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Kolisetty PV, Ali SS, Ahmad I, Sudhy IK, Prakash O, Kishore YR. Giant Cell Tumor of the Tendon Sheath of the Hand: Analysis of Factors Impacting Recurrence. Indian J Plast Surg 2024; 57:123-128. [PMID: 38774731 PMCID: PMC11105819 DOI: 10.1055/s-0044-1779657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Background Giant cell tumors of the tendon sheath (GCTTS) of the hand are considered the second most common benign tumors of the hand after ganglion cysts. Excision biopsy is considered the standard treatment at present. They are notorious for having a very high rate of recurrence as given in many studies. Many factors are said to be associated with recurrence of the tumors. The goal of this study is to evaluate the long-term results of a series of 48 patients operated on at a single institute and to find out if there is any correlation between the proposed risk factors with recurrence. Methods A retrospective analysis was done in cases of GCTTS operated on between 2015 and 2021. The patients were invited for follow-up for a minimum of 2 years, and the patient files were reviewed. Further data were collected at follow-up including recurrence, range of movement, sensation, skin necrosis, scarring, and digital neuropathy. A data analysis was done. The correlation between the proposed risk factors and recurrence was calculated with the Pearson correlation coefficient. A p -value of less than 0.05 was considered statistically significant. Results During the 6 years, 48 patients were operated on. Recurrence was observed in eight patients (16%) at an average of 38.7 months from the time of surgery. Of the risk factors, tumors with satellite nodules and tumor adjacency to joint correlated significantly with recurrence. No complications were observed during follow-up. Conclusion GCTTS of the hand has a high propensity to recur. The presence of satellite nodules and proximity to interphalangeal joints are two important risk factors for recurrence. Magnification during surgery ensures complete excision of the tumor and reduces the chance of recurrence.
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Affiliation(s)
- Pavan Venkateswar Kolisetty
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sheikh Sarfraz Ali
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Imran Ahmad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Indrajith K. Sudhy
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Om Prakash
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Y. Ranga Kishore
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Awosusi BL, Attia OM. Recurrent Localized Tenosynovial Giant Cell Tumor of the Left Ring Finger: A Case Report and Literature Review. Cureus 2024; 16:e55962. [PMID: 38601375 PMCID: PMC11006002 DOI: 10.7759/cureus.55962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Here, we report the case of recurrent swelling and pain in the proximal interphalangeal joint of the left ring finger, which was later diagnosed as a localized tenosynovial giant cell tumor in a young adult female. The first presentation was at the same anatomical site four years prior. Examination at presentation showed a firm skin-colored nodule in the volar aspect of the left ring finger. The swelling was seen to be partly attached to underlying structures and was non-tender. After a careful physical examination and plain radiograph imaging of the hand, the two differential diagnoses considered were tenosynovial giant cell tumor and ganglion cyst. A surgical excision was performed, and histopathologic evaluation showed features consistent with a tenosynovial giant cell tumor, localized type. The resection margins were clear of tumor. The patient had no intraoperative or postoperative complications. Postoperative physiotherapy was recommended. No recurrence was seen after postoperative surgical follow-up for one year. This report highlights the importance of histopathologic evaluation and confirmation of clear surgical margins in the management of tenosynovial giant cell tumors. In recurrent cases, surgical re-excision with clear margins provides good clinical outcomes. Before surgical excision, patients should be informed about the biologic nature of the lesion and the high risk of recurrence. The management modalities to prevent recurrence and the need for long-term follow-up should also be discussed with the patient.
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Affiliation(s)
| | - Omar M Attia
- Plastic Surgery, King Khalid Hospital, AlMajmaah, SAU
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3
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Ertem H, Selük S, Orman O, Öztürk K, Baydar M. The effect of surgical factors on recurrence of tendon sheath giant cell tumours. J Hand Surg Eur Vol 2024:17531934231222401. [PMID: 38191002 DOI: 10.1177/17531934231222401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
In this retrospective study, we evaluated the impact of tumour-related and surgical factors on the recurrence of giant cell tumours of tendon sheath. A total of 95 patients were treated at our institution between February 2012 and March 2021. We identified the factors most likely to be associated with recurrence from evaluation of classification, neurovascular invasion, bone erosion and joint invasion. Based on these criteria, we identified 49 patients with a high risk of recurrence. Of the 95 patients, recurrence was observed in 17. Among the 49 patients classified as high-risk, 13 were found to have recurrence. This study demonstrates that recurrence is more common in the high-risk patient group.Level of evidence: IV.
