Giant Cell Tumor of the Calcaneus

Abstract

A 17-year-old female presented to us with pain and swelling in the right heel. Examination revealed the swelling to be tender, hard and fixed to the calcaneus. Radiographs showed an expansile, lytic lesion of the calcaneus with well-defined margins and no extraosseus spread. A core biopsy was done which showed multinucleated giant cells in a sea of mononuclear stromal cells, suggestive of a giant cell tumour (GCT). Curettage and filling up of the defect with bone cement was done under anaesthesia. The patient was fully ambulatory three months after the surgery. At two-year follow-up, the patient continued to be asymptomatic and radiographs revealed no signs of recurrence. It is important to note that GCT can occur in these rare sites and unusual age groups, and hence requires a good level of awareness of the surgeon and adequate preoperative workup, including biopsy, before proceeding to the definitive treatment of the lesion. Considering its potential local aggressiveness, early intervention is necessary. The patient should be kept under regular follow-up to detect any recurrence or metastasis in early stage.

Keywords: bone cementing; calcaneum; calcaneus; curettage; gct; giant cell tumor; recurrence.

Figure 1. Preoperative radiographic assessment of the lesion.

An expansile, eccentric, lytic lesion with non-sclerotic rim in the right calcaneus on X- rays (A, B); a well-defined hyperintense lesion with cystic areas abutting the posterior and medial surfaces of the calcaneus with hypointense margins and narrow zone of transition on MRI (C, D).

Figure 2. Curettage of the lesion and bone cementation.

Figure 3. Clinical and radiographic assessment at two-year follow-up.

Well-healed surgical scar with quiescent local site (A, B); X-ray having no evidence of recurrence at two-year follow-up (C).