Giant cell tumor affecting distal radius has been considered more aggressive, as compared to its counterparts in other locations. While resection has been advocated as the treatment of choice with lower rates of recurrence, curettage has reportedly led to superior functional outcomes. This retrospective study aimed to evaluate the functional and oncological outcomes of patients managed for GCT distal radius by either extended intralesional curettage (EIC) or resection and arthrodesis with radialisation of ulna (RRU), with respect to rates of local recurrence and function. Twenty-four patients operated for giant cell tumor of distal radius by a single surgeon from 2011 to 2021, were included in the study. The demographic, clinico-radiological, and surgical details were recorded and analyzed, as were the functional and oncological outcomes. At a median (IQR) follow-up of 6.3 years (range 2 years to 15.9 years), the rate of recurrence in curettage was found to be higher than that in resection but was not statistically significant (35.7% vs 20%, p > 0.05). Patients managed elsewhere and then presented to us for recurrence had a higher rate of local recurrence (66.6%, p = 0.01). Average time to recurrence was 14 months (range 2-24 months). On final follow-up, patients in curettage group had better functional outcomes in terms of grip strength and range of motion. Mean Modified Mayo Wrist score and MSTS score were 78.2 and 25.63, respectively, for EIC group and 69.6 and 25.75, respectively, for RRU group. Extended intralesional curettage resulted in an earlier rehabilitation with a mobile wrist and acceptable disease control when compared with resection and arthrodesis with radialisation of ulna.

Giant cell tumor (GCT) is a common benign aggressive tumor that mostly occurs in the proximal tibia, distal radius, and distal femur but is rarely seen in the distal region of the humerus. It originally presents between the ages of 30 and 50 with suddenly occurring pain. Treatment is generally curettage adjuvant treatment if necessary and reconstruction if required. In our case report, we present the clinical and radiological findings, diagnosis, and management of a 33-year-old female patient with a giant cell tumor (GCT) accompanied by a secondary aneurysmal bone cyst (ABC) in the left distal humerus, where the patient experienced pain for many years without significant history of trauma. Upon clinical examination, the patient displayed tenderness over the medial side of the elbow but no noted swelling, redness, or hotness. She had a painless full range of motion, with an intact distal neurovascular examination. Imaging concluded GCT with secondary ABC. A biopsy confirmed the diagnosis, ruling out metastatic lesions. The patient underwent surgical intervention, with plate fixation, which yielded excellent outcomes.

UNASSIGNED: The management of distal radius giant cell tumors (GCTs) remains challenging, and the optimal approach is still a matter of debate. This systematic review and meta-analysis aimed to compare the outcomes of extended curettage and wide resection, the mainstays of treatment.
UNASSIGNED: Medline (via PubMed), Cochrane Library, Web of Science, Google Scholar, ClinicalTrials.gov, and Embase databases were searched for comparative studies that assessed extended curettage with adjuvant therapy and wide resection with reconstruction in patients with GCTs of the distal radius up to April 2023. Data were collected and analyzed on rates of local recurrence, metastasis, overall complications, and functional outcomes. The Newcastle-Ottawa scale was used to appraise the risk of bias within each study.
UNASSIGNED: Fifteen studies (n = 373 patients) were included and analyzed. Patients who underwent curettage were more likely to develop recurrence (risk ratio [RR] = 3.02 [95% confidence interval; CI, 1.87-4.89], P < .01), showed fewer complications (RR = 0.32 [95% CI, 0.21-0.49], P < .01), and showed greater improvement in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand scores (P < .00001) than those who underwent wide resection. No significant difference was found regarding metastasis (RR = 1.03 [95% CI, 0.38-2.78], P = .95).
UNASSIGNED: Regarding the surgical approach to GCT of the distal radius, curettage with adjuvant therapy was associated with a higher likelihood of recurrence compared with wide resection with reconstruction. Nevertheless, the curettage approach resulted in significantly lower rates of operative complications, decreased pain scores, and better functional outcomes in comparison to the resection group.

Diffuse tenosynovial giant cell tumor (D-TGCT), previously known as pigmented villonodular synovitis (PVNS), is a benign, aggressive, and distracting proliferative synovial lesion. D-TGCT is commonly seen in large joints such as the knee and hip. We present the case of a 57-year-old female who initially presented with swelling on the left midfoot that increased over four years. Clinically, a ganglion was suspected on the left midfoot and an MRI showed a heterogeneous lobulated soft tissue mass on the superior aspect of the tarsal midfoot measuring 5.8 x 2.4 x 4.2 cm. The mass causing remodeling and bony erosion was more appreciated at the medial aspect of the talus bone and extended to the sinus tarsi and talocalcaneal joint space. Surgical excision of the mass was performed, and pathology reports found lobulated soft tissue lesions composed of mononuclear cells, multinucleated giant cells, sheets of foamy macrophages, inflammatory cells, and hemosiderin-laden macrophages. This case represents D-TGCT without atypia or malignancy based on the findings.