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Affiliation(s)
- Hakan Ertem
- University of Health Sciences Turkey, M.S. Baltalimani Bone Diseases Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkiye
| | - Sefa Selük
- Bulanik State Hospital, Orthopaedics and Traumatology Clinic, Mus, Turkiye
| | - Osman Orman
- University of Health Sciences Turkey, M.S. Baltalimani Bone Diseases Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkiye
| | - Kahraman Öztürk
- Acibadem Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkiye
| | - Mehmet Baydar
- University of Health Sciences Turkey, M.S. Baltalimani Bone Diseases Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkiye
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Li L, Yu M, Wang L, Zhang D. Intramuscular nodular fasciitis in the left lower extremity: A rare case report. Asian J Surg 2023; 46:5353-5354. [PMID: 37574358 DOI: 10.1016/j.asjsur.2023.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Lei Li
- Department of Neurosurgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Mengxing Yu
- Department of Pathology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Lan Wang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
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Khurana A, Singh JP, Preeti, Littlefield Z, Young S, Shah A. Demystifying Giant Cell Tumours of Tendon Sheath (GCTTS): A Case Series of 18 Cases with Review of Literature. Indian J Orthop 2023; 57:1858-1873. [PMID: 37881282 PMCID: PMC10593659 DOI: 10.1007/s43465-023-00990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/29/2023] [Indexed: 10/27/2023]
Abstract
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.
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Rohini, New Delhi, Delhi India
| | - J. P. Singh
- Department of Surgery, ESIC Hospital Rohini, New Delhi, Delhi India
| | - Preeti
- Department of Pathology, ESIC Hospital Rohini, New Delhi, Delhi India
| | | | - Sean Young
- Department of Orthopaedics, UAB School of Medicine, Alabama, USA
| | - Ashish Shah
- Department of Orthopaedics, UAB School of Medicine, Alabama, USA
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Kim JH, Lee SK, Kim JY. MRI Prediction Model for Tenosynovial Giant Cell Tumor with Risk of Diffuse-type. Acad Radiol 2023; 30:2616-2624. [PMID: 36754646 DOI: 10.1016/j.acra.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To propose a magnetic resonance imaging (MRI) prediction model for diffuse-type tenosynovial giant cell tumors (D-TSGCTs). MATERIALS AND METHODS Anatomic locations were classified and then nodularity, margin, peripheral and internal hypointensity, and bone and cartilage involvement were evaluated on MRI. Student's t-test, chi-square test, diagnostic performance, logistic regression analysis, and decision tree were performed. RESULTS Nineteen intra-articular (11 localized; eight diffuse) and 55 extra-articular (44 localized; 11 diffuse) TSGCTs were included. Extra-articular D-TSGCTs showed significantly more frequent multinodular (72.7% vs. 25.0%, p = 0.009), and infiltrative lesions (90.9% vs. 34.1%, p = 0.002), without peripheral hypointensity (90.9% vs. 18.2%, p < 0.001), and contained granular internal hypointensity (72.7% vs. 31.8%; p = 0.003) with more frequent bone (81.8% vs. 27.3%; p = 0.003) and cartilage (50.0% vs. 0.0%; p = 0.038) involvement than localized-type. Intra-articular D-TSGCT also showed significance in all MRI features (100.0% vs. 9.1%, p = 0.001; 100.0% vs. 27.3%, p = 0.007; 100.0% vs. 36.4%, p = 0.018; 100.0% vs. 27.3%, p = 0.007; 50.0% vs. 0.0%, p = 0.038), except bone involvement (37.5% vs. 9.1%, p = 0.352) than localized-type. Cartilage involvement revealed the highest specificity (88.6-100.0%), regardless of location. Nodularity (100.0%; odds-ratio [OR]: 70.000) and peripheral hypointensity (90.9%; OR: 62.250) demonstrated the highest sensitivities ORs for D-TSGCT in intra-articular and extra-articular cases, respectively. MRI models for D-TSGCG beginning with the cartilage involvement in both anatomic locations and next on nodularity and peripheral hypointensity in intra-articular and extra-articular locations, respectively, exhibited sensitivity and specificity of 100% and 90.9% for intra-articular and 100% and 77.2% for extra-articular TSGCTs, respectively. CONCLUSION MRI can suggest the risk of D-TSGCT by combining imaging features with anatomic locations.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea.
