A Case Report of Giant Cell Tumor in the Thumb Distal Phalanx

The following report describes a rare case of giant cell tumor (GCT) of the bone that presented in the distal phalanx of the thumb. GCT of the bone is a relatively rare, and typically benign condition that presents most frequently in the metaphysis of long bones in women age 30-50 years old. There are only three other instances in the literature describing GCT of the bone presenting in the distal phalanx of the thumb. Although rare, delayed or missed diagnosis can be very debilitating to the patient.

A 28-year-old male laborer who is right hand dominant and works with his hands for a living presented to the emergency department (ED) with swelling and pain at the distal aspect of his left thumb with no known injury. The patient was seen 4 weeks previously and was treated for cellulitis of the hand with antibiotics. At that time, no radiographs were taken. Despite this treatment, the patient reported increased swelling and pain over the next 2 weeks. He then sought treatment in the ED where a hand surgeon was consulted and radiographs were obtained that displayed a lytic, disruptive, and mildly expansile lesion of the distal phalanx of the first finger concerning for sarcoma. The risks and benefits of surgery were discussed with the patient and surgical intervention was planned.

Due to how rarely this condition presents clinically, the patient was initially misdiagnosed and definitive treatment was delayed. Although rare, this is an important diagnosis to consider in patients presenting similarly. The patient ultimately received adequate treatment, but the delay in diagnosis in combination with the locally aggressive nature of this tumor could have led to extensive surgical intervention with impairment in hand function. As a laborer whose income relies on daily use of his hands a delayed diagnosis; in this case could have had a catastrophic impact.