Rare Coexistence: Giant Cell Tumor Recurrence and Infection in the Proximal Tibia - A Case Report

Area of Science:

• Orthopedic Oncology
• Surgical Pathology
• Infectious Diseases

Background:

• Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm with a notable recurrence rate, often linked to incomplete tumor removal.
• Postoperative infection following GCTB treatment presents a significant challenge, complicating management and potentially increasing recurrence risk.
• Adjuvant therapies have shown limited efficacy in preventing GCTB recurrence, underscoring the importance of complete surgical resection.

Observation:

• A 28-year-old female with a history of GCTB in the right proximal tibia presented with recurrent tumor and infection 1 year after initial surgery (curettage, cementing, plate stabilization).
• Radiography and MRI confirmed tumor recurrence around the existing hardware, without joint line or neurovascular involvement.
• Intraoperative cultures identified methicillin-sensitive Staphylococcus aureus, guiding antibiotic selection.

Findings:

• The patient underwent implant removal, extended curettage, revision plate stabilization, and cementing with targeted antibiotic prophylaxis.
• Postoperatively, she received a course of intravenous and oral antibiotics based on culture sensitivity results.
• The patient experienced no post-operative wound complications and achieved a satisfactory functional outcome.

Implications:

• This case highlights a rare presentation of concurrent GCTB recurrence and infection, demonstrating a viable single-stage surgical approach.
• The combined strategy of extended curettage and antibiotic-laden bone cement effectively addressed both neoplastic recurrence and bone infection.
• This approach offers a potential solution for managing complex GCTB recurrences with superimposed infection, leading to favorable long-term outcomes.