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea
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Qamar R, Ahmad F, Chowdhry M, Parikh M, Joshi K. Giant Cell Tumor of the Tendon Sheath of the Thumb: A Case Report. Cureus 2023; 15:e48162. [PMID: 38046705 PMCID: PMC10693257 DOI: 10.7759/cureus.48162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The giant cell tumor of the tendon sheath (GCTTS) is a benign nodular tumor that is found on the tendon sheath of hands and feet. It is the second most common tumor of the hand, next only to ganglion cysts. Several hypotheses were formulated about the etiological factors of these tumors, but still, there is not a common opinion on etiology, prognostic factors, and recurrence rate. We report a case of GCTTS in a young male where a lesion was identified in his left thumb. Although marginal excision is the treatment of choice, it is often difficult to perform due to the location and the strict adherence of the tumor to the tendon or neurovascular bundles. The primary issue with the treatment lies in its elevated recurrence rates. Apart from cases of incomplete excision, there is a lack of consensus regarding the impact of other risk factors on the likelihood of recurrence.
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Affiliation(s)
- Rayed Qamar
- Orthopaedic Surgery, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Faiz Ahmad
- Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, IND
| | - Madhav Chowdhry
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Mit Parikh
- Orthopaedic Surgery, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Kavya Joshi
- Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, IND
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8
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Meza-Martinez DA, Beyuma-Mora HE, Palomino-Payan JA, Fematt-Rodriguez BJ, Garcia-Hernandez I. Uncommon Presentation of a Giant Cell Tumor of the Tendon Sheath of the Hand: A Case Report. Cureus 2023; 15:e49310. [PMID: 38024079 PMCID: PMC10667080 DOI: 10.7759/cureus.49310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
A giant cell tumor of the tendon sheath (GCTTS) presents as a rare neoplasm demanding a heightened index of suspicion for precise diagnostic evaluation, especially when manifesting in the digital phalanges, as it is part of a group of neoplasms known as tenosynovial giant cell tumors (TCGTs). An accurate and timely diagnosis is crucial, as it significantly enhances treatment outcomes for this heterogeneous group of lesions. We describe the case of a male patient who presented with multiple nodules in the fourth finger of his left hand and was ultimately diagnosed with a localized form of a GCTTS, an unusual presentation for localized forms of this entity. Our objective is to outline the diagnostic and therapeutic approach, discussing options for differential diagnosis and treatment modalities. To achieve this, we conducted a literature review and compared our findings and the observed evolution in our patient. Early recognition of hand tumors allows for timely diagnosis, facilitating optimal resections during surgical procedures. This, in turn, reduces morbidity and enhances the functionality of the affected extremity, as detailed in the current case.
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Affiliation(s)
- Daniel A Meza-Martinez
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Hugo E Beyuma-Mora
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
| | - Julio A Palomino-Payan
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Brando J Fematt-Rodriguez
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Irean Garcia-Hernandez
- Pathology, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
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9
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Du X, Xia A, Sun J, Ye Y. Localized tenosynovial giant cell tumor in children. J Child Orthop 2023; 17:420-427. [PMID: 37799313 PMCID: PMC10549694 DOI: 10.1177/18632521231186795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 10/07/2023] Open
Abstract
Background To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children. Methods The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis. Results The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations. Conclusion Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate. Level of evidence Level III.
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Affiliation(s)
| | - Anning Xia
- Anning Xia, Department of Orthopedics, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China.
| | - Junying Sun
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yinting Ye
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
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Zyluk A, Owczarska A. Outcomes of Surgery for Benign Tumours in The Upper Extremity. HANDCHIR MIKROCHIR P 2023; 55:344-349. [PMID: 36893786 DOI: 10.1055/a-2008-0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Benign tumours of the upper extremity are common in hand surgeons' practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas. THE OBJECTIVE of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence. MATERIAL AND METHODS A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12-36) post-operatively. RESULTS The most common tumour in this study was giant cell tumour of the tendon sheath - 96 cases (27.7%), followed by lipoma - 44 cases (12.7%). Most lesions - 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath - 31.3%. The independent factors increasing risk of recurrence following the tumour's resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not "en block" resection of tumours. A brief review of the literature referring to the presented material is offered.
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Affiliation(s)
- Andrzej Zyluk
- Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Ada Owczarska
- Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
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Shergill KK, Pillai HJ, Singh S, Singh R. Giant Cell Tumor of Tendon Sheath: A Common Benign Entity With a Sore Note. Cureus 2023; 15:e43819. [PMID: 37736462 PMCID: PMC10509044 DOI: 10.7759/cureus.43819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Giant cell tumor of the tendon sheath (GCTTS) is a slow-growing benign lesion that is reported to be the second most common soft tissue tumor of the hand. Etiopathogenesis remains unexplained, and pre-operative diagnosis is lacking in the majority of cases. A high recurrence rate remains a challenge for the surgeons, with incomplete excision being the most consensually accepted reason. A standard operative protocol of using a magnifying loupe/operating microscope for surgery helps in meticulous dissection and thus reduces the incidence of recurrence in GCTTS. We present the case of a 30-year-old female with a slowly growing nodular lesion on her right index finger, reported as GCTTS post-operatively; however, there was no recurrence at 18 months follow-up because of the use of a magnifying loupe during surgery.
