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Mei H, Tian C, Lin H, Lu X, Ni Y. Surgical Techniques and Functional Reconstruction for Complex Tenosynovial Giant Cell Tumor of Temporal Bone and Middle Skull Base. EAR, NOSE & THROAT JOURNAL 2023:1455613231186894. [PMID: 37458098 DOI: 10.1177/01455613231186894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objectives: Temporal tenosynovial giant cell tumors (TGCTs) are often large and have invaded the middle skull base. It is difficult to protect the important neurovascular structures around the tumor and perform functional reconstruction on the basis of complete tumor resection. This study aimed at analyzing the surgical techniques and functional reconstruction during the operation of complex TGCT of temporal bone and middle skull base. Methods: Five patients with pathologically confirmed TGCT of different complex types in the temporal bone and middle skull base were treated in our hospital from December 2020 to February 2023. We collected and retrospectively analyzed their medical records, including medical imaging, surgical procedures, and follow-up data. Results: The tumors invaded beyond the temporal bone and destroyed the middle skull base in all cases, involving the intracranial space and other important neurovascular structures. The internal carotid artery, infratemporal fossa, pterygopalatine fossa, and parapharyngeal space were also involved in 1 case. All the patients' tumors were completely removed, and the operations were performed mainly via modified infratemporal fossa approach, or combined with expanded middle cranial fossa approach. All cases with temporal and skull base destruction were repaired using the temporalis muscle flap with no occurrence of intracranial complications. The dura mater, condyle of temporomandibular joint, facial nerve, and internal carotid artery were fully preserved. Normal maxillofacial morphology was also preserved. The air conductive hearing of 2 patients was preserved. Conclusions: We found and summarized some surgical techniques that can help safeguard the important structures around massive TGCTs of temporal bone and middle skull base, and reconstruct the defects after tumor resection. The techniques are effective and feasible.
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Affiliation(s)
- Honglin Mei
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Cirong Tian
- Department of Otolaryngology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hailiang Lin
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Xiaoling Lu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Yusu Ni
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
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2
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Schenk P, Schöni M, Urbanschitz L, Filli L, Rahm S, Zing P. Tenosynovial Giant Cell Tumor (TSGCT) of the hip: MRI accuracy and results of surgical treatment. Acta Orthop Belg 2023; 89:65-69. [PMID: 37294987 DOI: 10.52628/89.1.10424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tenosynovial Giant Cell Tumor (TSGCT) or formerly pigmented villonodular synovitis (PVNS) is a rare nonmalignant tumor of the synovia seldom affecting the hip. MRI and surgical resection are the gold standards in its diagnosis and treatment. However, the accuracy of MRI is unknown, and only few reports on its surgical treatment results exist. The goal of the study was to investigate the MRI accuracy, results after surgical treatment, and natural history of untreated MRI-diagnosed hip TSGCT. Twenty-four consecutive patients with suspected TSGCT on hip MRI, between December 2006 and January 2018, were identified from our medical database. Six refused to participate. About 18 patients with a minimal follow-up of 18 months were enrolled. Charts were reviewed for histopathology results, specific treatment and recurrence. At the last follow-up, all patients had a clinical (Harris Hip Score [HHS]) and radiological examination (x-ray and MRI). Out of 18 patients with suspected TSGCT on MRI, with a mean age of 35y (range 17-52), 14 had surgi- cal resection and 4 refused surgery 1 of whom had a CT-guided biopsy. Out of 15 cases with biopsies, in 10 TSGCT was confirmed. Three surgically-treated patients showed recurrence on MRI after 24, 31 and 43 months. Two non-treated patients showed progression after 18 and 116 months. At the last follow-up (65 m; range 18-159), the mean HHS with or without recurrence was 90 and 80pts (ns). Operative vs. non-operative treatment showed HHS of 86 and 90pts (ns). In the conservatively-treated group, HHS with and without progression was 98 and 82pts (ns), respectively. MRI-suspected TSGCT of the hip was confirmed with biopsy in two-thirds of the cases. Surgical treatment showed recurrence in more than one-third of the patients. Two out of four untreated patients showed progression of the TSGCT-suspected lesion.
