[Multicentric giant cell tumor in the upper extremity].

Area of Science:

• Orthopedic Surgery
• Oncology
• Bone Pathology

Background:

• Multicentric giant cell tumors (GCT) of bone are exceptionally rare, accounting for less than 1% of all GCTs.
• Giant cell tumors typically present as a solitary lesion, making multicentric occurrences noteworthy.

Observation:

• A 24-year-old male initially presented with a giant cell tumor of the proximal humerus.
• Following initial treatment failure, the patient underwent resection-arthrodesis of the shoulder with a vascularized fibular autograft.
• Three years later, a second GCT developed in the distal radius, necessitating wrist resection-arthrodesis with a similar graft.
• A subsequent, distinct GCT localization in the distal humerus was treated with curettage and bone grafting, with favorable outcomes.

Findings:

• Histological confirmation of giant cell tumor was consistent across all three distinct localizations.
• The patient experienced multiple, sequential GCT occurrences at different skeletal sites over a 24-year period.
• Surgical interventions, including resection-arthrodesis and bone grafting with vascularized fibular autografts, were employed for treatment.

Implications:

• This case underscores the potential for multicentricity and recurrence in giant cell tumors of bone, even after initial surgical management.
• The long-term follow-up demonstrates the feasibility of reconstructive surgery, including free vascularized bone grafts, in managing complex GCT cases.
• Further research into the etiology and optimal management strategies for multicentric giant cell tumors is warranted.