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Affiliation(s)
| | - Hari J Pillai
- General Surgery, Indian Naval Ship and Hospital Jeevanti, Vasco Da Gamma, IND
| | - Savijot Singh
- General Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND
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12
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Sonkusale A, Gandhi P, Maurya V, Giri V. Giant Cell Tumor of Flexor Pollicis Longus Tendon Sheath: An Uncommon Case Report and Literature Review. J Orthop Case Rep 2023; 13:32-35. [PMID: 37654743 PMCID: PMC10465755 DOI: 10.13107/jocr.2023.v13.i08.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Giant cell tumors of tendon sheath are benign, rarely malignant, soft-tissue tumors arising from tenosynovial sheath and periarticular soft tissue. They usually present as painless masses with some restriction of movement. Histopathological diagnosis is gold standard although pre-operative fine-needle aspiration cytology (FNAC), plain radiographs, and MRI help in narrowing down the differentials. Giant cell tumor of the tendon sheath (GCTTS) although benign is notorious for having a high rate of recurrences, with most important risk factors being adjacency to joint and incomplete excision. Adequate marginal excision forms the mainstay for managing these tumors. Adjuvant radiotherapy has found some role in treating and decreasing the chances of recurrences. Case Report A 55-year-old lady was brought to the outpatient department with a history of painless, gradually progressive swelling on volar aspect of thumb. Swelling was well defined with a smooth surface. Overlying skin showed no signs of local inflammation or adherence. Pain radiographs showed soft-tissue shadow with some articular bony erosions. A ultrasound-guided FNAC and MRI showed a picture of GCTTS. An excisional biopsy was done and confirmed the diagnosis. Conclusion GCTTS is a benign entity with a slow course of evolution, although uncommon, and should be kept as differential for swellings of hand and feet. Complete excision with no evidence residual tumor is diagnostic as well as curative. A regular follow-up is essential on account of high rates of recurrences.
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Affiliation(s)
- Aashay Sonkusale
- Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Pratik Gandhi
- Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Vivek Maurya
- Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Vishal Giri
- Department of Orthopaedics, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Brummund D, Chang A. Distal Dorsal Thumb Mass: Giant Cell Tumor of the Tendon Sheath in an Unusual Location. Cureus 2023; 15:e41532. [PMID: 37551250 PMCID: PMC10404461 DOI: 10.7759/cureus.41532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Giant cell tumor of the tendon sheath (GCTTS) is a common mass in the digits, hands, and upper extremities. Diagnosis is made on clinical examination, adjunctive imaging, and distinct intraoperative findings. Surgical excision is the mainstay of treatment. GCTTS are typically found on flexor surfaces with the dorsal distal thumb being an unusual location. Any surgical approach to the digit should balance oncologic margins with preserving function. GCTTS have a tendency to recur and should be approached in a methodical manner with risk factors of recurrence in mind. This case report reviews the history of GCTTS, surgical approaches to the digit, and risk factors for recurrence to achieve success in the surgical management of these tumors.