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3
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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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4
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Kanbour A, Hurrell M, Ricciardo P. Management of tenosynovial giant cell tumour of the temporomandibular joint: a systematic review. ANZ J Surg 2022; 93:869-875. [PMID: 37052058 DOI: 10.1111/ans.18186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
Diffuse type tenosynovial giant cell tumour of the temporomandibular joint (D-TGCT-TMJ) is a rare proliferative disorder. The aim of this study was to perform a systematic review of the literature to summarize D-TGCT-TMJ management regimes and recurrence rates with at least 12 months of follow-up. Our secondary aim was to propose a minimum period of post-operative follow-up. A medline search for any D-TGCT-TMJ case detailing treatment, follow-up of at least 12 months, and presence of recurrence was undertaken. The following variables were extracted from the studies: patient's age and sex, presence of middle cranial fossa invasion, treatment undertaken, total length of follow-up, and presence of recurrence. All studies were assessed for bias as per the Joanna Briggs Institute systematic reviews appraisal tool. There were 63 cases reviewed and were predominantly managed with total resection (60.3%). Other modalities included: arthroplasty, subtotal resection with or without postoperative radiotherapy, medical therapy and surveillance. The recurrence rate was 9.52% and the longest follow-up period where recurrence was observed was at 60 months. Total resection and arthroplasty are common D-TGCT-TMJ management regimes. Patients with D-TGCT-TMJ should be followed up annually for at least 5 years postoperatively to assess for recurrence.
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Affiliation(s)
- Abdullah Kanbour
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
| | - Michael Hurrell
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
| | - Peter Ricciardo
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
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5
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Kumar R, Warmke LM, Wong WL. Ewing sarcoma of Hoffa fat pad in the knee: a case report and review of the literature on primary intraarticular sarcomas and Hoffa fat pad masses. Skeletal Radiol 2022; 52:1415-1420. [PMID: 36484842 DOI: 10.1007/s00256-022-04239-7] [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: 08/05/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
Primary intraarticular sarcomas are rare. We describe a unique case of intraarticular Ewing sarcoma arising in Hoffa fat pad of knee in a woman. The patient was treated successfully with chemotherapy and left knee arthroplasty; however, the tumor recurred after 3 years.We review the literature on primary intraarticular sarcomas and Hoffa fat pad masses in the knee.
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Affiliation(s)
- Rajendra Kumar
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Laura M Warmke
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA.,Indiana University, IU Health Pathology Laboratory, Indianapolis, IN, 46202, USA
| | - Wei-Li Wong
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
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6
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Malignant Diffuse-Type Tenosynovial Giant Cell Tumor in the Subcutaneous Tissue of the Midthigh: A Report of a Rare Tumor in an Unusual Location. Case Rep Orthop 2022; 2022:6986741. [PMID: 36171796 PMCID: PMC9512598 DOI: 10.1155/2022/6986741] [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: 04/09/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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7
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Hamel-Lemaire S, Fortin M, Avon SL. Pigmented villonodular synovitis of the temporomandibular joint: case report and literature review. J Oral Maxillofac Surg 2022; 80:1691-1704. [DOI: 10.1016/j.joms.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
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8
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Song J, Jiang K, Lv Z, Liu B. Surgical Treatment of Sacroiliac Pigment Villous Nodular Synovitis: A Case Report and Literature Review. Front Surg 2022; 9:760704. [PMID: 35574542 PMCID: PMC9095913 DOI: 10.3389/fsurg.2022.760704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Pigmented villonodular synovitis (PNVS) is a rare and disabling disease that is thought to occur mostly in the knee joint. Here, the authors first present a unique case of PNVS occurring at the sacroiliac joint. The patient complained of sacroiliac joint pain with mild swelling. CT and MRI showed that the tumor was ~63 by 91 by 107 mm in size, and was considered to be a fibrous borderline or low-grade malignancy. Intraoperative macroscopic features of the synovitis during operation suggested PNVS, which was confirmed by histopathological examination. The clinical symptoms and signs of the disease, in this case, are not obvious, and radiological investigations, including MRI, suggest high aggressiveness. The author believes that it may be more likely to relapse and metastasis and recommends complete removal of the synovial membrane and regular follow-up, while preoperative or postoperative radiotherapy and molecular targeted therapy are not recommended for the time being.
