Infected Osteoclastoma of the Knee: An Unusual Presentation

Introduction. Giant cell tumor is a benign or locally aggressive tumor of uncertain origin that appears in mature bone, most commonly in the distal femur, proximal tibia which characteristically extends right up to the subarticular bone plate. Case Report. We report here a 35-year-old female presenting with swelling of the left knee. On examination, the swelling was solitary, about 20？×？15？cm in size with the skin over the swelling stretched and glistening. On the fifth day of hospital stay, the swelling burst open and blood tinged pus started pouring out. X-ray and MRI scan showed a well-defined T2 hyperintense expansile eccentrically located osteolytic lesion involving the metaphyseal region of the proximal tibia and extending into the subarticular space and multiple T1/T2 hypointense septations are noted within the lesion suggestive of osteoclastoma. The patient was counseled regarding the tumor and prognosis and various treatment options. She was treated successfully with above knee amputation. The tissue was sent for histopathology which confirmed osteoclastoma. Conclusion. It is important to recognize giant cell tumors early, so that they can be treated promptly with local measures to prevent morbidity and mortality in young adults. 1. Introduction Giant cell tumor is so named because it contains profusion of multinucleated osteoclast-type giant cells, giving rise to the synonym osteoclastoma. The term osteoclastoma was first used in Great Britain by Stewart in 1922. It is a benign but locally aggressive neoplasm representing approximately 5% of all primary bone tumors. It usually arises in patients in their twenties to forties. The tumor is slightly more common in female. They are typically epiphyseometaphyseal tumors, with the majority involving the distal femur and proximal tibia. The clinical history of a giant cell tumor usually includes pain and limitation of motion because of the tumor’s proximity to the joint space. Swelling occurs late in the course of the giant cell tumor. Patients presenting to the doctor early in the course of the tumor can be treated with local surgery such as thorough curettage and cryosurgery or burring of the cavity with or without phenol installation. The lesional area may then be packed with allograft or polymethyl methacrylate. Such treatment reduces the local recurrence rate to less than 20% and the prognosis is excellent if it does not recur locally [1]. If this tumor is not diagnosed and treated early, it continues to grow in size causing massive local tissue destruction and may get secondarily infected