Rare Coexistence: Giant Cell Tumor Recurrence and Infection in the Proximal Tibia - A Case Report.

Abstract

Introduction: Giant cell tumor of bone (GCTB) ranks among the most prevalent locally aggressive tumor lesions, displaying a diverse range of biological behaviors. Recurrence of GCTB is well-documented, often attributed to microscopic tumour remnants remaining after intralesional curettage, with increased concern when infection occurs postoperatively. Studies suggest the limited effectiveness of adjuvants in preventing giant cell tumour recurrence, emphasizing the necessity of complete removal of malignant cells. We describe our experience with a rare presentation of recurrence together with infection in an operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization.

Case report: A 28 year-old female who was operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization in 2020 presented to our outpatient department with complaints pain in right leg while walking for 3 months in October 2021. Plain radiography of the right knee suggestive of lytic lesion over medial aspect of the right tibia around cement with plate in situ and magnetic resonance imaging right knee suggestive of recurrence of the tumor with no breach in joint line and no involvement of neurovascular structures. The patient was planned for implant removal with extended curettage and plate stabilization and cementing with antibiotics (vancomycin and gentamycin) after sending tissues for culture sensitivity and histopathology. Intraoperative cultures showed growth of methicillin-sensitive staphylococcus aureus which was sensitive to cefoxitin, gentamicin, cotrimoxazole, and doxycycline following which pt received 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics as per culture sensitivity with no post-operative wound complications and had satisfactory functional outcome. The patient was followed at regular intervals till 2-year follow-up did not show any signs of recurrence and infection.

Conclusion: The manifestation of GCTB recurrence alongside infection is exceedingly rare with limited literature evidence. Our case illustrates a method to address both issues concurrently during a single procedure, utilizing antibiotic bone cement to tackle infection and extended curettage for thorough removal of neoplastic cells from the surrounding bone.