Recurrent Giant Cell Tumour of the Calcaneum - A Case Report

Recurrent Giant Cell Tumour of the Calcaneum - A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Recurrent Giant Cell Tumour of the Calcaneum - A Case Report Varun Roheet S S, Siva Prakash, Balaji R, Chepauk Ramesh, Arun Kannan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2493638/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction - A 20-year-old female who presented with multiply recurrent giant cell tumour (GCT) of the left calcaneum and destruction of talus. To our knowledge, there has been no literature published on the method for reconstruction of the hind foot after complete removal of both calcaneum and talus. Case presentation - She was managed with an en-bloc talocalcaneal resection and reconstruction with femoral head allograft. She developed soft tissue recurrence at one year and was managed with wide excision of the soft tissue component and flap coverage. Conclusion - At 5 years follow up, she was free of recurrence and had painless ambulation.This case illustrates successful use of femoral head allograft for reconstruction of both talus and calcaneum, and management of soft tissue recurrence with wide local excision. GCT Calcaneum Case Report Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Introduction The most common location of a Giant cell tumour (GCT) is in the long bones of the lower extremities especially around the knee [ 1 ] . GCT of the calcaneum is rare and comprises less than 1% of all GCT’s [ 2 ] . In cases of GCT with extensive involvement of the calcaneum, reconstruction has been achieved through allograft reconstruction or using custom prosthetic implants to replace the calcaneum [ 3 ] . In this report we present a case of a 20-year-old female with recurrent GCT of the left calcaneum with loss of significant portion of talus after multiple surgeries. She required excision of both the talus and calcaneum and reconstruction of the entire hind foot with femoral head allograft. To our knowledge, there has been no literature published on the method for reconstruction of the hind foot after complete removal of both calcaneum and talus. Case Presentation A 20-year-old female presented with complaints of pain and a swelling in the left foot. She had been diagnosed with GCT of the calcanuem at a different centre at the age of 15. She had multiple recurrences that had necessitated 5 surgical procedures before she presented to us (Table 1 ). Table 1 – Shows the multiple surgeries which were performed before presenting to our institute Age at surgery Procedure performed 15 Calcaneal biopsy and curettage with bone grafting 16 Calcaneal curettage + filling of defect with cement 17 Calcaneal curettage + filling of defect with cancellous bone graft 18 Calcaneal curettage + filling of defect with cancellous bone graft 19 Calcaneal curettage and reconstruction with fibular bone graft Physical examination revealed a swelling in the posterior aspect of the left foot with multiple surgical scars and varus deformity of the hind foot. Radiographs and computed tomography of the left foot showed post-operative changes with sclerosis and irregular margins in the calcaneum with destruction of the inferior half of the talus including its articular surface (Fig. 1 ,2 & 3 ). There was also a fibular bone graft with k wire which was extending from calcaneum to the cuneiform and navicular bones (Fig. 1 ). A magnetic resonance imaging (MRI) showed tumor involvement of the calcaneum with ill-defined enhancing soft tissue along the medial aspect. (Fig. 4). This was suggestive of recurrent giant cell tumor of the left calcaneum with destruction of the inferior half of the talus. The biopsy slides from her previous surgery were reviewed at our institution and it was suggestive of a GCT. Given the extensive destruction of calcaneum, talus and multiple surgeries, the treatment options considered were (1) wide local excision of the tumor with removal of the calcaneum and talus and reconstruction with allograft or (2) below knee amputation. The high risk of recurrence with wide local excision was explained to her. She was unwilling to consider amputation and opted for wide local excision. Prior surgical incision along the posteromedial aspect of the ankle was utilized. The talus and calcaneum were excised as a single unit and sent for histopathology which later confirmed a GCT. Femoral head allograft was placed with the neck end approximated against the denuded articular surface of the distal tibia and fibula. The allograft was fixed to the distal tibia using three cannulated cancellous screws. The articular surfaces of the navicular and cuboid were denuded off cartilage and fixed with the allograft using one cannulated cancellous screw and a K-wire. Corticocancellous autograft obtained from the iliac crest was placed at the ankle and mid foot fusion sites (Fig. 5 ). Postoperatively, she was placed on non-weight bearing protocol for 3 months followed by gradual progression of weight bearing. By 6 months, the graft was stable on radiographs with union to the tibia and she was able to walk comfortably without crutches. Needle biopsy from the soft tissue mass revealed a multinodular