Combined Approach (Surgery + Systemic Adjuvant Therapy) in a Giant Cell Tumor of Proximal Femur: A Rare Case Report

Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor involving the ends of the long bones seen in the second or third decade of life, more commonly in women. Even though it is benign, it has a potential for malignant transformation in 10% of cases and metastasis to the lung in 1-4% of patients. GCTB of the proximal femur has a high recurrence rate, high incidence of pathological fracture, and poor prognosis.

A 29-year-old man presented with pain and swelling in the left proximal femur of 1 year duration. After confirmation of his diagnosis using fine-needle aspiration cytology, he underwent a combined approach, i.e., near total excision of the tumor, extended curettage of the remaining portion of the tumor, and total hip replacement, followed by systemic therapy using monthly injection of denosumab for 1 year.

At 2½ years of follow-up, there was no evidence of recurrence of tumor either clinically or radiologically. Patient's pre-operative Harris Hip score was 20, which was improved to 86 at the latest follow-up. A combined approach using surgery and systemic therapy using denosumab can be considered in the proximal femoral giant cell tumor.