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Giant cell tumor of tendon sheath

Tumor biology and incidence

  • Second most common soft tissue mass of the hand, behind ganglions
  • Two forms: a localized, nodular type and a diffuse type that resembles pigmented villonodular synovitis (PVNS)
    • Localized, nodular form more common (and focus of this article); found in hand and foot
    • Diffuse form rare; usually found in larger, weight-bearing joints (knee, ankle)
  • Etiology unknown

Age

Can occur at any age, but most commonly diagnosed between ages 30 and 50

Gender

M:F = 2:3

Physical findings

  • Digit lesions present as slow-growing, non-tender, multilobulated masses
  • Most commonly adjacent to interphalangeal joints, although other sites may be affected
  • Growth classically seen on volar side of digit
  • On gross inspection, tumors have shallow grooves along deep surfaces created by underlying tendons
  • Lesions most often 0.5 to 4 cm

Plain films

Coritical erosion of bone occurs in approximately 10% of patients

Pathology

  • Sectioned tumor has mottled appearance, depending on amount of lipid and hemosiderin content
  • Under the microscope, multinucleated giant cells, mononuclear cells, xanthoma cells, and collagenation are present

Treatment

Lesions rarely malignant, but have ability to recur following local excision, in which case additional surgery may be warranted

Recommended reading

Enzinger FM, Weiss SH. Benign tumors and tumorlike lesions of synovial tissue. In: Enzinger FM, Weiss SW, eds. Soft Tissue Tumors. St Louis,Mo: Mosby;1995:735-55.

Reilly KE, Stern PJ, Dale JA. Recurrent giant cell tumors of the tendon sheath. J Hand Surg [Am]. Nov 1999;24(6):1298-302.

Ciattaglia G, Filosa G, Bugatti L. Giant cell tumor of tendon sheath. J Am Acad Dermatol. Oct 1991;25(4):728-9.

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