lesion composed of uniformly distributed osteoclastic giant cells on a background of oval to spindle-shaped stromal cells consistent with recurrence of GCT. The tumour was excised along with portion of the overlying skin (Fig. 8 ). The soft tissue defect was reconstructed with a perforator rotational flap. The patient was followed up with radiographs and MRI. At 5 year follow up there were no features suggestive of recurrence (Figs. 9 , 10 & 11 ). Resorption along the inferior aspect of the graft was seen at 1 year, but remained stable on further follow up. Conclusion A 20-year-old female with multiple recurrences of GCT of the calacneum who presented with destruction of talus and calcaneum was treated with en-bloc resection of the two bones and reconstruction with femoral head allograft. A soft tissue recurrence at 1 year was treated with wide excision and flap coverage. GCT of the calcaneum is generally treated with curettage and it may be extended with adjuvants such as phenol application or cryotherapy [ 4 ] . Our case presented an additional challenge as the talus was destroyed in addition to the calcanuem and needed reconstruction of the entire hind foot. This was successfully done with the use of an allograft. Compared with local recurrence in bone, recurrence in the soft tissue is rarely seen in clinical practice. Soft tissue recurrence most frequently arises in the area adjacent to curettage site, probably due to the contamination during surgical removal of the tumor [ 5 ] . Our patient had a soft tissue recurrence without involvement of her native bones or the allograft. We managed this with wide local excision of the soft tissue lesion. The absence of recurrence at 5 years of follow up suggests that the tumor clearance was complete at the time of surgery. The patient is able to fully weight bear and walk (Fig. 12). This case of complex multiply recurrent calcaneal GCT illustrates that (1) allograft reconstruction can be used in complex hind foot tumors that require en-bloc removal of calcaneum and talus, especially in young patients, and (2) soft tissue recurrence of GCT’s without osseous involvement can be managed with wide excision of the soft tissue lesion. Declarations Funding – No external funding Conflicts of interest/Competing interests – No conflicts of interest Ethics approval - Not applicable Consent to participate - The patient was informed that data concerning her case would be submitted for publication and the patient agreed. Written Consent for publication – All the authors of this manuscript consent for publication. Written Consent for publication was obtained from the patient. Availability of data and material – All datas available Code availability – Not applicable Authors Contributions – I. Dr. Varun Roheet S S 1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published II. Dr. Siva Prakash 1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published III. Dr. Balaji R 1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published IV. Dr. Chepauk Ramesh 1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published V. Dr. Arun Kannan 1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published References Bhattacharyya A, Das R, Darwani R. Giant cell tumor of the talus: a case report and review of literature. Foot Ankle Online J. 2010;3(8):2. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone.The Journal of bone and joint surgery. American volume. 1987 Jan1;69(1):106–14. Imanishi J, Choong PF. Three-dimensional printed calcaneal prosthesis following total calcanectomy. International journal of surgery case reports. 2015 Jan 1;10:83 – 7. Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer treatment reviews. 2010 Feb 1;36(1):1–7. Xu L, Jin J, Hu A, Xiong J, Wang D, Sun Q, Wang S. Soft tissue recurrence of giant cell tumor of the bone: prevalence and radiographic features. Journal of bone oncology. 2017 Nov 1;9:10 – 4. Supplementary Files CAREAK.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2493638","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":186507896,"identity":"d6c78c12-7084-453d-a644-cda48eed01cd","order_by":0,"name":"Varun Roheet S 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wires\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/e81f6e0832942a5d1a551931.png"},{"id":34944804,"identity":"51fc2f7f-9713-4857-bcb1-5187fed0d5e3","added_by":"auto","created_at":"2023-03-28 22:27:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":42888,"visible":true,"origin":"","legend":"\u003cp\u003eCT scan of left foot – Axial View\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/0a9d63c77b03228b8982b381.png"},{"id":34944381,"identity":"c9ed5881-9f66-4804-90a7-5f74fb2aad4c","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42782,"visible":true,"origin":"","legend":"\u003cp\u003eCT scan of left foot – Coronal View\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/d7894916b78019f3740beed9.png"},{"id":34944389,"identity":"bdf17d83-261c-4983-8099-aa66072e2b60","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":68549,"visible":true,"origin":"","legend":"\u003cp\u003eMRI of Left Ankle – T2 weighted - Coronal