PMC4779636_01
Anteroposterior and sagittal radiographs: well defined osteolytic lesion of the hallux proximal phalanx
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Neither cortex erosion nor soft tissues abnormalities were noticed (Figure 1).
Microscopic view (Hematoxylin and Eosin stain x 250): enchondroma appearance with multiple nodules of hyaline cartilage separated from another by bone marrow
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An initial biopsy was performed and showed typical features of a benign enchondroma (Figure 2).
Anteroposterior and sagittal radiographs 6 mouths postoperatively: bone satisfying appearance and incorporated bone graft
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The patients' postoperative period was uneventful with a successful healing and a satisfying clinical and radiological evolution (Figure 3).
Clinical aspect of the hallux tumefaction (5 year post operatively)
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By the fifth year postoperatively, the patient was presented with a new painful spurt of the big toe with a tumefaction that was significantly more pronounced than the initial clinical presentation (Figure 4).
Anteroposterior and sagittal radiographs (5 year post operatively): expanding multiloculated osteolytic lesion involving the whole hallux phalanx
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The radiological findings exhibited an expanding multiloculated osteolytic lesion involving whole proximal phalanx with no soft tissue nor articular involvement (Figure 5).
Frontal and sagittal CT view in soft tissue algorithm: expanding osteolytic lesion with focal cortical thinning and without interruption or fluid fluid levels
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CT scan performed confirmed the osteolytic lesion with a focal cortical thinning with no fluid-fluid levels (Figure 6).
Histological GCRG appearance: a- microscopic view (Hematoxylin and Eosin stainx250): mononuclear proliferation in fibrous stroma with multiple osteoclastic- like giant cells; b- microscopic view (Hematoxylin and Eosin stain x 400). Higher power field showing extensive osteoid, numerous small capillaries and mononuclear cells loosely arranged
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Recurrence was suspected and a new biopsy was performed and pathological analysis revealed histological aspects in favor of GCRG with multinucleated giant cells dispersed throughout hyper cellular and highly vascularized stroma, and newly formed bone and osteoid, with osteoblastic prominence (Figure 7).