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Vj P, Muruganandam A, Perumal S, Ak S, Sivaraman A. A Successful Arthroscopic Management of a Benign but Locally Aggressive Tenosynovial Giant Cell Tumour in the Shoulder. Cureus 2024; 16:e57492. [PMID: 38707076 PMCID: PMC11066457 DOI: 10.7759/cureus.57492] [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: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the shoulder joint. This prospective study aims to document the challenges encountered in achieving total synovectomy and assesses the clinical outcomes of arthroscopic synovectomy for PVNS in shoulder patients. Methods This is a prospective study conducted from April 2017 to September 2023. This monoarticular disease was observed among six patients (four females and two males). All patients underwent arthroscopic extensile synovectomy with biopsy and culture. The outcomes were measured using Constant score, American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) scores. All patients were followed up for a minimum of 36 months after arthroscopic synovectomy. Results All intraoperative findings were consistent with PVNS and confirmed with histopathological examination. All patients achieved a satisfactory, painless range of movements following surgery. The individual Constant score improved from a mean value of 64.83 to 94.50, the ASES score improved from a mean value of 81.15 to 99.73, and the UCLA score improved from a mean value of 23.16 to 34.83 post-arthroscopic intervention, proving its effectiveness. No recurrences were reported after 36 months of follow-up. Conclusion PVNS can be easily missed, and one must have a high index of suspicion to diagnose early. Delayed presentation of the disease had led to severe destruction of the joint. Early diagnosis and arthroscopic intervention prior to joint destruction are crucial for achieving a good functional outcome. Incomplete excision may lead to recurrence of the disease. Therefore, we propose extensile arthroscopic synovectomy of the shoulder, wherein by expecting and addressing the intraoperative challenges, complete excision can be achieved, thus preventing recurrence.
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Affiliation(s)
- Parthiban Vj
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Anandanarayan Muruganandam
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Suresh Perumal
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sanjay Ak
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Arumugam Sivaraman
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Alzobi O, Aminake G, Mohammed A, Hantouly A, Marín T, Zikria B. Outcomes of arthroscopic elbow synovectomy and neurolysis of the ulnar nerve for tenosynovial giant cell tumor in a young athlete: a case report and literature review. JSES Int 2023; 7:2542-2546. [PMID: 37969494 PMCID: PMC10638581 DOI: 10.1016/j.jseint.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- Osama Alzobi
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayyoub Mohammed
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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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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4
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Ansel S, Yan X, Chong P, Lo S, McCleery M, Mahendra A, MacDuff E, Cowie F, Nixon I, White J. Tenosynovial giant cell tumor: a case report. J Med Case Rep 2023; 17:419. [PMID: 37798760 PMCID: PMC10557153 DOI: 10.1186/s13256-023-04156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND This case reports the synchronous diagnosis of two rare unrelated diseases; leiomyosarcoma and tenosynovial giant cell tumor of the knee. It focuses on the challenges of diagnosing tenosynovial giant cell tumor, including cognitive biases in clinical medicine that delay diagnosis. It also demonstrates the pathogenic etiology of tenosynovial giant cell tumor, evidenced by the transient deterioration of the patients' knee symptoms following the administration of prophylactic granulocyte colony-stimulating factor given as part of the chemotherapeutic regime for leiomyosarcoma. CASE PRESENTATION A 37-year-old Caucasian man presented with a left groin lump and left knee pain with swelling and locking. Investigations including positron emission tomography-computed tomography and biopsy revealed leiomyosarcoma in a lymph node likely related to the spermatic cord, with high-grade uptake in the left knee that was presumed to be the primary site. His knee symptoms temporarily worsened each time granulocyte colony-stimulating factor was administered with each cycle of chemotherapy for leiomyosarcoma to help combat myelosuppressive toxicity. Subsequent magnetic resonance imaging and biopsy of the knee confirmed a tenosynovial giant cell tumor. His knee symptoms relating to the tenosynovial giant cell tumor improved following the completion of his leiomyosarcoma treatment. CONCLUSIONS Tenosynovial giant cell tumor remains a diagnostic challenge. We discuss the key clinical features and investigations that aid prompt diagnosis. The National Comprehensive Cancer Network clinical practice guidelines for soft tissue sarcoma have recently been updated to include the pharmacological management of tenosynovial giant cell tumor. Our case discussion provides an up-to-date review of the evidence for optimal management of patients with tenosynovial giant cell tumor, with a particular focus on novel pharmacological options that exploit underlying pathogenesis.
