Case Series: Outcome of Giant Cell Tumor in Small Bones of the Foot.

Introduction: Giant cell tumor (GCT) of bone is a locally aggressive primary bone neoplasm constituted by proliferating mononuclear spindle cells, among which there are numerous macrophages and evenly distributed large multinucleated osteoclast-like giant cells that may undergo malignant transformation. It corresponds to 5% of all primary neoplasias of the bone. It is more common in females, with an incidence between 20 and 45 years. It has a major preference for the epiphysis of the long bones. Approximately 3-4% of all GCTs are found in the small bones of the hands and feet. GCT in younger patients appears to occur in these locations more frequently than in long bones. GCT occurs more frequently in metatarsal bones than in other bones of feet. Involvement of the epiphysis is a rule, although in small bones, a significant portion of the shaft or even the entire bone can be involved. GCT of the acral skeleton shows more aggressive behavior than that of long tubular bones (higher recurrence rate, invasion) because of its location in small bones and difficulty in completely removing the tumor. Histologically benign lung metastases can occur. Methods and Materials: A prospective study was carried out in Surat, India, from 2018 to 2021, consisting of 7 patients. 6 cases were primary and 1 was recurrent. Campanacci Grade 1 for 2, Grade 2 for 2, Grade 3 for 3 patients. Operative procedures were extended curettage and adjuvants for 5, wide/marginal resection for 1, and ray amputation for 1. Musculoskeletal Tumor Society (MSTS) score was calculated for every patient. Results: 71.42% patients belonged to the age group of 20-30 years. 71.42% patients presented in stages II and III. Good to excellent functional outcome (MSTS score) for 7 cases. 0 cases had local recurrence, and 0 had lung metastasis. Conlusion: Primary GCT of small bones was found in the younger population and found to be biologically more aggressive than of long bones. Hence, the treatment of choice is extended curettage or wide/marginal resection. Adjuvant does not eliminate the risk of recurrence but possibly reduces its rate.