Giant cell tumour of the flexor tendon sheath of the hand: analysis of 27 cases

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.

Ultrasonography of fibroma of the tendon sheath in the hand and wrist

BACKGROUND

The purpose of our study was to explore the sonographic characteristics of fibromas of the tendon sheath of the hand and wrist and to evaluate the value of high frequency ultrasound in the diagnosis of FTS.

METHODS

We retrospectively reviewed the sonography of 42 patients with surgically proven FTS, including one with a relapsing tumor (43 lesions in total). The location, size, distribution, relationship with the surrounding tissue, two-dimensional gray-scale sonographic appearance and internal color blood flow of all lesions were analysed.

RESULTS

The maximum diameter ranged from 0.4 to 2.8 cm, with an average of 1.5 ± 0.6 cm. Twenty-eight lesions (65%) were associated with an adjacent tendon, while the other 15 lesions (35%) were next to the joint. Spindle or oval lesions were common, followed by irregular shape. The nodules with clear boundaries were hypoechoic and had posterior echo enhancement. Thirty-seven lesions (86%) were homogeneous, while 6 lesions (14%) had cystic components with no echo inside. Seventeen lesions (40%) had a large amount of blood flow. Nine lesions (20%) had a small amount of blood flow. The other 17 lesions (40%) had no significant blood flow.

CONCLUSIONS

The diagnosis of fibroma of the tendon sheath can be considered when ultrasound examination reveals a focal nodular mass adjacent to a tendon sheath with homogeneous hypoechogenicity and no or small or large amounts of blood flow.

Giant cell tumours in fingers among the Inuit population in Greenland

Objective

Giant cell tumours (GCTs) of the tendon sheets in fingers are rare. We therefore find it of interest to report on 5 cases identified in the Inuit population in Greenland within 16 months prior to this study.

Material and methods

The Inuit account for 56,000 people of the total population in Greenland. From November 2010 to 16 months prior to this study, we diagnosed 5 cases (0.6% of all orthopaedic operations) with a GCT of the flexor tendon sheet of a finger. The patients were aged between 10 and 54 years, and 4 were women. All of them had noticed slow-growing tumours over 3 or more years and were referred for a suspected ganglion.

Results

In two cases, the tumour was located at the distal interphalangeal (DIP) joint in the thumb and in one case at the third finger. Two other patients had tumours at the metacarpophalangeal (MCP) joint of the third finger and the thumb, respectively; one of these two had a communicating tumour to the DIP joint. The last patient had two tumours on the same finger, one at the MCP joint and the other at the DIP joint. In one case, the tumour had also eroded the cortex of the first phalanx of the thumb, and the largest tumour measured 5 cm.

Conclusion

GCTs of the flexor tendon sheets in fingers are rare. It could be a coincidence that we have seen 5 cases within a short period of time. It is not possible to identify past cases through a register. A tumour in a finger is not the most common location for a ganglion, especially not at the DIP level. Therefore, a large tumour at this location is more likely to be a GCT.

Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes

INTRODUCTION

A giant cell Tumour of the tendon sheath (GCTTS) is a slow-growing benign Tumour originating from the synovial cells of the tendon sheath. It is the second most common Tumour of the hand. The aim of this study was to perform a retrospective clinicopathological evaluation of GCTTS cases and determine whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness.

MATERIALS AND METHODS

The age, gender, Tumour location and diameter, treatment mode, Ki-67 proliferation index, mitotic rate, and recurrence were retrospectively evaluated in 35 patients diagnosed with GCTTS in the Department of Pathology, School of Medicine, Recep Tayyip Erdogan University between 2009 and 2014.

RESULTS

Of the 35 GCTTS cases, 23 were female, and 12 were male. The mean age was 45 y (range 10-70). Sixteen tumours were located in the right hand and 14 in the left hand, and five were in the feet. The mean Tumour diameter was 2.3 cm (0.6-6 cm). All patients underwent marginal excision. The mean postoperative follow-up period was 4 y (range 28 months-5 y). Only six patients showed recurrence. In these cases, the site of GCTTS recurrence was the phalanx of the hand. The mean Ki-67 index in the recurrence cases was 6.5%, whereas it was 2.3% in those without recurrence.

CONCLUSION

The Ki-67 proliferation index and mitotic activity were increased in recurrent cases compared to nonrecurrent cases. Therefore, these parameters may be helpful in predicting recurrence of GCTTS. However, adequate surgical excision and complete removal of the Tumour are important steps to minimize the recurrence rate.

Imaging and surgical approach for a schwannoma of the hand

Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis is often difficult, and final diagnosis is usually based on histopathological findings. Imaging techniques, such as magnetic resonance imaging and ultrasonography, can be optimized to improve assessment prior to surgical treatment. The present case demonstrates that high-resolution sonography can be useful in assessing the underlying cause of median nerve pathology.