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Affiliation(s)
- Jiashi Song
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Orthopedics, Rongjun Hospital, Jiaxing, China
| | - Kunpeng Jiang
- Department of Orthopedics, Rongjun Hospital, Jiaxing, China
| | - Zhanhu Lv
- Department of Orthopedics, Fourth Affiliated Hospital, School of Medicine, Shihezi University, Aksu, China
| | - Bing Liu
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bing Liu
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9
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Gharavi SM, Qiao Y, Faghihimehr A, Vossen J. Imaging of the Temporomandibular Joint. Diagnostics (Basel) 2022; 12:diagnostics12041006. [PMID: 35454054 PMCID: PMC9031630 DOI: 10.3390/diagnostics12041006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022] Open
Abstract
Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ.
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10
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Sun H, Ju XD, Huang HJ, Zhang X, Wang JQ. Clinical outcomes of endoscopic synovectomy with adjuvant radiotherapy of pigmented villonodular synovitis of the hip: a case series of single center. BMC Musculoskelet Disord 2022; 23:192. [PMID: 35236301 PMCID: PMC8889717 DOI: 10.1186/s12891-022-05141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip. Thus, the purpose of this study was to analyze the clinical outcomes of endoscopic synovectomy with/without radiotherapy postoperatively of PVNS hip. Methods We performed a retrospective study of patients who underwent endoscopy in our hospital from November 2010 to January 2021. Inclusion criteria was patients with magnetic resonance image (MRI) signs, endoscopic findings and/or histological evidence of PVNS. Exclusion criteria was patients lost follow-up. All patients underwent synovectomy endoscopically and were divided into two groups depending on receiving postoperative radiotherapy or not. The primary outcome measurements were the recurrence of PVNS, receiving revision, and/or converting to total hip arthroplasty (THA). The secondary outcome measurements were the patient-reported outcome (PRO) collected at pre- and post-operation, which consist of Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (IHOT-12), Non-arthritic Hip Scale (NAHS), and visual analog scale (VAS). Results In a case series of 16 patients (8 cases of male, 50%), 4 (25%) cases were localized type and 12 (75%) cases were diffuse type. The average follow-up was 44.8 ± 38.2 months (range,3 to 110). 8 (50%) cases (6 diffuse cases and 2 localized cases) received radiotherapy postoperatively, and the rest (6 diffuse cases and 2 localized cases) received endoscopic treatment alone. At the latest follow-up, 3 (18.75%) cases (2 diffuse cases and 1 localized case) who did not receive radiotherapy converted to arthroplasty. The preoperative HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of remaining 13 patients were 63.1 ± 19.1 (range,32.0 to 98.8), 54.8 ± 20.1 (range, 10.0 to 77.0), 50.9 ± 15.4 (range, 31.0 to 76.6),51.6 ± 15.9 (range, 20.0 to 84.4), 6.0 ± 1.4 (range,4.0 to 8.0) points, respectively. The latest HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of the 13 patients were 79.7 ± 10.8 (range, 58.0 to 97.6), 78.6 ± 9.1 (range,55.0 to 87.0), 74.7 ± 9.7 (range, 55.6 to 91.0), 78.9 ± 18.7 (range,20.0 to 92.5), 3.1 ± 1.2 (range,2.0 to 6.0) points respectively. Conclusion Endoscopic synovectomy can achieve satisfactory PRO in PVNS hip patients. Besides, postoperative adjuvant radiotherapy can achieve higher hip survivability than synovectomy alone in this present study.
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Affiliation(s)
- Hao Sun
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Xiao-Dong Ju
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China.
