Giant Cell Tumor of talus in a 14-year-old child treated by curettage and cementation: A case report

S. Kavin¹, Janani shree², S Chockalingam³, P R Ramasamy⁴

Department of Orthopaedic Surgery, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

A 14 years old girl presented with pain and swelling of left ankle for past 3 months. Clinical examination showed tenderness over sinus tarsi region and ROM of Left ankle near normal. The radiograph and MRI scan showed a well-defined lytic lesion affecting the neck of talus extending to the body. Trucut biopsy and final histopathological examination of lesion confirmed this to be a Giant Cell Tumor. This was treated with intra lesion curettage and cementation of talus. Post operatively clinical and radiological outcome observed and satisfactory. This case has been reviewed due to the rarity of this condition affecting small bone in a child. Our patient is the youngest child in the English literature with a lesion of the talus involving the head and neck treated with curettage and cementation.

Introduction

Giant Cell Tumors (GCT) are locally aggressive lesions that primarily affect the epiphyses of long bones. They typically present in the 3^rd to 4t^h decades of life and rare under 20 years of age. Even in adults, the involvement of the small bones in the foot is rare, frequently affecting the calcaneus and metatarsals, uncommon in talus. In a recent study published in July 2023 by Lim et al, only sixteen patients in 15 studies had been reported with talar involvement. The majority of these patients are adults and involvement in a child with small bone is rare.

Case Presentation

A 14-year-old female child presented with complaints of pain and swelling over left foot and ankle region for last 3 months. History of difficulty in bearing weight on affected leg present. Examination showed warmth, tenderness, restricted range of movements of ankle and subtalar joint. Plain radiograph of left ankle showed lytic lesion in talus. MRI showed lytic lesion of 2.7×2.5cm size involving head and neck of talus without cortical breach. CT guided biopsy was performed and histopathological examination was suggestive of GCT. As the lesion localised to talus, intralesional curettage and cementation surgery was performed. Curetted bone tissue biopsy confirmed the diagnosis of GCT. The child has been under regular review and at 18 months follow up radiological and functional outcome was good. Functional outcome calculated using foot and ankle score 97/100.

Histopathology image

Discussion

Giant cell tumors are common between the age of 20 and 40. Giant Cell tumours are rare in children with open physis. Puri et al reviewed the GCTs in children and adolescents and showed the incidence in children to be 6% and ranged between 1.8 to 10.6%. Our patient is one such rare presentation of GCT in a child. Female gender preponderance was noted more than men (82%) as is our patient. The common sites of involvement are distal femur, proximal tibia, distal radius and proximal humerus. Involvement of bones of foot and ankle and hand are very rare and have been reported in the literature. (Ref Vipin Sharma et al). R Patel et al reported 26 cases of GCT affecting the small bones of the hand and foot and ankle and all the patients were adult patients. Our patient is a rare presentation of GCT in a child affecting the talus in the foot. Curettage and bone grafting has been standard treatment. Panda et al detailed the benefits of bone cement filling overcome the shortfalls of bone grafts, enabling immediate structural support for weight bearing, while producing a hemotoxic effect to kill residual tumors and allowing the early detection of any recurrence. We have used the cementation successfully in talar neck lesion in this child, which has not been reported in English literature until now. These lesions in children had higher recurrence rates of 20%. Outpatient is free from recurrence at 18 months.

Conclusion

GCT of talus is extremely rare and most cases presented in the literature are adults. Ankle pain and swelling in patients should be evaluated properly for early detection of the tumour.Early intervention with curettage and bone cementing gives good functional outcome. Our patient is the youngest child in the English literature with GCT of head and neck of talus treated by intra lesion curettage and bone cementation

References

Kransdorf MJ, Sweet DE, Buetow PC, Giudici MA, Moser Jr RP. Giant cell tumor in skeletally immature patients. Radiology. 1992 Jul;184(1):233-7.
Zhang XP, Lu XC, Wang LL, Wei JQ, Yan J, Shao XN, Che YY, Cheng JL. Giant cell tumors of bone in patients aged 18 years old or younger: imaging features and tumor characteristics. International Journal of General Medicine. 2021 Nov 18:8389-97.
Swami D, Gahlot N, Elhence A. Giant Cell Tumor of the Talus: A Case Report and Review of Literature. Journal of Foot and Ankle Surgery (Asia Pacific). 2022 Apr 1;9(2):92-5.
Co HL, Wang EH. Giant cell tumor of the small bones of the foot. Journal of Orthopaedic Surgery. 2018 Sep 27;26(3):2309499018801168.

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Giant Cell Tumor of talus in a 14-year-old child treated by curettage and cementation: A case report