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. 2016:28:176-181.
doi: 10.1016/j.ijscr.2016.09.038. Epub 2016 Sep 28.

Management of aggressive giant cell tumor of calcaneal bone: A case report

Achmad Fauzi Kamal  1 , Agus Waryudi  2 , Zuhri Effendi  2 , Evelina Kodrat  3
Affiliations

Management of aggressive giant cell tumor of calcaneal bone: A case report

Achmad Fauzi Kamal et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: Prevalence of giant cell tumor (GCT) at atypical locations like bones of the feet are rare, seen in <1% of cases. GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Difficult diagnosis most often followed with complicated management and high recurrence rate remains a challenge that is rarely reported.

Presentation of case: We presented a case of forty-six-year-old male patient with giant cell tumor of the right calcaneus Campanacci 3 with secondary aneurysmal bone cyst (ABC). Wide excision total calcaneoctomy, followed by reconstruction bone defect using femoral head allograft and soft tissue coverage with sural flap had been done.

Discussion: Conservative surgery with careful curettage and placement of bone cement should be considered the treatment of choice when feasible. However, aggressive GCTs may require wide excision and reconstruction or may be amputation. We decided to do salvage surgery since: traditionally curettage is not possible, adequately wide resection of local tumor could be achieved, neurovascular bundle was not involved, and also bone and soft tissue reconstructions could be done. In addition, he refused for amputation.

Conclusion: Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation.

Keywords: Bone allograft; Calcaneoctomy; Giant cell tumor; Sural flap; Wide excision.

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Figures

Fig. 1
Fig. 1
Clinical pictures of the right heel showed a 7 × 10 × 6 cm lobulated mass over the right heel: (A) Lateral view. (B) Posterior view.
Fig. 2
Fig. 2
A: lateral view radiograph of ankle showed a radiolucent lesion occupying the right calcaneous. B: magnetic resonance imaging was consistent with solid mass derived from calcaneal bone expanding to the soft tissue. C: there was small area of cystic component, most probably secondary aneurismal bone cyst.
Fig. 3
Fig. 3
The histologic section reveals tumor consist of numerous multinucleated giant cells, and area of secondary aneurysmal bone cyst (HE, 40×) B. The multinucleated giant cells contain nuclei showing similar feature to those of mononuclear stromal cells (HE, 400×).
Fig. 4
Fig. 4
The pictures showed surgical procedures from wide excision to bone and soft tissue reconstruction. (A) tumor excision; (B) post excision of the tumor; (C) femoral head allograft; (D) femoral head insertion to change the calcaneus; (E) achilles tendon lengthening; (F) achilles tenodesis; (G) soft tissue coverage with sural flap; and (H) complete surgery.
Fig. 5
Fig. 5
Five months follow up after the surgery, (A) Clinical pictures (B) Radiographic pictures.
See this image and copyright information in PMC

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