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11
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Lin F, Zhang Y, Zhao P, Kong D, Feng Y, Dai C. Grading System and Surgical Strategy for Temporal Bone Diffuse-Type Tenosynovial Giant Cell Tumor. Laryngoscope 2021; 132:1275-1284. [PMID: 34709658 DOI: 10.1002/lary.29913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To develop a novel grading system and appropriate surgical approaches for patients with diffuse type tensosynovial giant cell tumor (D-TGCT) of the temporal bone. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed 31 patients with temporal bone D-TGCT between June 2012 and July 2021. All patients underwent comprehensive clinical evaluations, including clinical presentations, hearing threshold, imaging studies, surgical approaches, and prognosis. A grading system was developed based on the tumor location and adjacent neurovascular structures involvement according to imaging and intraoperative findings. RESULTS In this study, grade II tumors were the most common (13/31), followed by grades I (7/31), III (7/31), and IV (4/31) tumors. Seven grade I patients received the subtemporal middle cranial fossa approach (SMCF) combined with the canal wall up mastoidectomy and tympanoplasty (CWUT). Nine grade II patients underwent SMCF combined with subtotal petrosectomy (SPTR), and four grade II patients underwent SMCF combined with CWUT. Seven grade III patients received SMCF combined with SPTR and dura mater reconstruction, and four grade IV patients underwent infratemporal fossa approach type B. Gross total resection was achieved in all patients, and the median follow-up time was 30.1 months (range, 4-96 months). Three patients (one grade II, one grade III, and one grade IV) had recurrence during follow-up, and the patient with grade III tumor had two recurrences. CONCLUSIONS Gross total resection is the first-line treatment for patients with D-TGCT of the temporal bone. This novel grading system enables surgeons to select optimal surgical strategy. Long-term follow-up is mandatory postoperatively. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Feng Lin
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Peng Zhao
- Longgang Ear, Nose and Throat Hospital, Shenzhen, China
| | - Dedi Kong
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Yisi Feng
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
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12
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Choi YJ, Lee C, Jeon KJ, Han SS. Computed tomography and magnetic resonance imaging characteristics of giant cell tumors in the temporomandibular joint complex. Imaging Sci Dent 2021; 51:149-154. [PMID: 34235060 PMCID: PMC8219448 DOI: 10.5624/isd.20200300] [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] [Received: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to investigate the computed tomography and magnetic resonance imaging features of giant cell tumors in the temporomandibular joint region to facilitate accurate diagnoses. Materials and Methods From October 2007 to June 2020, 6 patients (2 men and 4 women) at Yonsei University Dental Hospital had histopathologically proven giant cell tumors in the temporomandibular joint. Their computed tomography and magnetic resonance imaging findings were reviewed retrospectively, and the cases were classified into 3 types based on the tumor center and growth pattern observed on the radiologic findings. Results The age of the 6 patients ranged from 25 to 53 years. Trismus was found in 5 of the 6 cases. One case recurred. The mean size of the tumors, defined based on their greatest diameter, was 32 mm (range, 15–41 mm). The characteristic features of all cases were a heterogeneously-enhancing tumorous mass with a lobulated margin on computed tomographic images and internal multiplicity of signal intensity on T2-weighted magnetic resonance images. According to the site of origin, 3 tumors were bone-centered, 2 were soft tissue-centered, and 1 was peri-articular. Conclusion Computed tomography and magnetic resonance imaging yielded a tripartite classification of giant cell tumors of the temporomandibular joint according to their location on imaging. This study could help clinicians in the differential diagnosis of giant cell tumors and assist in proper treatment planning for tumorous diseases of the temporomandibular joint.
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Affiliation(s)
- Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
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Baldi GG, Gronchi A, Stacchiotti S. Pexidartinib for the treatment of adult symptomatic patients with tenosynovial giant cell tumors. Expert Rev Clin Pharmacol 2020; 13:571-576. [PMID: 32478598 DOI: 10.1080/17512433.2020.1771179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a benign mesenchymal tumor arising from the synovium of tendon sheats and joints, driven by colony-stimulating factor 1 (CSF1) over-expression. Standard treatment is surgery, but local recurrences are frequent, especially in diffuse TGCT subtype, rarely cured with surgery. When TGCT becomes a chronic condition, which may severely compromise joint function and quality of life, patients may need a systemic therapy. Areas covered: We reviewed the drugs on clinical development in TGCT, focusing on the pharmacodynamics, pharmacokinetics, efficacy, and toxicity profile of pexidartinib, the first drug approved in the US for TGCT, and on the open questions about its optimal use in clinical practice. EXPERT OPINION CSFR1 inhibitors have opened a new avenue for treatment of TGCT patients. Pexidartinib is the first-in-class FDA approved agent for symptomatic locally advanced TGCT, based on a phase III study where pexidartinib showed high anti-tumor activity, improved patient symptoms, and functional outcome. A few cases of potentially life-threatening hepatic toxicity were observed. TGCT patients candidate to pexidartinib need to be carefully selected by the multidisciplinary board of center of expertise, balancing the expected risk-benefit ratio. Close monitoring of liver function and adequate education on the approved indication is warranted.