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Affiliation(s)
| | - Angela Chang
- Anesthesiology, Aventura Hospital and Medical Center, Miami, USA
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14
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Kim JH, Lee SK, Kim JY. Prediction of local recurrence in tenosynovial giant cell tumor of the knee: Based on preoperative MRI evaluation into disease subtypes and severity. PLoS One 2023; 18:e0287028. [PMID: 37315053 DOI: 10.1371/journal.pone.0287028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Tenosynovial giant cell tumors (TSGCTs) of the knee differ in their clinical outcome according to disease subtypes and severity. The aim of this study was to determine the predictive MRI features related to local recurrence in TSGCT of the knee regarding disease subtypes and severity. METHODS This retrospective study included 20 patients with pathology-proven TSGCT of the knee who underwent preoperative MRI and surgery from Jan. 2007 to Jan. 2022. The anatomical point of the lesion was determined with a knee mapping. And then MRI features related to disease subtype including nodularity (single vs. multinodular); margin (circumscribed vs. infiltrative); peripheral hypointenseity (present vs. absent); internal hypointensity reflecting hemosiderin deposition (speckled vs. granular) were assessed. Third, MRI features related to disease severity including involvement of bone, cartilage, and tendon were evaluated. MRI features for predicting local recurrence of TSGCT were tested using chi-square test and logistic regression analysis. RESULTS Ten patients with diffuse-type TSGCT (D-TSGCT) and 10 patients with localized-type TSGCT (L-TSGCT) were included. There were six cases of local recurrence and all of them were D-TSGCT and none for L-TSGCT with statistical difference (P = 0.015). D-TSGCT that was direct risk factor for local recurrence showed more multinodular (80.0% vs. 10.0%; P = 0.007), infiltrative margin (90.0% vs. 10.0%; P = 0.002), and absent peripheral hypointensity (100.0% vs. 20.0%; P = 0.001) than L-TSGCT. Multivariate analysis showed infiltrative margin (odds ratio [OR], 81.0; P = 0.003) was independent MRI factor for D-TSGCT. Disease severity for risk of local recurrence included cartilage (66.7% vs. 7.1%; P = 0.024) and tendon (100.0% vs. 28.6%; P = 0.015) involvement compared to no local recurrence. Multivariate analysis showed tendon involvement (OR, 12.5; P = 0.042) was predictive MRI parameter for local recurrence. By combining tumor margin and tendon involvement, local recurrence was predicted sensitively on preoperative MRI (sensitivity, 100%; specificity, 50%; accuracy, 65%). CONCLUSION D-TSGCTs was associated with local recurrence and showed multinodularity infiltrative margin, and absent peripheral hypointensity. Disease severity including cartilage and tendon involvement was associated with local recurrence. Preoperative MRI evaluation by combining disease subtypes and severity can predict local recurrence sensitively.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Tenosynovial giant cell tumors of digits: MRI differentiation between localized types and diffuse types with pathology correlation. Skeletal Radiol 2023; 52:593-603. [PMID: 36063189 DOI: 10.1007/s00256-022-04170-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the MRI findings between the localized- and diffuse-type tenosynovial giant cell tumors (TSGCTs) of digits with pathology correlation. METHODS Twenty-eight patients with newly diagnosed TSGCTs of digits (22 localized and 6 diffuse types) who underwent preoperative MRI and surgical excision were included from Jan. 2015 to September 2021. MRI findings regarding nodularity, margins, morphology of hypointensity with pathology correlation, and disease extent (bone erosion, articular involvement, muscle involvement, tendon destruction, and neurovascular encasement) were assessed. RESULTS Diffuse type was significantly larger (P = 0.006), more multinodular on both MRI and pathology (P = 0.038, both) with significant agreement, and infiltrative on both MRI and pathology (P < 0.001, both) with substantial agreement, and showed central granular on MRI and strong hemosiderin deposition on pathology (P = 0.022 and P = 0.021) with moderate agreement than localized type. Localized type showed significantly more frequent peripheral capsules on both MRI and pathology (P < 0.001, both) with moderate agreement than diffuse type. However, the septum on both MRI and pathology showed no statistically significant difference between the two groups (P = 0.529 and P = 0.372) without significant agreement. The disease extent was more severe in the diffuse type than the localized type regarding articular involvement (P < 0.001), muscle involvement (P < 0.001), and tendon destruction (P = 0.010). No statistically significant differences were found between the two groups regarding bone erosion (P = 0.196) or neurovascular bundle encasement (P = 0.165). CONCLUSIONS Diffuse-type TSGCTs of digits presented as locally aggressive lesions with larger, multinodular, infiltrative masses exhibiting stronger hemosiderin deposition and more severe disease extents of articular, muscle, and tendon involvement than the localized type.
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Jamaluddin J, Lee YS. An adult with a finger mass is it benign or malignant? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:153-155. [PMID: 36606175 PMCID: PMC9809447 DOI: 10.51866/tyk.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
We described the case of a 42-year-old man who presented with left index finger mass persisting for 6 months. The mass was small and, painless and had gradually increased in size with limited finger flexion. Physical examination showed a firm mass over the volar surface of the left index finger. There was no tenderness, redness, warmth or punctum. The overlying skin was normal, and the mass did not transilluminate. Further examination of the head and neck, chest, upper limbs and neurovascular system revealed normal findings. No similar masses were found elsewhere in the body. Bedside ultrasound with further investigation and management confirmed the suspected diagnosis.
