Diffuse-type giant cell tumor of the subcutaneous thigh

Localized pigmented villo-nodular synovitis of trochanteric bursa

This is the first report on a localized pigmented villo-nodular synovitis (PVNS or TSGCT) occurring in the trochanteric bursa. Bursal involvement in PVNS is extremely rare. Most often PVNS occurs either as a localized or diffuse lesion in a major synovial joint, such as the knee, ankle joint or hip joint. In principle, all synovial structures can be involved. The case reported here is remarkable regarding the long period between the occurrence of the first symptoms and the final diagnosis as well as the age of the female patient (75 yrs). Therapeutically a complete resection was performed in order to avoid recurrence. More then three years later the patient did well and there has been no evidence of recurrence yet.

Malignant Diffuse-Type Tenosynovial Giant Cell Tumor in the Subcutaneous Tissue of the Midthigh: A Report of a Rare Tumor in an Unusual Location

Malignant TS-GCT is an extremely rare and aggressive tumor with only few cases published in the literature, due to the small number of cases is not completely understood and is diagnostically challenging. Although surgical treatment is the primary treatment modality, there is no consensus regarding adjuvant treatment. Regardless of mode of treatment, the tumor still caries unfavorable prognosis. In this paper, we reviewed the literature for cases of malignant TS-GCT. We also would like to present an additional case of malignant TS-GCT that was found in an unusual location in subcutaneous tissue of the midthigh.

Intramuscular Tenosynovial Giant Cell Tumor Harboring a Novel CSF1-CD96 Fusion Transcript

Tenosynovial giant cell tumors typically arise in the synovium of joints, bursae, or tendon sheaths. They may occur in an intra- or extra-articular location and can be divided into localized and diffuse types. The neoplastic nature of the lesion has been supported by a recurrent CSF1 gene rearrangement in a small subset of lesional cells, of which the most common fusion partner is COL6A3. Herein, we report a case of intramuscular localized tenosynovial giant cell tumor harboring a novel CSF1-CD96 fusion transcript, thus expanding the molecular profile of this tumor.

Limited usefulness of classic MR findings in the diagnosis of tenosynovial giant cell tumor

OBJECTIVE

To determine the frequency with which MRI of tenosynovial giant cell tumor demonstrates hemosiderin, visible intralesional fat signal, and proximity to synovial tissue.

MATERIAL AND METHODS

This is a retrospective study of 31 cases of tenosynovial giant cell tumors which had concomitant MRI. Images were examined for lesion size, morphology, origin, bone erosions, MRI signal characteristics, contrast enhancement, and blooming artifact, comparing prospective and retrospective reports. Histology was reviewed for the presence of hemosiderin and xanthoma cells.

RESULTS

Eight lesions were diffuse and 23 were localized nodules. Three lesions were located in subcutaneous tissue and 4 adjacent to tendons beyond the extent of their tendon sheath. All lesions exhibited areas of low T1- and T2-weighted signal. Blooming artifact on gradient echo imaging was present in 86% of diffuse and only 27% of nodular disease. There was interobserver variability of 40% in assessing blooming. Iron was visible on H&E or iron stain in 97% of cases. Fat signal intensity was seen in only 3% of cases, although xanthoma cells were present on in 48%. The correct diagnosis was included in the prospective radiology differential diagnosis in 86% of diffuse cases and 62% of nodular cases.

CONCLUSION

Blooming on GRE MRI has low sensitivity for nodular tenosynovial giant cell tumors and is not universal in diffuse tumors. There was high interobserver variability in assessment of blooming. Intralesional fat signal is not a useful sign and may occur adjacent to tendons which lack a tendon sheath and may occur in a subcutaneous location.

Giant cell tumor of soft tissues: A case report of extra-articular diffuse-type giant cell tumor of the quadriceps

INTRODUCTION

Giant cell tumors of soft tissue (GCTs) are a relatively rare entity. It is a distinct but uncommon group of neoplasms morphologically identical to osseous giant cell tumor. The diffuse type of extra-articular GCT arising within muscle is a rare benign soft tissue tumor with a wide spectrum of clinical presentation.

PRESENTATION OF CASE

This article reports a rare case of a 44-year-old woman with a mass arising from her right thigh. MRI showed only a few areas of low T2 signal in a mass that was hyper intense to muscle. Histopathology of this lesion located within the right quadriceps muscle revealed admixture of multinucleated giant cell with mononuclear cells. This patient was treated by surgical resection and followed up for recurrence.

DISCUSSION

Diffuse-type GCTs are commonly located in the periarticular soft tissues, but on rare occasions these lesions can be purely intramuscular or subcutaneous and can be challenging to diagnose. Characteristic findings include gradient echo secondary to hemosiderin deposition, and the low signal on T2.

CONCLUSION

Because extra-articular diffuse-type GCTs are rare, the differential diagnosis is challenging. The clinical outcomes of diffuse-type GCTs are unclear because of their rarity. Benign clinical course is expected if the lesion is excised adequately.

