Giant Cell Tumor (GCT) of the Third Metatarsal in an Elderly
A 60-year-old male presented with complaints of pain and swelling over the dorsum aspect of the right foot for the past 1 year. The patient was apparently alright 1 year back. There was no history of trauma, fever, loss of weight, and loss of appetite. There was no history of previous surgeries. On examination, oval swelling measuring 5 × 3 cm on the dorsum of the right foot was noticed opposing 2nd, 3rd, and 4th metatarsal with well-defined margins. The skin was free from the swelling and the consistency was firm. Tenderness was present with no signs of inflammation.

Radiographs of the right foot revealed an expansile osteolytic lesion in the 3rd metatarsal with cortical thinning sparing the proximal one-third of the bone. The tarsometatarsal joint appeared normal. MRI foot showed a well-defined expansile, solid cystic lesion of approximate size 4.4*3.1*3.1 cm arising from the medullary cavity of the distal shaft and head of the 3rd metatarsal with surrounding soft-tissue edema with no soft-tissue extravasation and intra-articular extension. Fine-needle aspiration cytology was suggestive of GCT. As the patient was an elderly manual laborer and wanted early weight-bearing, we planned for excision with 3rd ray amputation.

The patient was operated on under spinal anesthesia, in the supine position. The incision was taken over the dorsum of the foot over 3rd metatarsal. Soft tissue was dissected and extensor tendons were separated, GCT mass was identified and was removed along with the 3rd metatarsal sparing proximal 1cm without disturbing the tarsometatarsal joint. Excised Specimen was measuring approximately about 6*3 cm which was sent for a histopathology examination. Hemostasis was achieved and the wound was closed in layers. Immediate postoperative X-ray foot showed complete removal of the tumor mass with the 3rd ray amputation. Histopathological examination confirmed the diagnosis of GCT. The post-operative period was uneventful, weight-bearing was started after 3 weeks of surgery. At present, 1.5 years follow-up, the patient is comfortable with no pain and difficulty in walking. Follow-up X-ray showed no recurrence with no other lesions.

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