The aim of this study is to bring attention to a unique occurrence in an uncommon location and to describe our approach to treatment in this context. We describe a case of a 36-year-old male who presented with complaints of pain in his left knee for three months, with a restricted range of motion, without a prior history of trauma. A thorough knee examination was performed, which was unremarkable except for a restricted range of motion and tenderness along the medial joint line. A plain radiograph of the knee revealed no bony injury. MRI was done to assess the extension and it confirmed a soft tissue mass beneath the patella. The patient was taken up for surgery after a pre-anesthetic checkup and the mass was removed arthroscopically in toto using a higher accessory antero-medial portal. The mass was removed with the help of a spatula without damaging it and sent for histopathological analysis. Histopathology confirmed that it was a giant cell tumour of the tendon sheath. The procedure was uneventful, and the patient achieved a full range of motion post-operatively.

Granular cell tumors (GCT) represent 0.5% of all soft tissue sarcomas (STS), and when metastatic, they exhibit aggressive behavior and determine limited survival. Metastatic GCTs are relatively chemo-resistant; however, there is growing evidence of the benefit of using pazopanib and other targeted therapies in this histology. This is a review of the role of pazopanib and other targeted therapies in the treatment of GCTs, along with some insights on pathology and molecular biology described in GCTs. From 256 articles found in our search, 10 case-report articles met the inclusion criteria. Pazopanib was the most employed systemic therapy. The median reported time on therapy with pazopanib was seven months. Eight out of ten patients (80%) experienced disease control with pazopanib, while four out of ten (40%) patients achieved an objective RECIST response. Molecular studies suggested that antitumoral effects of pazopanib in GCT might be due to a loss-of-function of ATP6AP1/2 genes which consequently enhance signaling through several molecular pathways, such as SFKs, STAT5a/b, and PDGFR-β. Other reported targeted therapies for malignant GCTs included pazopanib in combination with crizotinib, which showed disease control for four months in one patient, and a PI3K inhibitor which achieved disease control for nine months in another patient. Dasatinib and megestrol were ineffective in two other different patients. Pazopanib has been demonstrated to be active in advanced GCTs and may be considered as a preferable treatment option.

Giant cell tumor (GCT) of the proximal femur poses various challenges in its management and recurrence. We present a rare case of GCT of proximal femur in which recurrence and coxa vara deformity were encountered after index surgery. Management of the recurrence was done with intramedullary fixation with extended curettage and bone grafting. Different aspects of management such as the role of defect size, adjuvants, bone cement/bone graft, implants, and bisphosphonates have been highlighted in this article.

