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giant cell tumor ( gct ) of a phalanx of a finger is extremely rare .
the metaphyseal region of the metacarpals and phalanges has been found to be the common site of gcts in most of the reported cases [ 24 ] . though gct is not a sarcoma ,
its relatively high recurrence rate   coupled with local aggressiveness after simple curettage often requires extensive en bloc excision .
local recurrence following curettage and bone grafting has been reported to be as high as 90% [ 1 , 4 , 6 , 7 ] .
wide resection and reconstruction with structural bone grafting is also reported to have a high local recurrence rate .
multiple procedures like excision ( local or wide ) , ray amputation , and amputation are used to eradicate the disease completely .
even with single- or double - ray resection for primary or recurrent tumors , local tumor control may not be absolute . here ,
we report two cases of gct on phalanges of the finger , noting the rarity of a lesion at this site .
a 50  year old man presented in june 2001 with an ulcerated swelling of two  months duration over the amputated left ring finger .
careful history taking and a review of his records led to a diagnosis of gct of the proximal phalanx of the left ring finger , where amputation of the proximal phalanx through its base had been performed elsewhere one year earlier .
he gave an associated history of traumatic amputation of the pulp of the left index finger in his childhood .
a review of previous radiographs showed an expansile lytic lesion at the proximal phalanx involving only the proximal metaphysis and diaphysis , sparing the distal end with an intact articular surface .
1 ) showed sheets of mononuclear stromal cells with numerous osteoclastic giant cells and osteoid tissue formation in certain areas .
he was asymptomatic for one year after the surgery until he noticed a progressive swelling on the amputated stump .
the surgical scar was subsequently broken after a month , leading to ulcer formation , and exposing the underlying tumor mass.fig . 
1histopathological picture showing typical features of the giant cell tumor ( 40 magnification ) histopathological picture showing typical features of the giant cell tumor ( 40 magnification ) on examination , an ulcerative swelling about 2  cm    3  cm in size involving all of the amputated stump was seen ( fig . 
the margin of the ulcer was not everted and was fixed to the tumor mass .
regional lymph nodes were not palpable.fig .  2a amputation stump with ulcer at the tip .
b radiograph showing partial amputation of the proximal phalanx with expansile lesion involving the articular surface .
c ct scan showing the irregular expansile lytic lesion with cortical erosion a amputation stump with ulcer at the tip .
b radiograph showing partial amputation of the proximal phalanx with expansile lesion involving the articular surface .
c ct scan showing the irregular expansile lytic lesion with cortical erosion a radiograph revealed partial amputation of the proximal phalanx through the proximal one - third , with an expansile lesion in the remaining part involving the articular surface that was associated with soft tissue swelling ( fig . 
ct scan clearly demonstrated an irregular expansile lytic lesion with cortical erosion ( fig .  2c ) .
3 ) was found to involve the entire base of the proximal phalanx , including the articular cartilage , with areas of new bone formation .
3resected tumor mass extending up to the joint resected tumor mass extending up to the joint at his most recent follow - up ( 80  months ) , neither clinical nor radiological evidence of local recurrence was seen .
there was no limitation on the strength or motion of the uninvolved digits or wrist .
a 26  year old female presented with a painless swelling of the left little finger of six  months duration without any history of trauma or fever .
examination revealed a fusiform swelling in the middle phalanx of the little finger ( fig . 
radiographs demonstrated an expansile lytic lesion involving the entire phalanx with a cortical break ( fig . 
5a radiograph ( ap , lateral ) reveals an expansile lytic lesion with cortical break .
c postoperative radiograph ( ap , oblique ) at 14  months showing incorporation of the cancellous graft clinical photograph showing fusiform swelling of the little finger a radiograph ( ap , lateral ) reveals an expansile lytic lesion with cortical break . b ct scan of the middle phalanx showing marked osteolysis .
c postoperative radiograph ( ap , oblique ) at 14  months showing incorporation of the cancellous graft under general anesthesia , curettage of the lesion was performed with cancellous bone grafting from the iliac crest .
histology confirmed the diagnosis of a gct , demonstrating osteoclastic giant cells admixed with stromal cells .
the patient is undergoing regular check - ups for 24  months and has not shown any evidence of local recurrence clinically or radiologically ( fig . 
a 50  year old man presented in june 2001 with an ulcerated swelling of two  months duration over the amputated left ring finger .
careful history taking and a review of his records led to a diagnosis of gct of the proximal phalanx of the left ring finger , where amputation of the proximal phalanx through its base had been performed elsewhere one year earlier .
he gave an associated history of traumatic amputation of the pulp of the left index finger in his childhood .
a review of previous radiographs showed an expansile lytic lesion at the proximal phalanx involving only the proximal metaphysis and diaphysis , sparing the distal end with an intact articular surface .
1 ) showed sheets of mononuclear stromal cells with numerous osteoclastic giant cells and osteoid tissue formation in certain areas .
he was asymptomatic for one year after the surgery until he noticed a progressive swelling on the amputated stump .
the surgical scar was subsequently broken after a month , leading to ulcer formation , and exposing the underlying tumor mass.fig . 
1histopathological picture showing typical features of the giant cell tumor ( 40 magnification ) histopathological picture showing typical features of the giant cell tumor ( 40 magnification ) on examination , an ulcerative swelling about 2  cm    3  cm in size involving all of the amputated stump was seen ( fig . 
the margin of the ulcer was not everted and was fixed to the tumor mass .
regional lymph nodes were not palpable.fig .  2a amputation stump with ulcer at the tip .
b radiograph showing partial amputation of the proximal phalanx with expansile lesion involving the articular surface .
c ct scan showing the irregular expansile lytic lesion with cortical erosion a amputation stump with ulcer at the tip .
b radiograph showing partial amputation of the proximal phalanx with expansile lesion involving the articular surface .
c ct scan showing the irregular expansile lytic lesion with cortical erosion a radiograph revealed partial amputation of the proximal phalanx through the proximal one - third , with an expansile lesion in the remaining part involving the articular surface that was associated with soft tissue swelling ( fig . 
ct scan clearly demonstrated an irregular expansile lytic lesion with cortical erosion ( fig .  2c ) .