View\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/12a03ea340b91eb67a787fc0.png"},{"id":34944382,"identity":"e553f8be-049d-45c7-9b93-4c80fba0bf2f","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":66132,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative Radiograph of left ankle showing \u0026nbsp;\u0026nbsp;cannulated screws with bone graft\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/3260abaa38ff5a0aa109c18e.png"},{"id":34945297,"identity":"05ac4cac-f6ec-4ce9-a962-761cd9f9c8de","added_by":"auto","created_at":"2023-03-28 22:35:02","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":39480,"visible":true,"origin":"","legend":"\u003cp\u003eRadiograph of Left Ankle AP view taken 1 year after \u0026nbsp;\u0026nbsp;surgery\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/65a8a12acc757505c40fb2d5.png"},{"id":34944383,"identity":"8e09b2cc-c7af-4c2c-b39a-289e410fb812","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":44566,"visible":true,"origin":"","legend":"\u003cp\u003eRadiograph of Left Ankle Lateral view taken 1 year after \u0026nbsp;\u0026nbsp;surgery\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/d50bb74f7669e86c92d9de4b.png"},{"id":34944390,"identity":"b603339a-e9de-4d2b-94d3-4b8e480c27b2","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":292166,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative photograph of left ankle showing the \u0026nbsp;\u0026nbsp;soft tissue lesion on the medial aspect being removed with the overlying skin\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/20b068ee74e3ee1f6e4ea0e6.png"},{"id":34944386,"identity":"46e64337-07c1-448b-9a5a-56eb4e554087","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":54147,"visible":true,"origin":"","legend":"\u003cp\u003eRadiograph of Left Ankle AP view taken 2 years after \u0026nbsp;\u0026nbsp;surgery\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/5fc987ba13d6eb94e9a0368c.png"},{"id":34944392,"identity":"7a1288ab-d497-4e23-b78c-37d6a72c250d","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":957204,"visible":true,"origin":"","legend":"\u003cp\u003eRadiograph of Left Ankle AP\u0026amp; lateralview taken 5 \u0026nbsp;\u0026nbsp;years after surgery\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/e543aa4ae859a9c934ad9390.png"},{"id":34944391,"identity":"d1f09b32-06c7-459d-a3be-72bec898a9c4","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":112785,"visible":true,"origin":"","legend":"\u003cp\u003eShows the Left foot with healed flap and surgical \u0026nbsp;\u0026nbsp;scars\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/fafeb8418ca1692092fbee70.png"},{"id":34944387,"identity":"2383ea1b-68a8-48bd-b850-5fc63506a16a","added_by":"auto","created_at":"2023-03-28 22:19:02","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":102937,"visible":true,"origin":"","legend":"\u003cp\u003eShows the Patient walking full weight bearing \u0026nbsp;\u0026nbsp;without support\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/dd946d06e2d3c0ad3d754832.png"},{"id":35626394,"identity":"d9d894ad-aad2-4f68-90af-75fa4b65ac18","added_by":"auto","created_at":"2023-04-12 06:41:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1897720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/da883f31-03f9-4c2d-b7b0-09fe7452ecea.pdf"},{"id":34944802,"identity":"55aa6fdd-d02f-432d-8ebd-ad6b6b5de3f7","added_by":"auto","created_at":"2023-03-28 22:27:02","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":2219898,"visible":true,"origin":"","legend":"","description":"","filename":"CAREAK.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2493638/v1/d16f38965f955587c265a4c7.pdf"}],"financialInterests":"","formattedTitle":"Recurrent Giant Cell Tumour of the Calcaneum - A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe most common location of a Giant cell tumour (GCT) is in the long bones of the lower extremities especially around the knee \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. GCT of the calcaneum is rare and comprises less than 1% of all GCT\u0026rsquo;s \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. In cases of GCT with extensive involvement of the calcaneum, reconstruction has been achieved through allograft reconstruction or using custom prosthetic implants to replace the calcaneum \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this report we present a case of a 20-year-old female with recurrent GCT of the left calcaneum with loss of significant portion of talus after multiple surgeries. She required excision of both the talus and calcaneum and reconstruction of the entire hind foot with femoral head allograft. To our knowledge, there has been no literature published on the method for reconstruction of the hind foot after complete removal of both calcaneum and talus.