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Paper text:
giant cell tumour of bone ( gct ) is a common benign primary bone tumour , seen commonly in the distal femur , proximal tibia and distal radius .
we report an unusual presentation of recurrent giant cell tumour in a 25 year old male in the medial condyle and epicondyle of left humerus .
as it is an uncommon site for tumors , it was misdiagnosed as tuberculous osteomyelitis and was inadequately curetted .
we did en - bloc resection of the tumour , with judicious removal of partial trochlea .
though reconstruction was planned , it was found to be not necessary as the elbow was stable per - operatively .
there is no recurrence or metastasis of the tumor in the two - year follow - up .
though bone tumors are rare in distal humerus , biopsy is needed to confirm the diagnosis of any lytic lesion in this region for proper management .
giant cell tumour is a locally aggressive primary bone tumour , located eccentrically in the metaphysis and epiphysis of a long bone .
it commonly affects distal end of femur , proximal end of tibia and distal end of radius .
it is occasionally reported in small bones of hand and foot , spine and pelvis .
though it occurs in 20 - 35 year old individuals commonly , it can also be seen in children as young as 2 years and also in older individuals .
we report an unusual presentation of giant cell tumour in medial condyle and epicondyle of right humerus which mimicked tuberculosis .
a 26 year old male developed pain and swelling over medial aspect of left elbow 3 years ago .
x - ray showed ill - defined radiolucent lesion in the medial condyle of left distal humerus ( fig .
mri showed osteolytic lesion in medial epicondyle and trochlea which was hyperintense on all the sequences .
it was a well - defined lesion , and was extending into the soft tissue through a break in the medial cortex .
probably because of the rarity of gct at this particular site , it was not thought of , and the lesion was suspected to be tuberculous osteomyelitis .
histopathological examination showed multinucleate giant cells and spindle cells with identical nuclei and the lesion was diagnosed as gct .
patient came to our institution six months after the reappearance of the swelling i.e. , one year after curettage . at the time of presentation , the elbow was in 50 of flexion and the range of motion was restricted to 50 - 90. the swelling was 4   5  in size , situated anteromedially just above the elbow joint .
x - ray showed well - defined expansile osteolytic lesion in the medial epicondyle and part of the trochlea .
cortical destruction was seen medially , hence the tumour was graded as grade iii giant cell tumour according to companacci grading ( fig .
2 ) . mri showed breach in the medial cortex , with the tumour extending into the soft tissue .
pathological fracture of medial cortex was seen and the tumour was extending anteriorly outside the bone .
enbloc resection of the tumour was done , including part of the trochlea ( fig .
4 ) . reconstruction was deferred as the joint appeared to be stable intra - operatively .
post - operatively , neurovascular function was intact and the elbow was mobilized from third week post - operatively .
x - ray chest and elbow taken six months , one year and two years post - operatively showed no recurrence or metastasis .
the incidence of giant cell tumour is 5% among primary bone tumors , of which 3% show metastasis in lungs .
though gct is a benign bone tumor , it breaches the cortex and invades the soft tissues .
low degree of suspicion may be the reason for inadequate removal of the tumour during the primary surgery .
giant cell tumour in upper limb is considered to be more aggressive than the tumour in lower limb .
resection of the tumour involving the whole distal humerus and reconstruction with total elbow arthroplasty is also described .
since the lesion is involving the trochlea only partly , resection of the tumour and supporting the medial aspect of the joint with autogenous tricortical iliac crest graft is planned .
but there is no instability after resection of the tumour and elbow movement is regained completely .
so , reconstruction is deferred , to be done later if it is deemed necessary . patient does nt opt for reconstruction when
apart from having mild pain , patient is satisfied with the function of his left elbow .
his elbow performance score has improved from 30 to 85 . as is in the case of recurrent gct
patient is advised regular follow - up to detect local recurrence and metastasis at the earliest .
though occurrence of gct is rare in distal humerus , it should be considered in the differential diagnosis of any radiolucent lesion .
introduction : giant cell tumour of bone ( gct ) is a common benign primary bone tumour , seen commonly in the distal femur , proximal tibia and distal radius . 
 very few cases of gct are reported in distal humerus . 
 we report an unusual presentation of recurrent giant cell tumour in a 25 year old male in the medial condyle and epicondyle of left humerus.case series : patient presented elsewhere with lytic lesion of left elbow three years ago . 
 as it is an uncommon site for tumors , it was misdiagnosed as tuberculous osteomyelitis and was inadequately curetted . 
 patient presented to us with recurrence of tumor one year after the primary surgery . 
 we did en - bloc resection of the tumour , with judicious removal of partial trochlea . 
 though reconstruction was planned , it was found to be not necessary as the elbow was stable per - operatively . 
 patient regained near normal movements of the elbow with no instability . 
 his mayo elbow performance score improved from 30 to 85 . 
 there is no recurrence or metastasis of the tumor in the two - year follow-up.conclusion:though bone tumors are rare in distal humerus , biopsy is needed to confirm the diagnosis of any lytic lesion in this region for proper management .