A rare case of giant cell tumour of olecranon

Zile Singh Kundu; Umesh Yadav; Vinod Kamboj; Himansu Bhusan Behera

doi:10.4103/jotr.jotr_14_17

CASE REPORT

Year : 2017 | Volume : 9 | Issue : 2 | Page : 139-141

A rare case of giant cell tumour of olecranon

Zile Singh Kundu, Umesh Yadav, Vinod Kamboj, Himansu Bhusan Behera
Department of Orthopaedics, PGIMS, Rohtak, Haryana, India

Date of Web Publication

14-Dec-2017

Correspondence Address:
Dr. Zile Singh Kundu
Department of Orthopaedics, PGIMS, Rohtak, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jotr.jotr_14_17

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

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

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

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

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.

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