Tenosynovialer Riesenzelltumor

A Rare Case of Giant Cell Tumour of Tendon Sheath and Its Arthroscopic In Toto Excision

The aim of this study is to bring attention to a unique occurrence in an uncommon location and to describe our approach to treatment in this context. We describe a case of a 36-year-old male who presented with complaints of pain in his left knee for three months, with a restricted range of motion, without a prior history of trauma. A thorough knee examination was performed, which was unremarkable except for a restricted range of motion and tenderness along the medial joint line. A plain radiograph of the knee revealed no bony injury. MRI was done to assess the extension and it confirmed a soft tissue mass beneath the patella. The patient was taken up for surgery after a pre-anesthetic checkup and the mass was removed arthroscopically in toto using a higher accessory antero-medial portal. The mass was removed with the help of a spatula without damaging it and sent for histopathological analysis. Histopathology confirmed that it was a giant cell tumour of the tendon sheath. The procedure was uneventful, and the patient achieved a full range of motion post-operatively.

Demystifying Giant Cell Tumours of Tendon Sheath (GCTTS): A Case Series of 18 Cases with Review of Literature

Background

The giant cell tumour of the tendon sheath (GCTTS) is the second most frequent soft tissue tumour affecting the hand. No consensus exists on the etiology, prognostic factors, or recurrence rate of GCTTS. This article presents a series of 18 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of GCTTS.

Methods

A total of 18 patients with a histo-pathological diagnosis of a GCTTS of the hand or finger were reviewed. The location for the tumour was limited to the wrist and hand. All cases were operated under Wide Awake Local anaesthesia (WALANT), and using a magnifying loupe.

Results

A total of 18 patients presented at our institution with a diagnosis of GCTTS from 2016 to 2018. Of the 18 patients, 11 were female and 7 were male. The mean age of included patients was 43.6 years (31-59 years). The most common site for the lesion was the middle finger (4/18), followed by the index finger, wrist, and thumb (3/18 each). The little and ring finger were least commonly affected with one case each. The mean size of the tumour was 2.4 cm (0.5-5 cm). None of the patients reported recurrence of the lesion on an average follow-up of 18.8 months.

Conclusion

GCTTS is a benign, slowly growing lesion of the hand that typically does not cause any symptoms and is treated with surgical resection. Meticulous excision of the GCTTS using magnification loupes to ensure appropriate wide excision of the tumour is the treatment of choice to prevent a recurrence. In addition, a radiographic and histopathological examination must be performed on the tumour to rule out other diagnoses. Finally, the function of the hand should be reconstructed to minimize the loss of any functional unit.

PD-L1 Status in Tenosynovial Giant Cell Tumors

Background and Objectives: Tenosynovial giant cell tumors (TSGCTs) are benign soft tissue tumors that are divided into localized- and diffuse-type tumors, according to the World Health Organization classification of soft tissue tumours. The diffuse-type TSGCT sometimes behave aggressively and poses treatment challenges especially in patients with neurovascular involvement. Symptomatic patients who are not good candidates for surgery due to high morbidity risk may benefit from medical therapy. Objectives: Drugs that target programmed death ligand 1 (PD-L1) are among a new generation of medical therapy options, which, recently, have been explored and have displayed promising results in various cancer types; therefore, we aimed to investigate the PD-L1 status of TSGCTs as a possible therapeutic target. Materials and Methods: We assessed the PD-L1 status of 20 patients (15 men and 5 women, median age = 39 years) that had been diagnosed with TSGCTs in a single institution, between 2018 and 2020. The patients had localized- (n = 7) and diffuse-type (n = 13) TSGCTs. Formalin-fixed paraffin-embedded (FFPE) blocks were retrospectively retrieved from the pathology department. An immunohistochemical analysis was performed in sections of 3 micron thickness from these blocks. Results: Seventy-five percent of our patients with TSGCTs were immunopositive to PD-L1 staining. Conclusions: Taking into consideration the high positivity rate of PD-L1 staining in TSGCTs, PD-L1 blockage may be used as a valuable medical treatment for TSGCTs; however, further studies are needed.

A tenosynovial giant cell tumor arising from femoral attachment of the anterior cruciate ligament

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.

