Giant cell tumor of the talus: A case report
A 43-year-old female with a past medical history of partial epilepsy presented for 1 month of progressive left ankle pain following a fall. Three months prior to the fall, she had twisted her ankle but did not seek medical treatment. Physical exam revealed mild edema and tenderness of the lateral left ankle. A left ankle radiograph showed a remote avulsion of the tip of the lateral malleolus, but no bone or joint abnormalities were noted. She was diagnosed with an ankle sprain.

The patient was prescribed a walking boot and physical therapy, without clinical improvement. At her 2-month follow-up visit, the physical exam revealed continued edema on the anterior and lateral aspects of the left ankle, with tenderness but no palpable mass. An MRI performed at this time demonstrated a well-circumscribed lesion of the talar neck with reactive bone marrow edema. The patient underwent a CT-guided core needle biopsy which was inconclusive, but images demonstrated a well-circumscribed lytic lesion in the talar neck with extension to the articular surface

The needle biopsy revealed spindle cells admixed with giant cells and fibrous tissue. However, due to the paucity of lesional material, it was considered nondiagnostic.

Subsequently, the patient underwent a left talus open biopsy. Intraoperative fluoroscopy was used to confirm the location of the lesion. Frozen section analysis revealed spindle cells admixed with giant cells, fibrous tissue, and bone. No malignancy was detected, and the final diagnosis was deferred until the permanent slides could be evaluated.At 6 months status post open biopsy of the talus, ankle radiographs demonstrated progression of disease as expected. Intralesional curettage and use of adjuvants was recommended, to which the patient consented.

The patient then underwent an extended intralesional curettage and use of adjuvants, including high-speed burr, dilute hydrogen peroxide, sterile water, and argon beam. The talus was then filled with antibiotic-impregnated cement with added vancomycin. Postsurgical radiographs demonstrated cement-packing of the lesion and mild soft-tissue edema.

A histological examination from the second procedure confirmed the presence of the multinucleated giant cell. The postsurgical treatment plan consisted of denosumab, chest imaging, and regular ankle radiographs, to monitor for pulmonary metastasis and GCT recurrence. At 16 months after the extended curettage, there was no evidence of bone resorption around the cement or GCT recurrence.