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 20-year-old female presented with complaints of pain and a swelling in the left foot. She had been diagnosed with GCT of the calcanuem at a different centre at the age of 15. She had multiple recurrences that had necessitated 5 surgical procedures before she presented to us (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Shows the multiple surgeries which were performed before presenting to our institute\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcedure performed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcaneal biopsy and curettage with bone grafting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcaneal curettage\u0026thinsp;+\u0026thinsp;filling of defect with cement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcaneal curettage\u0026thinsp;+\u0026thinsp;filling of defect with cancellous bone graft\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcaneal curettage\u0026thinsp;+\u0026thinsp;filling of defect with cancellous bone graft\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcaneal curettage and reconstruction with fibular bone graft\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePhysical examination revealed a swelling in the posterior aspect of the left foot with multiple surgical scars and varus deformity of the hind foot. Radiographs and computed tomography of the left foot showed post-operative changes with sclerosis and irregular margins in the calcaneum with destruction of the inferior half of the talus including its articular surface (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,2 \u0026amp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was also a fibular bone graft with k wire which was extending from calcaneum to the cuneiform and navicular bones (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A magnetic resonance imaging (MRI) showed tumor involvement of the calcaneum with ill-defined enhancing soft tissue along the medial aspect. (Fig.\u0026nbsp;4). This was suggestive of recurrent giant cell tumor of the left calcaneum with destruction of the inferior half of the talus. The biopsy slides from her previous surgery were reviewed at our institution and it was suggestive of a GCT.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGiven the extensive destruction of calcaneum, talus and multiple surgeries, the treatment options considered were (1) wide local excision of the tumor with removal of the calcaneum and talus and reconstruction with allograft or (2) below knee amputation. The high risk of recurrence with wide local excision was explained to her. She was unwilling to consider amputation and opted for wide local excision.\u003c/p\u003e \u003cp\u003ePrior surgical incision along the posteromedial aspect of the ankle was utilized. The talus and calcaneum were excised as a single unit and sent for histopathology which later confirmed a GCT. Femoral head allograft was placed with the neck end approximated against the denuded articular surface of the distal tibia and fibula. The allograft was fixed to the distal tibia using three cannulated cancellous screws. The articular surfaces of the navicular and cuboid were denuded off cartilage and fixed with the allograft using one cannulated cancellous screw and a K-wire. Corticocancellous autograft obtained from the iliac crest was placed at the ankle and mid foot fusion sites (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Postoperatively, she was placed on non-weight bearing protocol for 3 months followed by gradual progression of weight bearing. By 6 months, the graft was stable on radiographs with union to the tibia and she was able to walk comfortably without crutches.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNeedle biopsy from the soft tissue mass revealed a multinodular lesion composed of uniformly distributed osteoclastic giant cells on a background of oval to spindle-shaped stromal cells consistent with recurrence of GCT. The tumour was excised along with portion of the overlying skin (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e8\u003c/span\u003e). The soft tissue defect was reconstructed with a perforator rotational flap.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient was followed up with radiographs and MRI. At 5 year follow up there were no features suggestive of recurrence (Figs.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e9\u003c/span\u003e, \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e10\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e11\u003c/span\u003e). Resorption along the inferior aspect of the graft was seen at 1 year, but remained stable on further follow up.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA 20-year-old female with multiple recurrences of GCT of the calacneum who presented with destruction of talus and calcaneum was treated with en-bloc resection of the two bones and reconstruction with femoral head allograft. A soft tissue recurrence at 1 year was treated with wide excision and flap coverage.\u003c/p\u003e \u003cp\u003eGCT of the calcaneum is generally treated with curettage and it may be extended with adjuvants such as phenol application or cryotherapy \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Our case presented an additional challenge as the talus was destroyed in addition to the calcanuem and needed reconstruction of the entire hind foot. This was successfully done with the use of an allograft.