Intramuscular diffuse-type tenosynovial giant cell tumor of the deltoid muscle in a child

Tenosynovial giant cell tumors (GCTs) typically form in the joints or extra-articular soft tissues such as the tendon sheath, and are benign tumors that commonly occur in the hands or wrists in the third to fifth decades of life. However, the diffuse type of extra-articular GCT arising within muscle is a rare soft tissue tumor, especially in a pediatric patient. In this report, we describe the magnetic resonance imaging and sonographic findings of a rare case of intramuscular diffuse-type GCT in the deltoid muscle of a 9-year-old boy.

Bilateral cadaveric Achilles tendon graft in reconstruction after Achilles tendon tumor resection

The standard approach to reconstruction after resection of a diffuse-type tenosynovial giant cell tumor is a local patch with free flaps. However, in cases in which the Achilles tendon involvement is extensive, and the entire tendon must be removed, an autologous flap graft might not be adequate to allow a return to function. We report a case of a 52-year-old female patient who developed bilateral tumors of the Achilles tendon, with a 10-year duration. By the time, she sought medical help, both Achilles tendons required removal. We chose to use Achilles tendon allografts to replace the Achilles tendons. Postoperatively, the patient did well. The allograft shortened the recovery time, and the patient regained full ankle range of motion.

Musculoskeletal CPD revision: cases from the New Zealand bone and soft tissue tumour registry

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.

Giant cell tumor of the tendon sheath: A rare case in the left knee of a 15-year-old boy

Localized forms of giant cell tumors are defined as giant cell tumors of the tendon sheath (GCTTS). GCTTS arises from the synovium of a joint, bursa or tendon sheath, and 85% of the tumors occur in the fingers. GCTTS in the knee is extremely rare. We report an unusual case of a 15-year-old boy who presented with an occult growing swelling and a 2-month history of infra-patellar pain in the left knee. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed soft tissue mass in the infra-patellar fat pad posterior to the patella tendon. Excision biopsy was performed by surgical removal. Histopathological examination revealed that it was GCTTS. During the follow-up period, his recovery was propitious and there was no recurrence. Owing to its few and non-specific symptoms, and local recurrence varying from 9 to 44%, its proper, early diagnosis and appropriate treatment is necessary. The purpose for which we report the case is to emphasize the possibility of GCTTS where there is a mass with non-specific symptoms such as infra-patellar pain of the knee, and to avoid misdiagnosis where possible.

Pigmented villonodular synovitis: radiologic-pathologic correlation

Pigmented villonodular synovitis (PVNS) represents an uncommon benign neoplastic process that may involve the synovium of the joint diffusely or focally (PVNS) or that may occur extraarticularly in a bursa (pigmented villonodular bursitis [PVNB]) or tendon sheath (pigmented villonodular tenosynovitis [PVNTS]). Pathologic specimens of the hypertrophic synovium may appear villous, nodular, or villonodular, and hemosiderin deposition, often prominent, is seen in most cases. The knee, followed by the hip, is the most common location for PVNS or PVNB, whereas PVNTS occurs most often in the hand and foot. PVNTS is also referred to as giant cell tumor of the tendon sheath (GCTTS). PVNTS is the most common form of this disease by a ratio of approximately 3:1. Radiographs reveal nonspecific features of a joint effusion in PVNS, a focal soft-tissue mass in PVNB or PVNTS, or a normal appearance. Extrinsic erosion of bone (on both sides of the joint) may also be seen and is most frequent with intraarticular involvement of the hip (>90% of cases). Cross-sectional imaging reveals diffuse involvement of the synovium (PVNS), an intimate relationship to the tendon (PVTNS), or a typical bursal location (PVNB), findings that suggest the diagnosis. However, the magnetic resonance (MR) imaging findings of prominent low signal intensity (seen with T2-weighting) and "blooming" artifact from the hemosiderin (seen with gradient-echo sequences) are nearly pathognomonic of this diagnosis. In addition, MR imaging is optimal for evaluating lesion extent. This information is crucial to guide treatment and to achieve complete surgical resection. Recurrence is more common with diffuse intraarticular disease and is difficult to distinguish, both pathologically and radiologically, from the rare complication of malignant PVNS. Recognizing the appearances of the various types of PVNS, which reflect their pathologic characteristics, improves radiologic assessment and is important for optimal patient management.

Infiltration of the pes anserinus complex by an extraarticular diffuse-type giant cell tumor (D-TGCT)

This report describes the case of a 26-year-old woman with a recurrent extraarticular diffuse-type tenosynovial giant cell tumor (D-TGCT) of the medial region of the knee affecting the pes anserinus and hamstring tendons. Presurgical MRI did not exclude infiltrative properties of the tumor. In the histological evaluation, the tumor showed an aggressive dispersion by infiltrating the collagenous tissue of the hamstring tendons. The treatment included a resection of the pes anserinus complex with distal semitendinosus and gracilis tendons. Regarding extraarticular D-TGCT a review of the literature showed a predominant affection of the medial region of the knee and thigh.