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Affiliation(s)
- Giacomo Giulio Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato , Prato, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan, Italy
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Lee JC, Huang HY. Soft Tissue Special Issue: Giant Cell-Rich Lesions of the Head and Neck Region. Head Neck Pathol 2020; 14:97-108. [PMID: 31950466 PMCID: PMC7021864 DOI: 10.1007/s12105-019-01086-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
Giant cell-rich lesions represent a heterogeneous group of tumors and non-neoplastic lesions, usually arising in bone, which harbor varying number of reactive osteoclastic-type multinucleate giant cells as a common feature. Among these entities, some are confined to the head and neck region (e.g., central giant cell granuloma and mimicking lesions, i.e., peripheral giant cell granuloma and cherubism) or show a relative predilection for this region (e.g., aneurysmal bone cyst and brown tumor of hyperparathyroidism), while others are rare but associated with distinct underlying disease (e.g., giant cell tumor of bone) or histology (e.g., tenosynovial giant cell tumor of the temporomandibular joint and phosphaturic mesenchymal tumor of the jaws) when occurring in the head and neck. Collectively, these lesions pose great challenge in the pathologic diagnosis, which often requires combinatory assessment from the clinical, histopathologic, and/or molecular aspects. This review provides a summary of pertinent clinical and pathologic features and an update of recent molecular and genetic findings of these entities. The considerations in differential diagnosis as well as the effects of the emerging therapeutic RANKL-antagonizing antibody denosumab will also be addressed.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833 Taiwan
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Long-term efficacy of imatinib mesylate in patients with advanced Tenosynovial Giant Cell Tumor. Sci Rep 2019; 9:14551. [PMID: 31601938 PMCID: PMC6786996 DOI: 10.1038/s41598-019-51211-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 09/23/2019] [Indexed: 12/18/2022] Open
Abstract
Tenosynovial giant cell tumors (TGCT), are rare colony stimulating factor-1(CSF-1)-driven proliferative disorders affecting joints. Diffuse-type TGCT often causes significant morbidity due to local recurrences necessitating multiple surgeries. Imatinib mesylate (IM) blocks the CSF-1 receptor. This study investigated the long term effects of IM in TGCT. We conducted an international multi-institutional retrospective study to assess the activity of IM: data was collected anonymously from individual patients with locally advanced, recurrent or metastatic TGCT. Sixty-two patients from 12 institutions across Europe, Australia and the United States were identified. Four patients with metastatic TGCT progressed rapidly on IM and were excluded for further analyses. Seventeen of 58 evaluable patients achieved complete response (CR) or partial response (PR). One- and five-year progression-free survival rates were 71% and 48%, respectively. Thirty-eight (66%) patients discontinued IM after a median of 7 (range 1–80) months. Reported adverse events in 45 (78%) patients were among other edema (48%) and fatigue (50%), mostly grade 1–2 (89%). Five patients experienced grade 3–4 toxicities. This study confirms, with additional follow-up, the efficacy of IM in TGCT. In responding cases we confirmed prolonged IM activity on TGCT symptoms even after discontinuation, but with high rates of treatment interruption and additional treatments.
