Giant cell tumor of the bone orthopedics.pptx

Giant cell tumor

1. CASE PRESENTATION By dr javeria khalid Pgy2 orthopedics

2. PATIENT NAME: FATIMA BIBI CONSULTANT: DR ABDUL REHMAN ASSISTANT: DR LAJPAT MR NO: 116654751 PROCEDURE: EXCISION OF GCT TUMOR OF HAND

3. CASE HISTORY

4. DETAILED HISTORY BIODATA: 30 year old female, para 4+0 , married, housewife, NKCM, resident of Karachi came via OPD with complaints of PRESENTING COMPALINS: Recurrent swelling on palmer side of right hand – 15 months

5. HISTORY OF PRESENTING COMPLAINT According to the patient she was in USOH 2-3 years back then she noticed swelling on palmer side of right hand. Gradual in onset Progressively increasing in size Around pea sized Soft to firm Irreducible immobile

6. HOPC (CONT) Associated with On and off pain. Not associated with Skin changes, Discharge, Fever Trauma Weight loss

7. HOPC (CONT) Not aggravated or relieved by any maneuver. There were no other similar swellings in her body.

8. SYSTEMIC REVIEW CNS: No history of irritability, fits and unconsciousness. CVS: No history of palpitations, bluish discoloration, cold sweats Respiratory system: No History of dyspnea, stridor , cough

9. PAST HISTORY PAST MEDICAL HISTORY : No significant medical history. PAST SURGICAL HISTORY : Excision of swelling on same site in April 22( 8 months back).

10. FAMILY HISTORY Her mother is alive and healthy and father died due to natural cause. No family history of TB,CANCER, DM, HTN or autoimmune diseases.

11. DRUG HISTORY No significant drug history PERSONAL HISTORY Normal appetite Normal sleep No history of addiction

12. GYNECOLOGICAL HISTORY No history of Menorrhagia, Dysmenorrhea, Dyspareunia She has regular menstrual cycle. She has 4 kids both born via SVD. No history of contraceptive usage No history of treatment for infertility.

13. CLINICAL EXAMINATION

14. GENERAL PHYSICAL EXAMINATION A young patient, normal height and built, well oriented in time, place and person. Vitals: BP: 110/90mmhg Pulse: 99 bpm Temp: Afebrile RR: 20 bpm O2 Sat: 99 % in room air . She had no signs of pallor , jaundice, cyanosis or edema. Her cervical, axillary and inguinal lymph nodes were not palpable

15. RELEVANT EXAMINATION Swelling on right hand palmer side , on previous surgical site scar. Around 4 *4 cm Immobile Irreducible Non-tender Non –fluctuant. Skin pinch negative Slip sign negative.

16. CNS EXAMINATION GCS -> 15/15 Upper and lower limbs had normal tone, power and reflexes. Cranial nerves were intact.

17. RESPIRATORY AND CVS EXAMINATION Respiratory examination : Patient had a respiratory rate of 20 bpm. She had no nasal flaring. On auscultation, there was normal air entry on the both sides. There were no added sounds. CVS : S1 + S2 audible.

18. ABDOMINAL EXAMINATION Abdominal contour was normal. No abnormal swelling , pulsation or scar marks was seen, cough impulse negative, carnet sign not appreciated, gut sounds audible.

19. INVESTIGATIONS CP: Hb =12.5 , wbc=7.7, plts =286 Coagulation profile: normal. UCE: K=4.5, Na=142, hco3= 23, CL=110 Viral markers: non -reactive

20. IMAGING FEATURES Radiological findings consistent with biopsy proven core of GCT (GIANT CELL TUMOR ) of the tendon sheath within the second intermetacarpal space.

21. DIFFERENTIAL DIAGNOSIS Chondroblastoma Chondromyxoid fibroma Clear cell chondroma Lipoma Ganglionic cyst Brown tumor Aneurysmal bone cyst. Giant cell tumor.

22. SURGICAL PROCEDURE AAA measures BRUNERS incision given and the swelling completely excised and sent for histopathology.

23. BIOPSY OF THE MASS Pale white well circumcised lesion which reaches to peripheral margin. Microscopic: spindle cell lesion composed of proliferating vaguely nodular to lobular architecture of bland spindle shaped cells, with compressed vascular channels. There were few myxoid areas. Findings suggestive of recurrent GIANT CELL TUMOR.

24. DIAGNOSIS RECURRENT GIANT CELL TUMOR OF TENDON SHEATH