Giant Cell Tumor of Left Femoral Head

Giant cell tumor is a uncommon violent non cancerous gentle tumor. It’s called Giant cell tumor because they appear Many giant cell, they are shaped by union of some unique cells into one bigger compound.

A giant cell tumor is an osteolytic tumor occurring in young adults at the epiphysis or end of the long bone. This occurs after the epiphysial plate has ossified and longitudinal bone growth is completed. The tumor of the bone expands to one side over lying skin is stretched.

Roentgen graphic findings-The tumor revealed by a large sharply circumscribed area in reduced density asymmetrically located in the epiphysis sub cortically and extending towards the metaphysic. No periosteum new bone formation. Multiple septae of bone and soft tissue traverse the interior characteristics loculated " Soap bubble appearance"

Presentation

The patient Mrs. Rehana parvin 45 years old came with the complain of moderate pain at the left hip joint with limping for 2 years. From 2008 to 2010 she was treated by many doctors. At the beginning there was history of gradual onset of mild to moderate pain at the left hip joint, no history of trauma of fever. After 1 year she complain of limping and cracking sound in left hip joint while start to walking. She took some analgesic (non steroidal anti inflammatory drug) for long time but no improvement occur. Recently she came to me with some documents.

On Clinical Examination

There was bony tenderness at left hip joint walk with limping restricted movement in all direction- flexion, extension, internal and external rotation, abduction and adduction. Crepitation in movement was present. There was no inguinal lymph nodes are enlarged.

Investigation:

On X-ray Examination:

On X-ray left hip joint revealed soap bubble appearance (o steolytic lesion) at the head and upper part of acetabuium and also haziness of the x-ray findings [ fig:1]

Lab examination

ESR: 28 mm in 1^st hour. Random blood sugar = Normal Hemoglobin-10 gm/ dl. E. C. G= Normal, X-ray chest = Normal On CT scan

The tumor revealed by a large, sharply circumscribed area in reduced density. It shows osteolytic lesion at the left femoral head & upper part of left acetabulum.

[Fig-2 and Fig-3]

On CT guides FNAC

There was suggestive of Giant cell tumor at left femoral head. Then we are advised for surgical treatment—HIP REPLACEMENT SURGERY. The surgery involves removal of disease part of the hip joint (Both femoral head and neck) and replacing it with new artificial part called bipolar prosthesis after excision of the left femoral head and the disease part (head of femur and left acetabulum) was send for histopathology and the report was the following-

Gross feature

Received 15 irregular piece of bony tissue the largest one measuring 3.5x3x3 cm. Embedded after decalcification.

Microspic features

Section from the following blocks show blood clot, nature adipose tissue dead and living bone. No neoplastic tissue seen in the supplied specimen.

Treatment:

The aim of surgical treatment is to improve movement, releve pain and thus normal function of the left hip joint. We use the postero- lateral austin moore approach. Cut the left femoral head and neck removing the proximal femur introduce the no.45 bipolar prosthesis.

[Fig:4]

close the wound in layers with one drain in situ which was remove after 48 hours and stitch was removed after 14 days (2 weeks) from the operation date. Physiotherapy & Quadriceps strengthing, exercise, ankle movement begins the day after surgery. weight bear & walking starts after 5^th day of operation

If not treated, these tumors will continue to grow and destroy bone surgery has proven to be the most effective treatment for giant cell tumors in this case decision to be made to perform" enbloc" resection of the femoral head and neck and replacement by bipolar hemi arthroplasty, Endoprothesis is the best option in this case and provide immediate stability and allow early

mobilization and weight bearing of the hip joint.

Discussion

Giant cell tumor is an unpredictable tumor. No definite biological parameters can be used to determine the prognosis or aggressiveness of this lesion. The over all out come of treatment is good. The patient would be follow-up regularly, 2-3 monthly for 6 months but no local recurrence or metastasis.

The aim of this study is to better evaluate the relationship of giant cell vascular necrosis of femoral head computed tomography (CT) is useful for demonstrating the cystic changes seen in femoral head. I have shown that computed tomography (CT) guided fine needle aspiration cytology (FNAC) is a useful tool in evaluation of the disease.

Giant cell tumor of femoral head is a chronic joint disease affecting uncommonly in very few patient with accidental diagnosis. The disease report upon activities of daily living ( e.g walking stair climbing and house keeping) ultimately leading to a loss of functional independence and qualify of life. Considering the nature of the disease of the hip joint and the unique function of hip the choice of treatment is replacement hemi orthoclastic. The clinical out come depends upon unique biomechanical function of hip joint, exercise and physiotherapy.

To establish the usefulness of computed tomography (CT) guided biopsy for diagnosing giant cell tumor of femoral head and determine whether these are osteolytic lesion that are characteristic for giant cell tumor but not for other arthopathies in cytology. Giant cell tumor at the upper end of tibio and lower end of femur and distal end of radius are sometimes common but giant cell tumor at the femoral head is uncommon tumor in our country. Despite debate in literature the treatment varies according to be site of involvement and grade of the disease. The clinical presentation and the pattern of femoral head involvement with mild to moderate functional incapacity of left hip joint.