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Fraser EJ, Sullivan M, Maclean F, Nesbitt A. Tenosynovial Giant-Cell Tumors of the Foot and Ankle: A Critical Analysis Review. JBJS Rev 2019; 5:01874474-201701000-00001. [PMID: 28135228 DOI: 10.2106/jbjs.rvw.16.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ethan J Fraser
- 1Department of Orthopaedic Surgery, St Vincent's Clinic, Sydney, Australia2Foot and Ankle Clinic, North Shore Private Hospital, Sydney, Australia3Douglass Hanly Moir Pathology, Macquarie Park, Australia4Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Australia
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Brant JA, Kaufman AC, Luu N, Grady SM, O Apos Malley BW, Ruckenstein MJ. Pigmented Villonodular Synovitis Presenting as Unilateral Hearing Loss: Review of the Literature and Case Report. ORL J Otorhinolaryngol Relat Spec 2019; 81:171-182. [PMID: 31242479 DOI: 10.1159/000499473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To review the existing literature on pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) and report a rare case of PVNS of the TMJ presenting with unilateral hearing loss. METHODS Review of the existing literature and a description of personal experience with PVNS of the TMJ presenting with unilateral hearing loss. RESULTS Review of the existing literature revealed 76 reported cases of PVNS of the TMJ. The most common presenting symptom was of a slowly enlarging mass or swelling of the preauricular area, with dysfunctional TMJ also frequently reported. All patients underwent surgical excision with some pursuing radiation as adjuvant therapy. Presented Patient: A 46-year-old man presented with several months of unilateral subjective hearing loss and aural fullness. Imaging revealed a mass centered along the superior TMJ with expansion through the squamous temporal bone and extra-axial intracranial extension into the middle cranial fossa. Imaging characteristics and fine-needle aspiration biopsy were consistent with PVNS. INTERVENTION The patient underwent near-total excision of the mass via frontotemporal craniectomy and lateral temporal bone resection. FOLLOW-UP At the 16-month follow-up there was no evidence of disease recurrence. CONCLUSION PVNS of the TMJ represents a rare entity that can present with a variety of symptoms including unilateral hearing loss.
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Affiliation(s)
- Jason A Brant
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam C Kaufman
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Neil Luu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean M Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bert W O Apos Malley
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Histologically benign metastasizing tenosynovial giant cell tumor mimicking metastatic malignancy: A case report and review of literature. Radiol Case Rep 2019; 14:934-940. [PMID: 31193787 PMCID: PMC6542375 DOI: 10.1016/j.radcr.2019.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 12/29/2022] Open
Abstract
Diffuse-type tenosynovial giant cell tumor (D-TGCT), otherwise known as pigmented villonodular synovitis, is a locally aggressive tumor which can show multiple recurrences but is rarely associated with metastasis. A handful of studies have elucidated the imaging features and clinical course in metastatic D-TGCT with malignant transformation on histology. However, only 5 cases of metastatic D-TGCT with benign histological features have been reported in the literature, with the clinical course and prognosis reported in only 1 case. Therefore, relatively little is known about the implications of histologically benign metastasis on the role of imaging, management, and clinical outcomes. We report a case of a 51-year-old female with recurrent D-TGCT localized to the knee that metastasized to the lymph nodes and soft tissue 3 years after above-the-knee amputation and 16 years after initial diagnosis of localized D-TGCT, despite benign histologic features on lymph node excision. This case highlights the necessity of timely MRI imaging to prevent delayed diagnosis, the role of histological findings on treatment response, and clinical outcomes associated with metastasized D-TGCT.
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Novikov D, Richardson MW, Ho C, Gould ES, Khan FA. A Rare Incidence of Pigmented Villonodular Synovitis of the Ankle in an Adolescent. J Foot Ankle Surg 2019; 57:1263-1266. [PMID: 30146337 DOI: 10.1053/j.jfas.2018.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 02/03/2023]
Abstract
Pigmented villonodular synovitis mostly affects the knee and other large joints such as the hip. Although the disease is most commonly found in adult patients aged 30 to 40 years, rare cases in children and the elderly have been reported. We present the case of an 11-year-old female who was found to have biopsy-proven pigmented villonodular synovitis in her subtalar joint in 2012. Five years after surgical excision, the patient has continued to be involved in competitive dancing and cheerleading without any pain in her ankle. Moreover, follow-up magnetic resonance imaging studies showed no evidence of recurrence. Our case report emphasizes that the disease should not be solely considered in the middle-age population but should be included in the differential diagnosis of the pediatric patient.
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Affiliation(s)
- David Novikov
- Medical Student, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Meghan W Richardson
- Resident, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Corey Ho
- Fellow, Department of Radiology, Stony Brook University Hospital, Stony Brook, NY
| | - Elaine S Gould
- Clinical Professor, Department of Radiology & Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Fazel A Khan
- Assistant Professor, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY.
