Tumor of giant cells bone in the 4th metacarpal in child: case report

Abstract

Introduction: Giant cell tumor (GCT), formerly known as osteoclastoma, is a relatively rare and benign neoplasm, but locally aggressive, causing significant destruction and involvement of adjacent tissues. Although generally considered benign due to its mild clinical presentation and low mortality rate, some authors classify it as a tumor with intermediate malignant potential, due to its locally aggressive nature and invasion of neighboring structures. GCT is more common in long bones, such as the distal femur, proximal tibia, distal radius, and proximal humerus. In the bones of the hand, it is a rare occurrence, mainly affecting young people between the ages of 15 and 30, with a higher incidence in women. The choice of treatment is crucial to prevent GCT recurrence. Surgical options include curettage, wide excision, and amputation, with or without additional therapies. The use of radiotherapy should be carefully considered due to the risk of malignancy. The present study aims to report a case of a giant cell tumor in the metacarpal bone of a child, addressing its diagnosis and treatment. Case Report: This is a case report conducted through a review of medical records and examinations. A five year old female patient reported that the tumor manifestation began after an insect bite but did not affect her movements. X-rays and magnetic resonance imaging (MRI) were performed, revealing a tumor in the 4th metacarpal of the right hand, with evidence of cortical bone inflation. These findings raised the suspicion of an enchondroma, which is a benign bone tumor formed by cartilage cells, especially considering the patient’s young age. Based on the exam results, treatment began with intralesional resection surgery by curettage of the lesion, and the patient’s hand was immobilized for two weeks. Initially, a second surgery was planned for the amputation of the fourth metacarpal. However, it was decided to use a monoclonal antibody, a treatment indicated for GCT, using the drug Denosumab. The patient is currently undergoing treatment and is doing well. Conclusion: The goal of treatment in these cases is to completely remove the tumor while preserving movement. Our patient responded well to both therapies: surgery and chemotherapy, with no recurrence of the tumor at the primary site or elsewhere. She has maintained her mobility and remains under outpatient follow-up.