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Affiliation(s)
- Jazlan Jamaluddin
- MD (Moscow), MMed (Family Medicine) (UiTM), Klinik Kesihatan Sauk, Jalan Besar, Lenggong, Sauk, Kuala Kangsar, Perak, Malaysia.
| | - Yeow Siong Lee
- MBBS (IMU), MMed (Family Medicine) (UM), Klinik Kesihatan Selayang Baru, Jalan Sungai Tua, Batu Caves, Selangor Darul Ehsan, Malaysia
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17
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Jadhav S, Awasthi A, Deshpande S, Jadawala V, Salwan A. Giant Cell Tumor of Extensor Tendon Sheath in Ring Finger: A Case Report. Cureus 2022; 14:e29605. [PMID: 36312635 PMCID: PMC9595353 DOI: 10.7759/cureus.29605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
Giant cell tumour of the tendon sheath (GCTTS) is a rare benign soft tissue tumour with no known cause. It is more prevalent in the hand than in the ankle and foot. It appears as a non-painful, perceptible enlargement. Although pre-operative imaging and fine-needle aspiration cytology (FNAC) corroborate suspicion, histology following surgical resection is used to confirm the diagnosis. Due to its rarity, a case of giant cell tumour (GCT) of the extensor tendon sheath of the left ring finger is reported here. A 39-year-old female presented with a six-month history of painless swelling over left ring finger. The swelling was spontaneous, slowly progressive and painless. On clinical examination, a 1.5 cm x 1 cm firm swelling was seen on the dorsal surface of the left ring finger extending from the distal portion of the middle phalanx to the proximal half of the distal phalanx. The swelling was well-defined, smooth, firm, and uniform in consistency. The swelling was movable sideways with no attachment to the bone when examined clinically. X-ray of the hand showed soft tissue mass without the involvement of the bone. Soft tissue mass was seen on ultrasonography. An excisional biopsy was done. Histopathology showed typical features of GCTTS. Our case is a rare example of GCTTS in a single digit of the hand. Furthermore, considering its high recurrence risk, the tumour should be totally excised. Finally, if required, the hand's function should be recreated to minimise the loss.
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Jerome JTJ, Sofia LR, Santhi N. Recurrent Tenosynovial Giant Cell Tumor (TGCT) in Thumb Treated by Excision and Adjuvant 3DCRT Radiation. Indian J Orthop 2022; 56:1469-1473. [PMID: 35928652 PMCID: PMC9283620 DOI: 10.1007/s43465-022-00665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED Tenosynovial giant cell tumors (TGCT) are benign intra-articular and soft-tissue tumors. However, they are known for recurrence in incomplete excisions and tumors adjacent to the distal joints and neurovascular structures in hand. With poor knowledge of intrinsic biology behind these clonal neoplastic tumors, wide excision and three-dimensional conformal adjuvant radiotherapy to the tumor bed significantly prevent a recurrence. We report a recurrent TGCT of the thumb around the interphalangeal joint in a 54-year-old man treated with wide excision and adjuvant three-dimensional conformal radiation therapy (3DCRT). There was no recurrence, and the patient had excellent functional outcomes at 3 years of follow-up. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00665-w.
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Affiliation(s)
- J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu 620017 India
| | - Loganathan Rajesh Sofia
- grid.430017.10000 0004 1766 6693Regional Cancer Center, Thanjavur, India ,Consultant GVN Hospital, Trichy, India
| | - Natesan Santhi
- Department of Biochemistry, Government Pudukkottai Medical College, Pudukkottai, India
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The relationship of preoperative hematologic parameters to invasion of anatomic structures and recurrence in tenosynovial giant-cell tumor of the digits. HAND SURGERY & REHABILITATION 2022; 41:513-517. [DOI: 10.1016/j.hansur.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/26/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
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20
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Wang W, Long MM, Wei CJ, Cui XW, Ren JY, Gu YH, Li QF, Dai SD, Gu B, Wang ZC. Clinical comparison of tenosynovial giant cell tumors, synovial chondromatosis, and synovial sarcoma: analysis and report of 53 cases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1059. [PMID: 34422971 PMCID: PMC8339857 DOI: 10.21037/atm-21-542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/18/2021] [Indexed: 12/12/2022]
Abstract
Background Tenosynovial giant cell tumors (TGCTs), synovial chondromatosis (SC), and synovial sarcoma (SS) exhibit similarities in clinical features and histochemical characteristics, and differential diagnosis remains challenging in clinical practice. Methods Data were collected from the pathology database of Shanghai Ninth People's Hospital regarding patients who underwent surgery from 2010 to 2019 with histologically confirmed TGCTs, SC, and SS. Demographic and clinicopathological data of these patients were reviewed. Immunohistochemistry staining of 14 different markers was performed. Correlation analyses of the prognoses were evaluated. Results A total of 26 patients with TGCTs (8 diffuse TGCTs and 18 localized TGCTs), 16 with SC, and 11 with SS were identified. Pain was the main symptom of patients with both TGCTs and SC, while a palpable mass was the most common symptom for patients with SS. In addition to clinical features, we identified vital risk factors for disease recurrence. The mean follow-up periods were 51, 39, and 14 months for TGCTs, SC, and SS, respectively. Younger patients with diffuse TGCTs or patients with a higher neutrophil/lymphocyte ratio (NLR) displayed a significantly higher frequency of recurrence. We also plotted receiver operating characteristic (ROC) curve analysis for age and NLR. The area under the ROC curve (AUC) was calculated and demonstrated the ability to distinguish recurrent from nonrecurrent cases. In addition, higher CD163 expression was linked to recurrent diffuse TGCT cases. Conclusions These data indicated possible characteristics of different aspects of TGCTs, SC, and SS. Further clarification and understanding of these factors will help with differential clinical diagnosis and recurrent risk assessment.