Tenosynovial giant cell tumors as accidental findings after episodes of distortion of the ankle: two case reports

INTRODUCTION

Tenosynovial giant cell tumors are benign tumors of uncertain pathogenesis. They occur in the joints, tendons and synovial bursas. Due to a high recurrence rate of up to 50%, some authors call a giant cell tumor a semimalignant tumor. To date, less than 10 cases of tenosynovial giant cell tumor of the ankle have been published in the international medical literature.

CASE PRESENTATION

In this case report, we present two patients with localized tumors that were detected accidentally after the occurrence of ankle sprains with persisting pain in the joint. The tumors were resected by open marginal surgery and regular follow-up examinations were carried out.

CONCLUSIONS

We present an unusual occurrence of a tumor along with a possible follow-up strategy, which has not been previously discussed in the international literature.

Postoperative management of pigmented villonodular synovitis in a single subject

STUDY DESIGN

Case report.

BACKGROUND

Pigmented villonodular synovitis (PVNS) is a rare, benign disorder characterized by idiopathic proliferation affecting the synovium of joints, tendon sheaths, and bursae. Diagnosing PVNS in the knee is difficult because the clinical presentation and symptoms mimic those of more common disorders at the joint, such as internal derangements or arthritis. Operative treatment of PVNS typically consists of arthroscopic or open synovectomy, but no reports of postoperative rehabilitation exist.

CASE DESCRIPTION

This case describes the postoperative rehabilitation of a 46-year-old female who had left knee surgery secondary to PVNS. Rehabilitation consisted of combined manual therapy, exercise, and gait training to improve function and gait, and cognitive-behavioral techniques to improve self-efficacy.

OUTCOMES

All impairments improved in 2.5 months of physical therapy to normal, and the patient estimated 80% to 90% return to function.

DISCUSSION

This patient obtained excellent outcomes in 2.5 months of physical therapy following surgery for PVNS. Although no firm conclusions can be drawn from a case report, this patient responded well to a biopsychosocial approach that combined physical therapy with cognitive-behavioral techniques.

LEVEL OF EVIDENCE

Therapy, level 4.

External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis

PURPOSE

Diffuse pigmented villonodular synovitis is a rare proliferative disorder of synovial membranes with invasive and expansive growth patterns. Radical synovectomy is regarded as the treatment of choice. However, because of the high recurrence rates, additive treatment might be useful. Radiotherapy (RT) has been evaluated with positive results, but the optimal treatment schedules are vague. We have reviewed our experience with postoperative RT in cases of suspected or proven residual disease.

METHODS AND MATERIALS

Between December 1996 and January 2006, 7 diffuse pigmented villonodular synovitis patients underwent RT at our institution. The most common location was the knee joint (5 patients). All patients underwent radical surgery and were treated subsequently with 6-MV photon RT. The total doses applied were 30-50 Gy, depending on the resection status and estimated risk of relapse. For analysis, we retrospectively reviewed all patients in April 2006.

RESULTS

The mean follow-up time was 29 months (range, 3-112 months). RT had no acute adverse effects. At the assessment, no evidence was found of recurrent or persisting disease in any patient. Of the 7 patients, 6 reported asymptomatic limb function and excellent quality of life; 1 patient had persistent restriction of joint movement after repeated surgery. No radiotherapeutic late effects were seen.

CONCLUSION

The results of our series have confirmed the efficacy and safety of postoperative RT for diffuse pigmented villonodular synovitis. Hence, this treatment should be considered for patients with suspected or proven residual disease.

Diffuse-type tenosynovial giant cell tumor in association with neurofibromatosis type 1-Noonan syndrome: possibly more than a chance relationship

A case of diffuse-type tenosynovial giant cell tumor arising in the left upper extremity is reported in a 23-year-old man with neurofibromatosis type 1 (NF1)-Noonan syndrome. The predominately mononuclear cellular proliferation with psammomatous calcifications had the immunohistochemical and ultrastructural features of a fibrohistiocytic neoplasm. This uncommon type of soft tissue neoplasm occurring in this unique clinical setting served to open an inquiry into the subject of non-neurogenic tumors in association with NF1 and Noonan syndrome, both manifested in our patient. Nonossifying fibroma of bone as a presumptive fibrohistiocytic tumor is an uncommon but well-documented manifestation in NF1, whereas in Noonan-like syndrome, both giant cell granuloma and pigmented villonodular synovitis are recognized as associated lesions with histologic and immunophenotypic similarities with the diffuse-type tenosynovial giant cell tumor.