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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 139-141

A rare case of giant cell tumour of olecranon


Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Date of Web Publication14-Dec-2017

Correspondence Address:
Dr. Zile Singh Kundu
Department of Orthopaedics, PGIMS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_14_17

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  Abstract 


The report describes a rare case of giant cell tumor (GST) of olecranon in a 34-year-old lady who presented with pain and swelling in the left elbow after trivial trauma. Radiologically, an expansile lytic lesion in the olecranon was noticed and a fine-needle aspiration cytology proved out to be a GST. The lesion was treated with an extended curettage and autograft. The patient on regular follow-up reported full painless range of motion of elbow and there was no recurrence of the lesion.

Keywords: Curettage, Giant cell tumor, olecranon


How to cite this article:
Kundu ZS, Yadav U, Kamboj V, Behera HB. A rare case of giant cell tumour of olecranon. J Orthop Traumatol Rehabil 2017;9:139-41

How to cite this URL:
Kundu ZS, Yadav U, Kamboj V, Behera HB. A rare case of giant cell tumour of olecranon. J Orthop Traumatol Rehabil [serial online] 2017 [cited 2021 Mar 2];9:139-41. Available from: https://www.jotr.in/text.asp?2017/9/2/139/220757




  Introduction Top


Giant cell tumor (GST) of bone or osteoclastoma is classically described as a locally invasive tumor that occurs close to the joint of a mature bone. GCT is a rare, generally benign and locally aggressive tumor.[1] It represents approximately 3%–5% of all primary bone tumors. It usually occurs in adults between the ages of 20 and 40 years. 75%–90% of GCTs are located at the epiphysis of long bones and in most series, common sites are proximal tibia, distal femur, and distal radius.[1] Although GCTs have been observed in other less frequent sites, such as the patella,[2],[3] great trochanter, and skull,[4] involvement of the olecranon is extremely rare.[1]


  Case Report Top


A 34-year-old female presented with a history of pain and swelling over her left elbow after having a trivial injury owing to slip and fall. On examination, tenderness and swelling were present on posterior aspect of elbow more prominently over olecranon, overlying skin being normal without any engorged or visible veins. On palpation, local temperature was normal and swelling was tender, firm in consistency. Three point bony relationship of humeral epicondyles and olecranon was maintained and there was no abnormality in the carrying angle of elbow. There was limited range of movements of 30°–80° at elbow joint. The neurovascular examination was normal. There was no axillary lymphadenopathy. Chest radiograph was normal and laboratory screening tests were within normal limits.

Radiographs of elbow showed well-defined expansile osteolytic lesion with a cortical breach in the dorsal aspect of the olecranon, suggestive of a pathological fracture [Figure 1]. Presumptive diagnosis was made as GST of olecranon. Magnetic resonance imaging showed an altered signal with no soft tissue extension [Figure 2]. Fine-needle aspiration cytology was performed which confirmed the diagnosis. Thenceforth, extended curettage of lesion with autograft was planned.
Figure 1: Radiograph showing an expansile lytic lesion in the olecranon extending into the subchondral region with an associated pathological fracture

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Figure 2: Magnetic resonance imaging showing a relatively well-defined lesion of hyperintensive signals in a T2-weighted image with no soft tissue extension

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A posterolateral incision was given over left elbow and fracture of dorsal aspect of olecranon was noted. Lytic cavity was assessed and gelatinous “chocolate brown” material was curetted out. Thorough curettage was adjuvant with a sharp burr, cautery on spray mode, and hydrogen peroxide to prevent recurrence. The cavity was packed with autograft from ipsilateral iliac crest to add strength to the curetted lesion.

Histopathology of the resected specimen revealed mononuclear ovoid and spindle-shaped cells associated with multinucleated giant cells and macrophages [Figure 3].
Figure 3: Histological analysis showing mononuclear ovoid and spindle-shaped cells associated with multinucleated giant cells and macrophages characteristic of giant cell tumor of bone

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Follow-up was done at regular interval and the patient showed obvious incorporation of autograft with pain-free movements with healing of pathological fracture [Figure 4] and [Figure 5]. No recurrence or any other complication was noted during follow-up period.
Figure 4: Follow-up radiograph showing incorporation of autograft

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Figure 5: Clinically pain-free movements at elbow joint

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  Discussion Top


Most GSTs are found in the proximal tibia, distal femur, and distal radius.[1],[5] Other less frequent sites include the proximal femur, vertebral bodies, distal tibia, proximal fibula, hand, and wrist.[1],[5] In addition, GCTs occurring in the patella and great trochanter have been reported.[2],[3],[4]