\u003c/p\u003e \u003cp\u003eCompared with local recurrence in bone, recurrence in the soft tissue is rarely seen in clinical practice. Soft tissue recurrence most frequently arises in the area adjacent to curettage site, probably due to the contamination during surgical removal of the tumor \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Our patient had a soft tissue recurrence without involvement of her native bones or the allograft. We managed this with wide local excision of the soft tissue lesion. The absence of recurrence at 5 years of follow up suggests that the tumor clearance was complete at the time of surgery. The patient is able to fully weight bear and walk (Fig.\u0026nbsp;12).\u003c/p\u003e \u003cp\u003eThis case of complex multiply recurrent calcaneal GCT illustrates that (1) allograft reconstruction can be used in complex hind foot tumors that require en-bloc removal of calcaneum and talus, especially in young patients, and (2) soft tissue recurrence of GCT\u0026rsquo;s without osseous involvement can be managed with wide excision of the soft tissue lesion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding \u0026ndash; No external funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflicts of interest/Competing interests \u0026ndash; No conflicts of interest\u003c/p\u003e\n\u003cp\u003eEthics approval - Not applicable\u003c/p\u003e\n\u003cp\u003eConsent to participate - The patient was informed that data concerning her case would be submitted for publication and the patient agreed.\u003c/p\u003e\n\u003cp\u003eWritten Consent for publication \u0026ndash; All the authors of this manuscript consent for publication. Written Consent for publication was obtained from the patient.\u003c/p\u003e\n\u003cp\u003eAvailability of data and material \u0026ndash; All datas available\u003c/p\u003e\n\u003cp\u003eCode availability \u0026ndash; Not applicable\u003c/p\u003e\n\u003cp\u003eAuthors Contributions \u0026ndash;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI. Dr. Varun Roheet S S\u003c/p\u003e\n\u003cp\u003e1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published\u003c/p\u003e\n\u003cp\u003eII. Dr. Siva Prakash\u003c/p\u003e\n\u003cp\u003e1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published\u003c/p\u003e\n\u003cp\u003eIII. Dr. Balaji R\u003c/p\u003e\n\u003cp\u003e1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published\u003c/p\u003e\n\u003cp\u003eIV. Dr. Chepauk Ramesh\u003c/p\u003e\n\u003cp\u003e1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published\u003c/p\u003e\n\u003cp\u003eV. Dr. Arun Kannan\u003c/p\u003e\n\u003cp\u003e1) substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be published\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBhattacharyya A, Das R, Darwani R. Giant cell tumor of the talus: a case report and review of literature. Foot Ankle Online J. 2010;3(8):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone.The Journal of bone and joint surgery. American volume. 1987 Jan1;69(1):106\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImanishi J, Choong PF. Three-dimensional printed calcaneal prosthesis following total calcanectomy. International journal of surgery case reports. 2015 Jan 1;10:83 \u0026ndash; 7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErrani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer treatment reviews. 2010 Feb 1;36(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu L, Jin J, Hu A, Xiong J, Wang D, Sun Q, Wang S. Soft tissue recurrence of giant cell tumor of the bone: prevalence and radiographic features. Journal of bone oncology. 2017 Nov 1;9:10 \u0026ndash; 4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"GCT, Calcaneum, Case Report","lastPublishedDoi":"10.21203/rs.3.rs-2493638/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2493638/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction - A 20-year-old female who presented with multiply recurrent giant cell tumour (GCT) of the left calcaneum and destruction of talus. To our knowledge, there has been no literature published on the method for reconstruction of the hind foot after complete removal of both calcaneum and talus.\u003c/p\u003e\n\u003cp\u003eCase presentation - She was managed with an en-bloc talocalcaneal resection and reconstruction with femoral head allograft. She developed soft tissue recurrence at one year and was managed with wide excision of the soft tissue component and flap coverage.\u003c/p\u003e\n\u003cp\u003eConclusion\u003cstrong\u003e - \u003c/strong\u003eAt 5 years follow up, she was free of recurrence and had painless ambulation.This case illustrates successful use of femoral head allograft for reconstruction of both talus and calcaneum, and management of soft tissue recurrence with wide local excision.\u003c/p\u003e","manuscriptTitle":"Recurrent Giant Cell Tumour of the Calcaneum - A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-28 22:18:57","doi":"10.21203/rs.3.rs-2493638/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5bc4e365-f01d-4438-969e-517c37d61b73","owner":[],"postedDate":"March 28th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-04-12T06:41:16+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-28 22:18:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2493638","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2493638","identity":"rs-2493638","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}