was published more than 20 years ago. 1 The next largest report described 10 giant cell tumors in the carpus and presented a literature review.…”

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…GCTs are the most common tumor of the capitate and are generally treated with curettage versus complete excision. 3 With total capitate excision, augmentation with CMC arthrodesis yields excellent long-term results with no recurrence at the cost of decreased wrist motion. 91,92 Excision without any additional reconstructive effort has also been suggested and shows remarkable hand function even at the 5-year mark.…”

“…Bone tumors of the hand are rare; carpus tumor involvement is even rarer. [3][4][5] Scaphoid tumors are preferentially treated with curettage and bone grafting to maintain scaphoid structure and surrounding carpal stability. 6 Giant cell tumors (GCT) make up around 2 to 5% of all carpal tumors and usually involve a single carpal bone.…”

“…6 Giant cell tumors (GCT) make up around 2 to 5% of all carpal tumors and usually involve a single carpal bone. 3 One case described treatment of scaphoid GCT with excision and silicone implant with good functional results and no recurrence after 9 years. 7 If GCTs reoccur after initial curettage, scaphoidectomy with 4CA eliminates recurrence and maintains satisfactory grip strength and mobility.…”