In several large studies,[6],[7],[8] a total number of 1447 GCT of bone cases have been reported, but none of them were located in the olecranon. In addition, Hoch et al.[9] reported one patient with multicentric GCTs involving the left proximal ulna from a 12-year retrospective study conducted at the Mayo Clinic. Shankman et al. analyzed 1728 GCT cases and found 42 to be localized in distal end of ulna but none in proximal ulna.[10] Although Dahlin and Unni mentioned one case of GCT of proximal ulna in a series of 429 cases,[11] Yang et al. reported a rare case of GCT olecranon with pathological fracture and extending into the elbow joint.[12]

Olecranon is a rare site for ganglion cyst,[13] osteoid osteoma,[14] and metastasis [15] as well. A brown tumor resulting from hyperparathyroidism presents with similar radiographic features. The clinical course and X-ray examination helped in the exclusion of these differential diagnoses. Despite the eccentric location, the lesion had characteristics similar to those occurring in bones with a smaller diameter, such as the proximal fibula.[6]

Similarly, the lesion was treated in the same way as GCT occurring in a common location. Intralesional curettage was done despite a higher incidence of local recurrence.[16] The use of local adjuvants such as liquid nitrogen,[17] bone cement,[18] and hydrogen peroxide [19] may reduce the rate of local recurrence. In this case, we made use of sharp burrs, cautery on spray mode, and irrigation with hydrogen peroxide solution.


  Conclusion Top


GCT of bone is a relatively common benign bone lesion that is usually located in long bones, while involvement of the olecranon is extremely rare.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, et al. Giant cell tumor of the extremity: Retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 2012;94:461-7.  Back to cited text no. 1
    
2.
Agarwal S, Jain UK, Chandra T, Bansal GJ, Mishra US. Giant-cell tumors of the patella. Orthopedics 2002;25:749-51.  Back to cited text no. 2
    
3.
Yoshida Y, Kojima T, Taniguchi M, Osaka S, Tokuhashi Y. Giant-cell tumor of the patella. Acta Med Okayama 2012;66:73-6.  Back to cited text no. 3
    
4.
Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone: Imaging and pathology of specific lesions. In: Resnick D, editor. Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia: Saunder; 1995. p. 3628-938.  Back to cited text no. 4
    
5.
Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.  Back to cited text no. 5
    
6.
Unni KK. Dahlin's Bone Tumors: General Aspect and Data on 11087 Cases. 5th ed. Philadelphia: Lippincott-Raven; 1996. p. 263-83.  Back to cited text no. 6
    
7.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.  Back to cited text no. 7
    
8.
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 1970;52:619-64.  Back to cited text no. 8
    
9.
Hoch B, Inwards C, Sundaram M, Rosenberg AE. Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am 2006;88:1998-2008.  Back to cited text no. 9
    
10.
Shankman S, Greenspan A, Klein MJ, Lewis MM. Giant cell tumor of the ischium. A report of two cases and review of the literature. Skeletal Radiol 1988;17:46-51.  Back to cited text no. 10
    
11.
Dahlin DC, Unni KK, editors. Bone Tumours: General Aspects and Data on 8542 Cases. 4th ed. Springfield: Charles C Thomas Publication; 1986. p. 120.  Back to cited text no. 11
    
12.
Yang C, Gong Y, Liu J, Qi X. Rare giant cell tumor involvement of the olecranon bone. J Res Med Sci 2014;19:574-6.  Back to cited text no. 12
    
13.
Zarezadeh A, Nourbakhsh M, Shemshaki H, Etemadifar MR, Mazoochian F. Intraosseous ganglion cyst of olecranon. Int J Prev Med 2012;3:581-4.  Back to cited text no. 13
    
14.
Tounsi N, Trigui M, Ayadi K, Kallel S, Boudaouara Sallemi T, Keskes H. Osteoid osteoma of the olecranon. Rev Chir Orthop Reparatrice Appar Mot 2006;92:495-8.  Back to cited text no. 14
    
15.
Culleton S, de Sa E, Christakis M, Ford M, Zbieranowski I, Sinclair E, et al. Rare bone metastases of the olecranon. J Palliat Med 2008;11:1088-91.  Back to cited text no. 15
    
16.
Cho HS, Park IH, Han I, Kang SC, Kim HS. Giant cell tumor of the femoral head and neck: Result of intralesional curettage. Arch Orthop Trauma Surg 2010;130:1329-33.  Back to cited text no. 16
    
17.
Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res 1999;359:176-88.  Back to cited text no. 17
    
18.
Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res 1995;321:245-50.  Back to cited text no. 18
    
19.
Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res 1998;347:250-60.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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