Extensive Giant Cell Tumor Involving Entire Tibia with Talar Extension and Pulmonary Metastases: Successful Limb Preservation with Denosumab and Angioembolization.

INTRODUCTION: Giant cell tumor of bone (GCTB) is a benign but locally aggressive neoplasm with a recognized propensity for recurrence and occasional pulmonary metastasis. Diffuse involvement of an entire long bone is exceptionally rare. CASE REPORT: A 29-year-old female with four previous surgeries for recurrent distal tibial giant cell tumor presented with extensive involvement of the entire tibia, talar extension, and pulmonary metastases. Histopathology and H3.3G34W immunostaining confirmed the diagnosis. Limb salvage reconstruction was not feasible and amputation was declined. Selective angioembolization followed by denosumab 120 mg monthly for 6 months resulted in significant clinical improvement and disease stabilization. At 24 months, the patient remained independently ambulatory with stable local and pulmonary disease. CONCLUSION: Combined angioembolization and denosumab may provide durable disease control and limb preservation in selected patients with extensive unresectable GCTB.