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Affiliation(s)
- Sonam Ansel
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland.
| | - Xiangfei Yan
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Peter Chong
- Departments of General Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Steven Lo
- Departments of Plastic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Mark McCleery
- Departments of Radiology, Glasgow Royal Infirmary Glasgow Royal Infirmary, Glasgow, Scotland
| | - Ashish Mahendra
- Departments of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Elaine MacDuff
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Fiona Cowie
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Ioanna Nixon
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
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5
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Stacchiotti S, Dürr HR, Schaefer IM, Woertler K, Haas R, Trama A, Caraceni A, Bajpai J, Baldi GG, Bernthal N, Blay JY, Boye K, Broto JM, Chen WWT, Dei Tos PA, Desai J, Emhofer S, Eriksson M, Gronchi A, Gelderblom H, Hardes J, Hartmann W, Healey J, Italiano A, Jones RL, Kawai A, Leithner A, Loong H, Mascard E, Morosi C, Otten N, Palmerini E, Patel SR, Reichardt P, Rubin B, Rutkowski P, Sangalli C, Schuster K, Seddon BM, Shkodra M, Staals EL, Tap W, van de Rijn M, van Langevelde K, Vanhoenacker FMM, Wagner A, Wiltink L, Stern S, Van de Sande VM, Bauer S. Best clinical management of tenosynovial giant cell tumour (TGCT): A consensus paper from the community of experts. Cancer Treat Rev 2023; 112:102491. [PMID: 36502615 DOI: 10.1016/j.ctrv.2022.102491] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
Tenosynovial giant cell tumour (TGCT) is a rare, locally aggressive, mesenchymal tumor arising from the joints, bursa and tendon sheaths. TGCT comprises a nodular- and a diffuse-type, with the former exhibiting mostly indolent course and the latter a locally aggressive behavior. Although usually not life-threatening, TGCT may cause chronic pain and adversely impact function and quality of life (QoL). CSFR1 inhibitors are effective with benefit on symptoms and QoL but are not available in most countries. The degree of uncertainty in selecting the most appropriate therapy and the lack of guidelines on the clinical management of TGCT make the adoption of new treatments inconsistent across the world, with suboptimal outcomes for patients. A global consensus meeting was organized in June 2022, involving experts from several disciplines and patient representatives from SPAGN to define the best evidence-based practice for the optimal approach to TGCT and generate the recommendations presented herein.
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Affiliation(s)
- Silvia Stacchiotti
- Department of cancer medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Klaus Woertler
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Rick Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jyoti Bajpai
- Department of Medical Oncology, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Jean-Yves Blay
- Department of Medical Oncology, Université Centre Léon Bérard, Lyon, France
| | - Kjetil Boye
- Department of Medical Oncology, Oslo University Hospital, Oslo, Norway
| | - Javier-Martin Broto
- Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Wei-Wu Tom Chen
- Department of Medical Oncology, National Taiwan University Hospital and Cancer Center, Taiwan
| | | | - Jayesh Desai
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
| | | | - Mikael Eriksson
- Department of Medical Oncology, LUCC - Lund University Cancer Centre, Lund, Sweden
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jendrik Hardes
- Department of Orthopaedic Oncology, Uniklinik Essen, Essen, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, Uniklinik Münster, Münster, Germany
| | - John Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden, London, United Kingdom
| | - Akira Kawai
- Department of Muscoloskeletal Oncology, National Cancer Center Hospital (NCCH), Tokyo, Japan
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Austria
| | - Herbert Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Eric Mascard
- Department of Paediatric Orthopaedic Surgery, Clinique Arago, Paris, France
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Emanuela Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Peter Reichardt
- Department of Medical Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Brian Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute and Department of Cancer Biology, Cleveland Clinic, Cleveland, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Beatrice M Seddon
- Department of Oncology, University College Hospital London, London, United Kingdom
| | - Morena Shkodra
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Eric L Staals
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - William Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | | | | | - Andrew Wagner
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Lisette Wiltink
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sydney Stern
- Patient Representative, Life Raft Group, and Pharmacokinetics, University of Maryland Baltimore, USA
| | | | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, Uniklinik Essen, Essen, Germany
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Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Elbow. Case Rep Orthop 2022; 2022:7956167. [PMID: 36277026 PMCID: PMC9584726 DOI: 10.1155/2022/7956167] [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: 06/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of synovium that surrounds the joints, tendon sheaths, and bursae. The elbow is rarely affected, making it difficult to establish treatment guidelines. This article relates on a case of a male patient who presented with elbow pain and decreased range of motion. Diagnosis was established with magnetic resonance imaging (MRI) and biopsy, followed by arthroscopic removal and synovectomy. The patient was pain free shortly after surgery and gained free range of motion after six weeks. At the most recent follow-up after six months, he remained clinically well. The most recent MRI did not reveal any recurrence.