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Affiliation(s)
- Wei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Man-Mei Long
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng-Jiang Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi-Wei Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie-Yi Ren
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Hui Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shun-Dong Dai
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Chao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gallagher M, Cooper L, Ibanez Mata J. Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape. BMJ Case Rep 2021; 14:14/1/e238418. [PMID: 33431463 PMCID: PMC7802716 DOI: 10.1136/bcr-2020-238418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Calcifying aponeurotic fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. A 15-year-old student presented to his general practitioner with a 1-year history of a progressively enlarging painless finger swelling. The lesion was excised by the local paediatric orthopaedic service and recurred over the course of the following 4 months. Histology confirmed a diagnosis of CAF. He was referred to our specialist hand surgery service and the lesion was excised along with the ulnar lateral band and the overlying skin. At 9 months, there was no clinical evidence of recurrence. We are the first group to report the potential benefit of including of the overlying skin in the histological specimen to reduce the residual disease burden. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand and highlights the importance of centralised specialist care.
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Affiliation(s)
- Michael Gallagher
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Plastic Surgery, St Thomas' Hospital, London, UK
| | - Lilli Cooper
- Department of Plastic Surgery, St Thomas' Hospital, London, UK
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22
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Surface mould brachytherapy planning in giant cell tumour of the tendon sheath of finger and dosimetric comparison with external beam radiotherapy: a case report. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Giant cell tumour of the tendon sheath (GCTTS) is the second most common tumour of the hand. Despite surgery, local recurrence after excision has been reported in up to 45% of cases. Post-operative radiotherapy (PORT) has been found to be promising in preventing these recurrences in high-risk group. One of the reservations of PORT is secondary effects of radiation which may cause a decreased range of motion of the affected joint, sensory changes and nail changes. Surface mould brachytherapy can provide a high dose to target volume with a rapid fall of dose to surrounding structures. Despite this, it is less used, the possible reason can be less technical proficiency.Methods:We have technically illustrated surface mould brachytherapy in a case of GCTTS of the left index finger, and compared dosimetrically with more widely used conventional photon and electron external beam radiotherapy.Conclusion:The 6-MV photon treatment plan with a bolus plan provided the least dose to skin (106%) and phalanges (103%). It has a Homogeneity index (1·06) closest to 1, whereas the Conformity index of all plans was similar. The dose coverage was adequate in all plans. The second-best plan dosimetrically was the surface mould brachytherapy.
