AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Mohamed Hamid Awadelseid, Department of Orthopedic Excellence Trauma Centre- Khartoum, Sudan.
Citation: Mohamed H Awadelseid. (2022). Giant Cell Tumor of the Distal Tibia and Fibula (Rare Location). Journal of Clinical Surgery and Research. 3(2); DOI:10.31579/2768-2757/037
Copyright: ©2022 Mohamed Hamid Awadelseid, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 02 December 2021 | Accepted: 03 January 2022 | Published: 17 January 2022
Keywords: giant cell tumor; wide surgical resection; tibia
Giant cell tumor of the distal tibia is a rare, benign and usually asymptomatic condition. The discovery is sometimes made following a medical imaging examination or a painful symptom or more often a visible or palpable swelling with or without vascular and/or nerve compression. At an advanced stage, the X-ray is of paramount importance. The well complete surgical resection is part of the therapeutic. We present a clinical case report of a young man with a giant cell tumor localized in the distal tibia in Khartoum, Sudan. This case concerns a 37-year-old patient who presented in July 2021 of a huge painful swelling at left distal tibia treated with bonesetter at Kassla, eastern Sudan and whose X-ray radiography showed lytic lesion of the cortical bone in the lower third of the tibia. After the operative resection of the tumor mass, the pathological examination of the operative specimen revealed the diagnosis of a giant cell tumor. A giant cell tumor is a benign condition, with a few symptoms and the location at the ankle is exceptional. Complete surgical resection is a viable treatment option.
Giant cell tumor (GCT) of bone is one of the commonest benign bone tumors encountered by an orthopedic surgeon. The reported incidence of GCT in the Oriental and Asian population is higher than that in the Caucasian population and may account for 20% of all skeletal neoplasms. It has a well-known propensity for local recurrence after surgical treatment although considered to be benign tumors of bone [1].
GCT has a relatively high recurrence rate. Metastases occur in 1% to 9% of patients with GCT and some earlier studies have correlated the incidence of metastases with aggressive growth and local recurrence. Current recurrence rates between 10-20% with meticulous curettage and extension of tumor removal using mechanized burrs and adjuvant therapy are a vast improvement on the historically reported recurrence rates of 50-60% with curettage alone. GCT of bone constitutes 20% of biopsy analyzed benign bone tumors. It affects young adults between the ages of 20 and 40 years, several authors have reported a slight predominance of women over men. However, GCT can be seen in patients over 50 years old. Ninety percent of GCT exhibits the typical epiphyseal location. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and or its capsule are rarely invaded. In rare instances in which GCT occurs in a skeletally immature patient ,the lesion is likely to be found in the metaphysis,The most common locations, in decreasing order are the distal femur, the proximal tibia, the distal radius, and the sacrum .Fifty percent of GCTs arise around the knee region. Other frequent sites include the fibular head, the proximal femur, and the proximal humerus. Pelvic GCT is rare [6]. Multicentricity or the synchronous occurrence of GCT in different sites is known to occur, but is exceedingly rare [2].
We report a case of a 37-year-old man who presented in July 2021, with a huge painful swelling his left distal tibia with an X-ray radiography showing lysis of the cortical bone in the lower third of the tibia. After the operative excision of the tumor mass, the pathological examination of the specimen revealed the diagnosis of a giant cell tumor. With a lytic lesion of the distal tibia and fibula bones in a young man on X-ray, one must think of a giant cell tumor [3].
We report the case of a 37-year-old young man with no notable pathological antecedents who presented at the orthopedic consultation for a painful swelling of the left distal tibia and fibula that had been evolving for 5 months and without any alteration of the general state. There was change in color and consistency of the skin with respect to the tumor action.
On physical examination, there was a dorsoflextion blockage of foot because of the large volume occupied by the tumor mass and the articular destruction at the level of the distal tibio-fibular joint; plantar flexion estimated at 10˚ and dorsal flextion at 3˚; inversion at 5˚ and eversion at 2˚. The x-ray showed a lesion with blurred boundaries, extending into the soft tissue that is not limited by a bony shell; with destruction of the cortex, invasion of soft parts and honeycomb pseudo-partitions (Figure 1-2). And finally the Magntic Resonant Imaging (MRI) of the left leg showed (Figure 3-4-5-6) a lysis of the cortex of the lower extremity of the leg. It corresponds to grade 3 of the Campanacci and Merled ’Aubignee classification.
A complete surgical resection below knee amputation (BKA) was offered to the patient. Under spinal anesthesia, this incision was made proximally to expose a healthy portion of the leg bone. Surgical removal of the tumor by BKA a proximal resection of the tibia and fibular bone by about 2 cm in the healthy zone.
The anatomopathological assessment (Figure 7) showed abundant mononuclear cells and discrete nuclear anomalies with marked mitotic activity, but without atypical forms. The histological examination of the bone fragments confirmed a grade 3 giant cell tumor according to Sanerkin, Jaffe Lichtenstein and Pottis. CT scan was done to exclude pulmonary metastases (Figure 8). At three weeks removal of suture and start physiotherapy of knee. Surgical treatment with the excision of the large tumor mass by BKA improved the function of the leg and general condition of the patient.
Giant cell tumors (GCT) account for 5%–9% of all benign and malignant bone tumors. They are considered benign but may present a progressive, potentially malignant clinical course. GCT recur in a high percentage of cases, become sarcomatous, yet produce metastases even without apparent malignant changes [4].
In the literature, the recurrence rate varies considerably, depending not only on the site and extension of the lesion but also on the type of primary treatment performed [5].
Successful treatment of GCTs and the adequacy of tumor removal is influenced by tumor location, associated fracture, soft tissue extension, and understanding of the functional consequences of resection .each option has advantage and disadvantage [6].
This technique has the advantage of preserving knee joint function, improved general and psychological condition of the patient and recurrences are no more frequent than with other techniques according to several authors. Excision with tumor free margins is associated with lesser recurrence rates. However, for periarticular lesions this is usually accompanied with a suboptimal functional outcome [7]. Various studies suggest that wide resection is associated with a decreased risk of local recurrence when compared with intralesional curettage and may increase the recurrence free survival rate from 84% to 100% [8]. However, wide resection is associated with higher rates of surgical complications which led to functional impairment, generally necessitating reconstruction. This procedure resulted in good function preserving knee joint function after removal of suture 3 weeks later. After a 5 months follow up, there was no recurrence or functional sequelae of the leg. Giant cell bone tumors generally have a good prognosis [9].
The giant cell tumor of the distal tibia and fibula bone, although rare, does not present any particularity.
The gold standard X-ray image guided radiography with the bone tissue histology confirmed the diagnosis. Use a CT scan or an MRI study if we fear an invasion of soft parts. Surgical treatment preserved joint function. This should be considered when presented with a lytic epiphyseal bone lesion.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
