Complicated recurrent giant cell tumor of the proximal phalanx of the fourth finger of the left hand in an elderly patient.Clinical case

Giant cell tumor of bone (GCTB) is a locally aggressive, lytic, primary bone neoplasm classified as a tumor with uncertain malignant potential. GCTB of the small bones of the hand and foot remains poorly studied and unpredictable in terms of recurrence. Most recurrences occur within two years after surgery.The aim of this study is to present a clinical case of a giant, recurrent, complicated giant cell tumor of the proximal phalanx of the fourth finger of the left hand in an elderly female patient, thereby drawing surgeons’ attention to the importance of this problem.The patient underwent amputation of the fourth ray in accordance with the principles of ablastics. One year later, she developed a recurrence involving the entire left forearm. In small bone localizations, GCTB tends to behave more aggressively and relapse more frequently, affecting critical anatomical structures of the hand and foot. Surgical techniques developed for long tubular bones are not always applicable in cases of GCTB in small bones. Additional difficulties are associated with defining the true boundaries of tumor spread within soft tissues and, consequently, determining the extent of their resection. The lack of clear clinical guidelines and underestimation of the aggressiveness of GCTB in small bones by oncologists further complicates treatment strategy selection.The presented case highlights the necessity of more radical surgical approaches for this pathology, as well as the need to raise awareness among oncologists regarding modern treatment strategies, taking into account the high frequency and unpredictable nature of recurrences.Keywords:giant cell tumor of bone, denosumab, bone tumor, local recurrence, malignant transformation, bone resection, types of hand amputations.