Giant Cell Tumor of Third Metacarpal: A Rare Case Report and Review of Literature

Giant cell tumor (GCT) or osteoclastoma is an osteolytic, mostly benign but locally aggressive tumor occurring in young adults at the meta-epiphyseal region of long bones such as lower end of the femur, upper end of the tibia, and lower end of the radius, and proximal humerus in descending order of frequency. Only 2% of all GCT of bone occur in hand. GCT of metacarpal (MC) has different characteristics than that of other long bones. It has more aggressive behavior with involvement of entire length of MC with soft tissue extension.

We are reporting a case of GCT of the 3rdMC in a 19-year-old female. She presented to us with a painful, firm, ovoid, and gradually progressive swelling measuring 4 cm × 3 cm over the dorsum of the left (non-dominant)hand, since past 6 months. Fine-needle aspiration cytology was suggestive of GCT of the tendon sheath. Pre-operative magnetic resonance imaging and computed tomography scan revealed the extent of the lesion with no neurovascular involvement. Although various reconstructive procedures to salvage the affected Ray have been reported in literature, we planned for a surgical resection of the lesion leaving behind 1 cm of healthy MC base which appeared to be normal radiologically and intraoperatively. Reconstruction of the defect was done using non-vascularized contoured fibular strut graft, fixed with 2.5 mm mini reconstruction plate, along with reconstruction of the collateral ligaments of the metacarpophalangeal joint. The histopathological study confirmed the diagnosis of GCT.

GCT of hand is a rare tumor, due to its relatively more aggressive behavior and high chance of recurrence it, nevertheless, provokes quite difficult issue to solve. Prognosis, treatment, and results are directly dependent on early diagnosis and adequate therapy.