BACKGROUND: Prompt diagnosis of passive transfer failure in the neonatal period is important for early treatment.
OBJECTIVE: To compare the diagnostic performance of serum glutaraldehyde coagulation test (GCT) and colostrum BRIX% for failure to transfer passive immunity (FTPI) diagnosis with the results of SNAP foal test and to evaluate the results of serum GCT and colostrum BRIX% measurements in foals with diarrhoea in the 0-1 month period.
METHODS: In vitro experiments.
METHODS: Excess serum and colostrum (n: 298) from samples collected from newborn foals and their dams for clinical purposes were used. Foals were classified as FTPI positive (IgG < 8 g/L) or negative (IgG ≥ 8 g/L) using the SNAP foal test. We compared the sensitivity and specificity of serum GCT and colostrum BRIX % for diagnosing FTPI in all foals and in the sub-group of foals which developed diarrhoea within the first month of life was noted. The relationships between the results of the serum GCT and colostrum BRIX% and diarrhoea in foals with and without FTPI were evaluated.
RESULTS: Serum GCT and colostrum BRIX % were statistically significantly different (p < 0.05) between the foals without FTPI and with FTPI classified according to the SNAP test. Using a cut-off value for serum GCT of >10, sensitivity was 100% (95% CI 92.9%-100%) and specificity 100% (98.3%-100%) while with a cut-off value of ≤24, with colostrum BRIX% of ≤24 sensitivity was 92% (80.9%-97.8%), and specificity was 98% (95.3-99.3). In the sub-group of foals without FTPI using a colostrum BRIX% cut-off value of ≤26 the sensitivity for prediction of diarrhoea in the 0-1 month period was only 72.4% (52.8-87.3, p < 0.001) with specificity 54.3% (47.6-61.1) but the test performance was not robust (ROC AUC 0.61).
CONCLUSIONS: The number of repeated measurements in the evaluation of serum GCT, and colostrum BRIX% was low. More clinical problems could be examined.
CONCLUSIONS: The serum GCT, and colostrum BRIX%, both economical and practical to use in the field, gave results comparable with the SNAP foal IgG test. The ability to accurately predict diarrhoea in the first month of life with these tests was limited.
UNASSIGNED: Être capable de diagnostiquer rapidement un défaut de transfert d\'immunité passive en période néonatale est primordial au prompt traitement des poulains.
OBJECTIVE: Comparer la performance diagnostique du test de coagulation au glutaraldéhyde sur sérum (GCT) et du BRIX du colostrum pour le diagnostic de défaut de transfert d\'immunité passive (FTPI) avec les résultats de test SNAP Foal. Évaluer les résultats de GCT sur sérum et les mesures de colostrum BRIX chez les poulains âgés de 0–1 mois d\'âge souffrant de diarrhée. TYPE D\'ÉTUDE: Étude in vitro. MÉTHODES: Les excédents de sérum et colostrum (N = 298) provenant de poulains nouveaux‐nés et leur mère à partir d\'échantillons cliniques ont été sauvegardés. Les poulains ont été divisés en deux groupes: FTPI négatifs (IgG ≥ 8 g/L) et positifs (IgG ≤ 8 g/L). La spécificité et la sensibilité de GCT sur sérum et le % BRIX du colostrum ont été comparés pour diagnostiquer les défauts de transfert d\'immunité passive chez tous les poulains, incluant le sous‐groupe ayant développé de la diarrhée. En parallèle, le développement de diarrhée chez les poulains jusqu\'à 1 mois d\'âge a été noté. La relation entre les résultats de GCT sur sérum et le % BRIX du colostrum et la diarrhée chez les poulains souffrant de diarrhée avec ou sans défaut de transfert d\'immunité passive a été évaluée. RÉSULTATS: Le GCT sur sérum et le % BRIX du colostrum ont montré une différence statistiquement significative (p < 0.05) entre les poulains sans FTPI et ceux avec FTPI tel que déterminé par le SNAP Foal test. En utilisant une valeur seuil pour le GCT sur sérum de >10, la sensibilité était de 100% (95% IC 92.9%–100%) et la spécificité de 100% également (98.3%–100%). Avec une valeur seuil à ≤24, avec une valeur au colostrum BRIX% de ≤24, la sensibilité était de 92% (80.9%–97.8%) et la spécificité de 98% (95.3%–99.3%). Dans le groupe de poulains sans défaut de transfert d\'immunité passive, en utilisant une valeur seuil de ≤26, la sensibilité pour la détection de diarrhée durant la période de 0–1 mois d\'âge était seulement de 72.4% (52.8–87.3%, p < 0.001) avec une spécificité de 54.3% (47.6%–61.1%), mais la performance du teste n\'était considérée robuste (ROC AUC 0.61).
UNASSIGNED: Le nombre de mesures répétées lors de l\'évaluation de GCT sur sérum et du % BRIX de colostrum était bas. Davantage de paramètres pourraient être ajoutés.
CONCLUSIONS: Le GCT sur sérum et le % BRIX de colostrum, tous deux économique et facile à utiliser en pratique, ont donné des résultats comparables aux résultats de SNAP Foal pour les immunoglobulines G.

Giant cell tumours (GCTs) of the bone often arise in the long bones while occurrence in smaller bones of the hand and feet is very rare. We report a case of GCT in the talus of a 17-year-old male who presented with a six-month history of worsening pain in his left ankle and loss of function, reducing his ability to walk and participate in sports. Radiographs of the ankle showed bony overgrowth on the head and neck of the talus with cortical breaching. MRI revealed possible extension into soft tissue and bone marrow oedema. CT scan also revealed an aggressive lytic lesion at the head and neck of the talus. He was managed with intralesional curettage and autologous bone grafting with bone harvested from the left knee. There was no evidence of recurrence at the six-month follow-up and the patient was able to walk freely. In conclusion, GCTs of the talus tend to occur in younger and healthier patients and have disastrous consequences if they persist, recur, or metastasize. Given the severe negative impact that GCTs have on a patient\'s quality of life, they must be ruled out when investigating any ankle pain or reduced mobility. Current treatment options have produced consistently positive results while novel therapies that enable a faster return to weight bearing and reduce recurrence appear promising.

A giant cell tumour (GCT) is a benign and locally aggressive tumour that is usually observable in a skeletally mature patient involving the end of long bones. The reported incidence of this tumour in a skeletally immature patient is extremely rare. However, we report one such case in the distal radius of a seven-year-old female patient. Having presented with painful swelling of the right distal forearm, she underwent clinical and radiological examination, and a diagnosis of distal radius GCT was made. The tumour was treated with curettage, fibular graft, and synthetic bone graft. This case report shows the importance of including GCT in children as a differential diagnosis. This tumour may have a good prognosis if diagnosed and treated early.