Giant-cell tumour of the humerus
GC.4633
Humerus Posterior half of a vertical section of the left arm, showing a giant-cell tumour of the,
From a male aged 21 years who had just completed his apprenticeship as a joiner. Six months previously he had noticed stiffness and a certain amount of discomfort in the left arm. At first pain was restricted to movement during the day but later recurred at night and interfered with sleep. The increasing weakness necessitated his supporting his forearm by a sling and two months before admission to hospital the upper part of the arm became swollen. On examination a fusiform swelling some 100 mm in length was found in relation to the superior part of the humerus and projected distally beyond the pectoralis major. The swelling was tender to touch firm and seemed bony in parts with an irregular surface. It was not adherent to the skin and the artery could be felt medial to it. Radiograms showed an enlarging neoplasm which had partially destroyed the bone. During examination under a general anaesthetic the humerus fractured at the tumour, an incision was made and pulpy granulation-like tissue round the bone suggested a sarcoma and the arm was disarticulated at the shoulder. He made a rapid and satisfactory recovery. On histological examination the tumour was variously considered a sarcoma, a haemangiectatic sarcoma and a simple giant-cell tumour. Nineteen years later he was well and since his operation had not lost a day's work through illness.
A little way superior to the middle of the humerus the marrow cavity is the seat of a new growth which has destroyed the cancellous and compact bone and has bulged laterally and medially into the over: :lying soft parts from which, however, it remains well-defined. The superior part of the tumour is very haemorrhagic, the inferior part more fibrous and fleshy with a number of cyst-like spaces where the tumour had undergone degeneration. The deficiency of the humeral cortex on the medial side extends to some 50 mm but laterally where subperiosteal new bone overlies the tumour a recent fracture has occurred.
