Giant cell tumour of talus - Punjab Orthopaedic Association

Case Report 

Giant cell tumour of talus- 

A rare presentation & our management 

Murali SM*, Victor Moirangthem # , Mothilal SN** 

*Assistant Professor, **Professor & Head 

Department of Orthopaedics 

Sri Satya Sai Medical College & Research Institute, Chennai 

# 

Assistant Professor 

Department of Orthopaedics,Chettinad Medical College, Chennai 

ABSTRACT 

Giant Cell Tumour of the small bones of the hand and foot are relatively uncommon. We are reporting a case 

of Giant Cell Tumour of the talus in a 20 year old female patient. She presented with painful swelling of left 

ankle with a large osteolytic lesion in the talus on conventional radiographs. Due to the extensive nature of 

the lesion, talectomy and fusion was done. Biopsy showed a grade 2 Giant Cell Tumour of bone. After 30 

months of follow-up,the tumour showed no signs of recurrence. 

Keywords: Giant cell tumour, Talus, Talectomy, Tibiocalcaneal fusion 

INTRODUCTION 

Giant Cell Tumour of the talus is extremely rare and so far 

only 14 cases are reported in the literature 1-3 . Giant Cell 

Tumour (GCT) is a locally aggressive neoplasm characterised 

by richly vascularised tissue containing proliferating 

mononuclear stromal cells and many osteoclast-like 

multinucleated giant cells randomly but evenly distributed 

throughout. The recurrence of tumour is fairly common with 

GCT’s and may metastasize in 3% of patients. Currently, the 

modalities of treatment for GCT include curettage and grafting, 

enbloc resection with grafting or arthrodesis, chemical cautery, 

talectomy and amputation 1,4 . 

CASE REPORT 

A 20 year old woman presented with pain in the left ankle for 

one year following trivial injury. It had gradually increased in 

intensity with the appearance of swelling around the ankle for 

the past 2 months. On examination, the swelling was diffuse 

obliterating the bony prominences, moderately tender and had 

mild local inflammation. Movements were limited in both the 

ankle and subtalar joints. Walking was difficult due to pain. 

Corresponding Author : 

Dr Murali SM, 

47 Oliver Road, Mylapore, 

Chennai-600004,India. 

Email : muraliorth@gmail.com 

Pb Journal of Orthopaedics Vol-XIII, No.1, 2012 

There was no distal neurovascular deficit. 

Based on history and physical findings, our primary 

differential diagnosis were as follows: tubercular arthritis, Giant 

Cell Tumour of bone and aneurysmal bone cyst. Except for a 

slightly raised erythrocyte sedimentation rate, routine 

laboratory testing was normal. Plain radiographs showed an 

osteolytic lesion involving the head, neck and body of the 

talus with partial collapse of the neck (Fig 1). 

The surrounding bony tissue had thinned out. The margins 

of subtalar and talonavicular joints showed mild sclerosis. 

AP View 

Lateral View 

Fig 1. Preoperative X ray-showing lytic lesions of head, 

neck, body of talus. Collapse of talar neck. 

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Murali et al 

Fig 2. Preoperative CT scan- showing sclerosis of 

talonavicular and subtalar joints 

Fig 4. Excised Tumour Tisssue- sent for HPE 

Fig 3. Intraoperative Picture- talus being exposed 

Her chest roentgenogram was negative for any pathological 

process of metastases. The NCCT of the foot and ankle revealed 

an aggressive GCT involving almost the whole of the talus 

(Fig 2). There was no evidence of joint disruption or spread to 

any of the adjacent bones. 

Because of the aggressive nature of the lesion and 

radiological evidence of early degenerative changes, it was 

suggested that a more substantial surgery than simple 

curettage and bone grafting would be necessary (Fig 3 &4). 

With these factors in mind, talectomy followed by 

tibiocalcaneal arthrodesis was performed with Charnley’s 

compression clamps (Fig 6). Histopathlogical examination 

showed grade 2 GCT of bone (Fig 5a & 5 b). The clamps were 

removed at the end of 2 months and hydroxyapatite bone graft 

were used as union was delayed. The patient was allowed to 

ambulate gradually with a PTB cast. Until the last follow up at 

the completion of 30 months, the patient showed no signs of 

recurrence (Fig 7a & 7b). 

(a) 

Fig 5(a,b). Histopathological Picture- shows Grade 2 GCT 

(b) 


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Giant cell tumour of talus 

Fig 6. Postoperative Pictures- talectomy and tibiocalcaneal 

compression arthrodesis done 

DISCUSSION 

GCT of the talus is relatively rare and only 14 cases are reported 

in the Orthopaedic literature 1,2,3 . Nonetheless, it presents a 

difficult problem because the lesion is locally destructive, recurs 

even in the face of aggressive surgery and on occasion, may 

even metasize. Murariet al 5 found GCT to be the most common 

benign primary osseous neoplasms in the foot, comprising 19% 

of all lesions. The tumour is frequently found in the calaneus 

and metatarsals, rarely affecting the talus 1 . When the tumour 

does present within the talus, it is most commonly localized to 

the head and neck 1 as seen in our case. 

The most common initial intervention consists of curettage 

and bone grafting. The recurrence rate of GCT after this 

procedure has been reported to be high as 50% to 90% 

depending on the location 4,6 . Wold and Swee 4 found a 

recurrence rate of 75% in GCT of the tarsal bones after grafting, 

and there has been one case reported of a talar GCT 

metastasizing to the liver and lungs 3 . Wold and Swee 4 again 

found that the mean time to recurrence after curettage and 

grafting was 6.6 months, with the longest time recurrence 

occurring at 11 months in their cohort. 

As the prevention of tumour recurrence, further osseous 

destruction, and metastasis are paramount, talectomy with 

tibiocalcaneal fusion allows for complete eradication of the 

tumour and preservation of function. Mohanty et 

al 7 demonstrated their success in treating GCT of talus using 

talectomy and tibicalcaneal fusion. Dhillon et al 8 reviewed 12 

cases of bony tumours involving the talus and advocated 

talectomy for GCT with talar collapse. There was no recurrence 

at an average 25.8 months follow up 9 . 

In our follow up of the case for 30months, the patient 

showed no signs of tumour recurrence and a gradual return to 

a.Medial 

her normal daily activities. Therefore, we conclude that 

talectomy with tibiocalcaneal fusion has a strong indication 

for aggressive Giant Cell Tumours with extensive bony 

destruction, collapse and adjacent articular degeneration. 

REFERENCES 

Fig 7(a,b). Postoperative scars 

b. Lateral 

Fig 8. Follow-up X rays at 30 months- did not show 

any signs of recurrence 

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Giant cell tumour of talus - Punjab Orthopaedic Association

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