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23
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Saaiq M. Giant Cell Tumor of Tendon Sheath in the Hand and Wrist. J Hand Microsurg 2020. [DOI: 10.1055/s-0040-1718971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Muhammad Saaiq
- Department of Plastic Surgery, National Institute of Rehabilitation Medicine, Islamabad, Pakistan
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Lv Z, Liu J. Giant cell tumor of tendon sheath at the hand: A case report and literature review. Ann Med Surg (Lond) 2020; 58:143-146. [PMID: 32983435 PMCID: PMC7498736 DOI: 10.1016/j.amsu.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction GCTTS is the second most popular soft tissue tumor at the hand next to ganglion cyst, and also named tenosynovial giant cell tumor or pigmented villonodular tenosynovitis. It is divided into localized form and diffuse form. We introduce a report of a rare case of GCTTS in a female where lesions were identiied within the left ring finger and also conducted a literature review. Presentation of case We describe a 32-year-old female patient with GCTTS a single digit since six months. Radiographic and histopathological examination is necessary to help determine whether to take further treatment. Surgical excision was performed, including complete removal of the tumor and reconstruction of the pulley with autologous tendon. Histopathology suggested that these masses were consistent with GCTTS without malignancy. There was no clinical and radiologic evidence of recurrence six months after surgery. Discussion GCTTS is a benign fibrous tissue tumor originating from the tenosynosheath, bursae and joint synovium. This tumor is more common in adults aged 30–50, and is slanted toward females. The major risk of GCTTS is recurrence and joint damage, which requires surgical resection. The integrity of the pulley plays an important role in the function of the hand. In this case, the ipsilateral metacarpal tendon was taken during the operation to reconstruct the pulley to reduce the possibility of loss of hand function. Conclusion This case represents a rare case of GCTTS at the hand within a single digit. Due to its high recurrence rate, the tumor should be completely removed to reduce the possibility of recurrence. Radiographic and histopathological examination must be performed on the tumor, which is determined to be benign and does not require further treatment. The function of the hand should be reconstructed to minimize the loss if necessary. We describe a 32-year-old female patient with GCTTS a single digit since six months. Preoperative examinations including clinical examination and imaging examination were improved. The scope and size of the tumor were fully evaluated to determine the surgical method. We completely excised the masses and the involved tendon sheath. The part of the ipsilateral palmaris longus tendon was used to reconstruct the A2 pulley. Postoperative pathology was performed to determine the nature of the tumor. The tumor should be completely removed to reduce the possibility of recurrence.
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Affiliation(s)
- Zhengming Lv
- Department of Orthopaedics, Taizhou People's Hospital, 366 TaiHu Road, Taizhou, 225300, Jiangsu, China
| | - Jie Liu
- Department of Orthopaedics, Taizhou People's Hospital, 366 TaiHu Road, Taizhou, 225300, Jiangsu, China
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Jin Q, Zhou H, Lu H. Infiltration of synovitis into the flexor tendon: a case report. J Int Med Res 2020; 48:300060520936180. [PMID: 32779512 PMCID: PMC7425283 DOI: 10.1177/0300060520936180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Synovitis is a type of aseptic inflammation that occurs within joints or surrounding tendons. No previous reports have described a hypertrophic synovium eroding the tendon sheath and manifesting as synovitis within the flexor tendon. We herein report a case involving a 10-year-old girl who presented to our hospital with a 1-month history of a swollen mass and progressive inability to completely flex her left index finger. The active flexion angle of the proximal interphalangeal joint was limited to 85°. A longitudinal incision of the flexor digitorum profundus tendon was surgically performed. The synovium inside and outside the flexor digitorum profundus tendon was completely removed. After the surgical excision, normal tendon gliding returned without recurrence by the 1-year follow-up. The active flexion angle of the proximal interphalangeal joint improved to 100°. To the best of our knowledge, this is the first case of synovitis affecting the flexor tendon and leading to limited flexion of a finger. The manifestation of a double ring sign on magnetic resonance imaging is quite characteristic. Early diagnosis and monitoring of the hyperproliferation and invasiveness of the synovial tissue are required. Surgical excision can be a simple and effective tool when necessary.
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Affiliation(s)
- Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
| | - Haiying Zhou
- College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
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Tumorous conditions of the pediatric hand and wrist: Ten-year experience of a single center. Jt Dis Relat Surg 2020; 31:341-345. [PMID: 32584735 PMCID: PMC7489175 DOI: 10.5606/ehc.2020.74972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to evaluate the distribution and prevalence of pediatric hand tumors and tumor-like lesions according to age and gender. Patients and methods
We retrospectively examined the details of hospital records of 646 patients who were operated for hand mass between January 2009 and January 2019 and whose pathological diagnosis was established in the same hospital. A total of 54 patients (18 males, 36 females; mean age 12.07 years; range, 3 month to 17 years) under 18 years of age who had been operated for the wrist or hand mass were included in the study. Results
Out of 54 tumors, 53 were benign (98%) and one was malignant (2%). There were 42 soft tissue tumors (78%) and 12 bone tumors (22%). The most common soft tissue mass was ganglion cyst (n=12). Six out of 12 ganglion cysts were on the dorsal side of hand or wrist and six were on the volar side. The distribution of the tumors according to gender was not statistically significant (p=0.73). We had two recurrences: one patient with giant cell tumor of the tendon sheath and one with palmar fibromatosis. Conclusion Pediatric hand/wrist masses are mostly benign tumorous conditions. The location of the pathologies may be different from the adults. Diagnosis of the tumor should be established carefully clinically and radiologically while malignant tumors should be kept in mind by both pediatricians and orthopedic surgeons.
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Abstract
This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.
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Affiliation(s)
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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