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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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8
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Cheok T, Wills K, Berman M, Jennings MP, Poonnoose PM. Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies. Arthrosc Sports Med Rehabil 2022; 4:e1873-e1886. [PMID: 36312712 PMCID: PMC9596911 DOI: 10.1016/j.asmr.2022.06.008] [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: 02/20/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To provide an up-to-date systematic review on the treatment options for pigmented villonodular synovitis (PVNS) of the hip and provide a grade of recommendation using standardized systems. Methods A systematic search of PubMed, Embase, Web of Science, and The Cochrane Library from the date of inception of each database through December 4, 2021, was performed. Studies that described the outcomes of treatment of hip PVNS were identified. These outcomes were discussed and synthesized by three reviewers, and a grade of recommendation was assigned. Results Twenty studies were identified. Seven studies described arthroscopic synovectomy, eight studies described open synovectomy, nine studies described arthroplasty, and one study described osmic acid synoviorthesis. Synovectomy, either open or arthroscopic, had similar rates of disease recurrence. Hip arthroplasty had low rates of disease recurrence compared to synovectomy; however, it was associated with significant risk of aseptic loosening in the longer term. Conclusion Synovectomy, either open or arthroscopic based on surgeon preference, is favored in the treatment of hip PVNS if there is no evidence of joint space narrowing. Arthroplasty should be considered in cases with joint space narrowing or recurrence following joint preservation therapy. There is insufficient evidence to support synoviorthesis either as monotherapy or adjuvant therapy. Level of Evidence IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Orthopaedic Surgery, MidCentral District Health Board Palmerston North Hospital, Roslyn, Palmerston North, New Zealand
- Address correspondence to Dr. Tim Cheok, B.Clin.Sc., M.D., M.S. (Trauma/Ortho), G.Dip.Biostat., G.Stat., MidCentral District Health Board Palmerston North Hospital, 50 Ruahine St., Roslyn, Palmerston North 4442, New Zealand.
| | - Kenneth Wills
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Morgan Berman
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Matthew Phillip Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Pradeep Mathew Poonnoose
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Sakamoto A, Noguchi T, Matsuda S. Tenosynovial giant cell tumor in the elbow of a child with the sole symptom of extension disturbance. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:291-294. [PMID: 37588952 PMCID: PMC10426596 DOI: 10.1016/j.xrrt.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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10
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Goyal N, Luchetti TJ, Blank AT, Cohen MS. Atraumatic, Progressive, and Painful Elbow Contracture From a Ganglion Cyst. J Hand Surg Am 2021; 46:345.e1-345.e3. [PMID: 32690340 DOI: 10.1016/j.jhsa.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/20/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
Ganglion cysts are benign soft tissue tumors that often occur adjacent to joints or tendons. We report a case of an elbow joint ganglion cyst in a patient who presented with a painful, progressive elbow contracture. The patient was successfully treated with resection of the subbrachialis ganglion cyst combined with an anterior capsular release and an ulnar nerve decompression to recover elbow motion. This case highlights the value of advanced imaging in patients presenting with an atraumatic, painful, and progressive elbow contracture.
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Affiliation(s)
- Nitin Goyal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
| | - Timothy J Luchetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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11
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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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