Unusual Coexistence of Giant Cell Tumor and Small Bone Tuberculosis of the Hand - A Case Report
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Abstract
Background: The coexistence of giant cell tumor (GCT) and metacarpal bone tuberculosis (TB) of the hand has never been described before in the English written literature. We report here a first observation.
Case presentation: We report the case of a 49-year-old male who presented with severe pain in his left hand following a blunt trauma. A plain X-ray of the metacarpal bones showed a pathological fracture of the 4th metacarpal bone (diaphysis), and computerized tomography and magnetic resonance imaging studies confirmed the diagnosis of destructive (lytic) lesions. biopsy of the metacarpal lesion revealed a GCT, and tissue cultures were positive for mycobacterium tuberculosis (TB). He was treated by a standard 4-drug protocol of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months and an additional 6 months of isoniazid and rifampicin. He then underwent excision of the metacarpal lesion, and the pathological examination showed a GCT with cultures negative for TB.
Conclusions: The correct diagnosis of this unique combination of pathologies (GCT and metacarpal bone TB) depended on a high index of clinical suspicion, referral to mycobacterial laboratory tests, careful histologic examination of tissue samples and especially radiomorphologic findings.
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Cooper AS, Travers B (1818) Surgical essays. London, England: Cox Longman & Co. 178-19 1.
McDonald SG (1998) Surgery for bone and soft tissue sarcomas. New York: Lippincott Williams & Wilkins. 756.
Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69: 106-114.
Wilkerson JA, Cracchiolo A 3rd (1969) Giant-cell tumor of the tibial diaphysis. J Bone Joint Surg Am 51: 1205-1209.
Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, et al. (2010) Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 36: 1-7.
Karpik M (2010) Giant cell tumor (tumor gigantocellularis, osteoclastoma) - epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil 12: 207-215.
Hoch B, Inwards C, Sundaram M, Rosenberg AE (2006) Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am 88: 1998-2008.
Oliveira VC, van der Heijden L, van der Geest IC, Campanacci DA, Gibbons CL, et al. (2013) Giant cell tumours of the small bones of the hands and feet: long-term results of 30 patients and a systematic literature review. Bone Joint J 95-B: 838-845.
Quinn R (2010) Giant cell tumor of bone. Ortho Info, AAOS.
Bajpai J, Meel O, Khatkar V, Saini S, Bajpai A (2014) Multi-centric giant cell tumor involving the distal fibula and talus misdiagnosed as tuberculosis: a case report. Foot Ankle Online J 7: 2.
Farshchi S, Hasibi M, Ashtiani MT, Yazdani N, Mokhtari Z, (2013) A misdiagnosis led to an extensive skull base surgery: infratemporal tuberculosis mimicking giant cell tumor. Indian J Otolaryngol Head Neck Surg 65: 83-85.
Pan KL, Ibrahim S (2000) Tuberculosis of the distal end of the radius mimicking a giant-cell tumor. Med J Malaysia 55: 105-106.
Rieger H, Pennig D, Edel G, Brug E (1990) Tuberculosis of the hand. Handchir Mikrochir Plast Chir 22: 183-190.
Sellier P, Wyler A (2007) Disseminated tubercular osteitis. CMAJ 177: 148.
Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010) Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. 250.
Kumar V, Abbas AK, Fausto N, Mitchell RN (2007) Robbins basic pathology (8th ed.). Saunders Elsevier 516-522.
Uppin SG, Sundaram C, Umamahesh M, Chandrashekar P, Rani YJ, et al. (2008) Lesions of the bones of the hands and feet: a study of 50 cases. Arch Pathol Lab Med 132: 800-812.
Biscaglia R, Bacchini P, Bertoni F (2000) Giant cell tumor of the bones of the hand and foot. Cancer 88: 2022-2032.
Fain JS, Unni KK, Beabout JW, Rock MG (1993) Nonepiphyseal giant cell tumor of the long bones: clinical, radiographic and pathologic study. Cancer 71: 3514 -3519.