Giant Cell Tumor of Tendon Sheath: Case Series and Review of Literature

Abstract

Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10–53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.

Keywords

Hand - Tendon sheath - Giant cell tumor - Recurrence

• References

• 1 Al-Qattan M. Giant cell tumors of tendon sheath: classification and recurrence rate. J Hand Surg 2001; 26B: 72-75
• 2 Lowyck H, De Smet L. Recurrence rate of giant cell tumors of the tendon sheath. Eur J Plast Surg 2006; 28: 385-388
• 3 Reilly KE, Stern PJ, Dale JA. Recurrent giant cell tumors of the tendon sheath. J Hand Surg Am 1999; 24: 1298-1302
• 4 Kotwal PP, Gupta V, Malhotra R. Giant cell tumour of the tendon sheath- is radiotherapy indicated to prevent recurrence after surgery?. J Bone Joint Surg 2000; 82B: 571-573
• 5 Rao AS, Vigorita VJ. Pigmented villonodular synovitis (Giant-Cell tumor of the tendon sheath and synovial membrane): a review of 81 cases. J Bone Joint Surg 1984; 66A: 76-94
• 6 Gholve PA, Hosalkar HS, Kreiger PA et al Giant cell tumor of tendon sheath: largest single series in children. J Pediatr Orthop 2007; 27: 67-74
• 7 Ikeda K, Osamura N, Tomita K. Giant cell tumour in the tendon sheath of the hand: importance of the type of lesion. Scand J Plast Reconstr Surg Hand Surg 2007; 41: 138-142
• 8 Ozalp T, Yercan H, Kurt C et al Giant cell tumor of tendon sheath of the hand. Acta Orthop Traumatol Turc 2004; 38: 120-124
• 9 Iyer KV, Kusum K, Kusum V. Fine-needle aspiration cytology of giant cell tumor of the tendon sheath. Diagn Cytopathol 2003; 29: 105-110
• 10 Rodriques C, Desai S, Chinoy R. Giant cell tumor of the tendon sheath: a retrospective study of 28 cases. J Surg Oncol 1998; 68: 100-103
• 11 Middleton WD, Patel V, Teefey SA et al Giant cell tumors of the tendon sheath: an analysis of sonographic findings. Am J Roentgenol 2004; 183: 337-339
• 12 Messoudi A, Fnini S, Labsaili N et al Giant cell tumors of the tendon sheath of the hand: 32 cases. Chir Main 2007; 26: 165-169
• 13 Liu PT. Radiological reasoning: acutely painful swollen finger. Am J Roentgenol 2007; 188: A13-S17
• 14 Monaghan H, Salter DM, Al-Nafussi A. Giant cell tumour of tendon sheath (localized nodular tenosynovitis): clinicopathological features of 71 cases. J Clin Pathol 2001; 54: 404-407
• 15 Grover R, Grobbelaar AO, Richman PI et al Measurement of invasive potential provides an accurate prognostic marker for giant cell tumor of tendon sheath. J Hand Surg 1998; 23B: 728-731
• 16 Lorea P, Van De Walle H, Kinnen L. Giant cell tumours of tendon sheath: lack of correlation between NM 23-H1 expression and recurrence. J Hand Surg 2004; 29B: 67-70
• 17 Ng VY, Thomas K, Crist M et al Fine needle aspiration for clinical triage of extremity soft tissue masses. Clin Orthop Rel Res 2010; 468: 1120-1128