Abdul Basit, Ather Zubairi, Rehman A Z.
Giant cell tumour of the first metacarpal.
J Coll Physicians Surg Pak Jan ;14(6):374-5.

A 32-year old lady presented to the outpatient department with history of swelling of the right thumb for four months. There was progressive increase in size and pain being aggravated on thumb movement. There was no history of trauma. Examination revealed a tender ill-defined swelling along the first metacarpal bone with pain on firm palpation and during thumb movement. Sensations over the thenar eminence was normal but mobility of the thumb was restricted and painful. X-ray of right hand showed a lytic area in the proximal half of the first metacarpal bone with cortical break on the medial side and extension into the soft tissue. Laboratory tests revealed normal serum calcium, phosphorus and alkaline phosphates level. The diagnosis of giant cell tumor was made. MRI confirmed grade III tumour with soft tissue involvement. Open biopsy was performed which showed expanded lytic greyish bone with haemorrhagic area in the first metacarpal bone. Cortical bone was disrupted in the middle of the tumour on its medial side and tumour tissue was not separable from the surrounding soft tissue. Tumour was diagnosed to be a low -grade giant cell tumour with few mitotic figures and no evidence of necrosis. In consultation with the radiologist, pathologist, oncologist and hand surgeon, reconstruction was planned, as the patient was unwilling for amputation, from the very first consultation. The entire bone was disarticulated and removed along with the soft tissue leaving the long flexor and extensor tendons. Substitution was done by placing a fibular graft with fixation by two K-wires. Wound healing was uneventful.

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