3 ) was found to involve the entire base of the proximal phalanx , including the articular cartilage , with areas of new bone formation .
3resected tumor mass extending up to the joint resected tumor mass extending up to the joint at his most recent follow - up ( 80  months ) , neither clinical nor radiological evidence of local recurrence was seen .
there was no limitation on the strength or motion of the uninvolved digits or wrist .
a 26  year old female presented with a painless swelling of the left little finger of six  months duration without any history of trauma or fever .
examination revealed a fusiform swelling in the middle phalanx of the little finger ( fig . 
radiographs demonstrated an expansile lytic lesion involving the entire phalanx with a cortical break ( fig . 
5a radiograph ( ap , lateral ) reveals an expansile lytic lesion with cortical break .
b ct scan of the middle phalanx showing marked osteolysis . c postoperative radiograph ( ap , oblique ) at 14  months showing incorporation of the cancellous graft clinical photograph showing fusiform swelling of the little finger a radiograph ( ap , lateral ) reveals an expansile lytic lesion with cortical break . b ct scan of the middle phalanx showing marked osteolysis .
c postoperative radiograph ( ap , oblique ) at 14  months showing incorporation of the cancellous graft under general anesthesia , curettage of the lesion was performed with cancellous bone grafting from the iliac crest . the recovery was uneventful .
histology confirmed the diagnosis of a gct , demonstrating osteoclastic giant cells admixed with stromal cells .
the patient is undergoing regular check - ups for 24  months and has not shown any evidence of local recurrence clinically or radiologically ( fig . 
gct of the hand is rare and seems to be different from conventional gct , which occurs at other sites in the skeleton .
it is even rarer to encounter a gct arising from the phalanges . of the more than 2,400 skeletal gcts reported in the literature ,
less than 50 were found to involve the phalanges of the hand [ 7 , 8 ] .
.   reported only two cases of gct arising from the phalanges in their series of 108 cases .
goldenberg et al . , in their analysis of 218 cases of gct , reported six cases involving the phalanges . in another two large series of 568 and 327 cases of gct , authors found only four and one cases of phalangeal involvement , respectively [ 11 , 12 ] .
reported a multicentric giant cell tumor of the hand involving a finger and the wrist .
benign metastazing giant cell tumor of the hand has also been reported . in our series of 124 skeletal gcts
giant cell tumors of the hand have been treated with curettage and cancellous bone grafting , wide resection , and structural bone grafting or ray amputation [ 1 , 4 , 6 , 7 , 15 ] .
high local recurrence rates have been reported with these treatment modalities [ 1 , 4 , 6 , 7 ] .
reported a gct of the middle phalanx treated with curettage and bone grafting , which recurred at 9  months and was successfully treated by excision and allograft replacement .
resection  iliac graft and double arthrodesis for gct of the proximal phalanx of the thumb has also been reported . our patient ( case no .
2 ) with curettage and iliac bone grafting recovered uneventfully . to avoid stiffness of fingers and tendon adhesion , we started active finger rehabilitation measures as early as the second week .
the patient was still disease free at the most recent follow - up , and was performing normal activities with a good grip strength .
most local recurrences of gct cases of the hand are reported to occur within one year of primary surgery [ 1 , 6 ] .
patel et al .   treated three cases of gct of the hand with curettage and bone grafting , two of which had local recurrence and required ray resection .
1 ) presented with local recurrence one year after primary surgery elsewhere , but has been disease free for more than 80  months following ray amputation of the amputated ring finger .
.   reported one of the largest series of gct of the hand , consisting of 28 lesions ( 14 in the phalanges ) in 21 patients .
two of the six cases of finger phalangeal involvement reported in goldenberg s series developed local recurrence .
table  1 shows the reported local recurrence rates of gct of the hand following curettage , resection and amputation.table  1reported local recurrence after curettage , resection and amputation for gct of the handsl no.authorsno .
of casescurettage    bone graftresection or ray amputationnos.local recurrencenos.local recurrence1.goldenberg 611512.averill et al .
1117.this study2116448 ( 75%)389 ( 24% ) reported local recurrence after curettage , resection and amputation for gct of the hand most of the gct cases with recurrent tumors require ray amputation to prevent recurrence .
there are reports of success with ray resection or amputation at the cost of the loss of a functional finger [ 7 , 15 ] .
we chose ray resection of the amputated ring finger with the aim of preventing recurrence .
the recurrent tumor in our patient expanded eccentrically , leading to breakage of the surgical scar and ulcer formation .
contrary to malignant ulcers , the margin of the ulcer was not everted and did not bleed on touch .
kumar and tuli   and dahlin et al .   reported similar histological findings in their series . following ray resection of the ring finger
the patient was satisfied with a cosmetically improved hand . in view of the comparative rarity of a tumor arising from the phalanges of the finger ,
giant cell tumor ( gct ) of bone arising from a phalanx of a finger is extremely rare . 
 we report two cases of gct arising from a phalanx of a finger . 
 one case presented with recurrence following the amputation of the left ring finger ( performed elsewhere ) . 
 he was treated successfully with ray amputation . 
 the other case was treated primarily by intralesional curettage and autogenous bone graft . at their most recent follow - ups ( 80 and 24  months , 
 respectively ) , both were recurrence free and had returned to their previous occupational and recreational activities .