Year: 2025 | Month: December | Volume: 12 | Issue: 12 | Pages: 703-707
DOI: https://doi.org/10.52403/ijrr.20251272
Progressive Course of Recurrent Giant Cell Tumor of the Distal Tibia in Adolescent: A Longitudinal Case Report
A. Mutawakil Ilham1, I Gede Eka Wiratnaya2, Michael Christanto1
1Faculty of Medicine, Udayana University, Denpasar, Indonesia
2Consultant of Orthopaedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia
Corresponding Author: A. Mutawakil Ilham
ABSTRACT
Introduction: Giant cell tumor of bone typically arises from the epiphysis of long bones; involvement of the distal tibia is a relative rarity, especially in adolescents. While this tumor is benign, GCTB may behave quite aggressively with recurrence or even pulmonary metastasis. The case below describes the natural history of a distal tibial GCTB that was complicated by recurrence and lung metastasis, detailing the use of multiple modalities of management.
Case presentation: A 17-year-old female patient presented with an eight-month history of progressive swelling and pain in the left ankle. Imaging showed an expansile lytic lesion in the distal tibia; biopsy confirmed GCTB. She then underwent wide excision with reconstruction using a fibular graft and talofibular arthrodesis. Two years later, during surveillance imaging, pulmonary nodules consistent with metastasis were shown; she was thus treated with monthly intravenous zoledronic acid, 4 mg for six months. In 2019, a local recurrence was detected and treated with curettage and augmentation with bone cement. On follow-up in 2021, the patient had no pain, was fully ambulatory, and was without further recurrence or metastatic progression.
Discussion: Distal tibial GCTB has a high tendency for recurrence despite adequate resection due to the poor soft-tissue cover surrounding it. Though pulmonary metastasis is rare, the case indicates the importance of long-term thoracic surveillance. Zoledronic acid in this case contributed to the radiological stabilization of metastatic lesions and thus appears as a possible adjunct in recurrent or metastatic GCTB.
Conclusion: This case illustrates the indolent course of the distal tibial GCTB and represents an example of tailored multi-modality treatment with extended follow-up. Zoledronic acid may offer effective disease stabilization to a highly selected patient population at high risk.
Keywords: Giant cell tumor, progression, recurrence, distal tibia, fibular graft, arthrodesis
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