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20
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Malignant Tenosynovial Giant Cell Tumor: The True "Synovial Sarcoma?" A Clinicopathologic, Immunohistochemical, and Molecular Cytogenetic Study of 10 Cases, Supporting Origin from Synoviocytes. Mod Pathol 2019; 32:242-251. [PMID: 30206409 DOI: 10.1038/s41379-018-0129-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/27/2023]
Abstract
We present our experience with ten well-characterized malignant tenosynovial giant cell tumors, including detailed immunohistochemical analysis of all cases and molecular cytogenetic study for CSF1 rearrangement in a subset. Cases occurred in 7 M and 3 F (mean age: 52 years; range: 26-72 years), and involved the ankle/foot (n = 1), finger/toe (n = 3), wrist (n = 1), pelvic region (n = 3), leg (n = 1), and thigh (n = 1). There were eight primary and two secondary malignant tenosynovial giant cell tumors. Histologically, all cases showed definite areas of typical tenosynovial giant cell tumor. The malignant areas varied in appearance. In some cases, isolated malignant-appearing large mononuclear cells with high nuclear grade and mitotic activity were identified within otherwise-typical tenosynovial giant cell tumor, as well as forming larger masses of similar-appearing malignant cells. Occasionally, these nodules of malignant large mononuclear cells showed transition to pleomorphic spindle cell sarcoma, with varying degrees of collagenization and myxoid change. One malignant tenosynovial giant cell tumor was composed of sheets of monotonous large mononuclear cells with high nuclear grade, growing in a hyalinized, osteoid-like matrix, with areas of heterologous osteocartilaginous differentiation. Mitotic activity ranged from 2 to 34 mitoses per 10 HPF (mean 18/10 HPF). Geographic necrosis was observed in four cases. The malignant-appearing large mononuclear cells were consistently positive for clusterin and negative for CD163, CD68, and CD11c. Desmin was positive in a small minority of these cells. Areas in malignant tenosynovial giant cell tumor resembling pleomorphic spindle cell sarcoma or osteo/chondrosarcoma showed loss of clusterin expression. RANKL immunohistochemistry was positive in the large mononuclear cells in eight cases. Two cases showed an unbalanced rearrangement of the CSF1 locus. Follow-up (nine patients; range 0.5-66 months; mean 20 months) showed three patients dead of disease, with three other living patients having lung and lymph node metastases; three patients were disease-free. We conclude that malignant tenosynovial giant cell tumors are highly aggressive sarcomas with significant potential for locally destructive growth, distant metastases, and death from disease. The morphologic and immunohistochemical features of these tumors and the presence of CSF1 rearrangements support origin of malignant tenosynovial giant cell tumor from synoviocytes.
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Wang JG, Liu J, He B, Gao L, Zhang L, Liu J. Diffuse Tenosynovial Giant Cell Tumor Around the Temporomandibular Joint: An Entity With Special Radiologic and Pathologic Features. J Oral Maxillofac Surg 2019; 77:1022.e1-1022.e39. [PMID: 30796908 DOI: 10.1016/j.joms.2019.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Diffuse tenosynovial giant cell tumor (TGCT) of the temporomandibular joint (TMJ) is rare. The aim of the present study was to summarize the clinical, radiologic, and pathologic features of this tumor. MATERIALS AND METHODS Nine cases of TGCT in the TMJ region were examined. All available radiologic and pathologic documents were carefully reviewed. These cases were grouped into 3 types according to the radiologic features: bone-centered type, intraosseous type, and soft tissue type. Cases reported in the literature were reviewed to better summarize the clinical characteristics. RESULTS TGCTs in the TMJ region showed some special radiologic and pathologic features. Radiologically, the lesion could be centered in the craniofacial bone or centered in the surrounding soft tissue. Four cases were categorized as the bone-centered type, 1 was categorized as the intraosseous type, and 4 were categorized as the soft tissue type. Pathologically, epithelioid mononuclear cells with abundant eosinophilic cytoplasm and eccentric nuclei were observed in all cases. Chondroid metaplasia was noted in 8 cases. Some areas were similar to giant cell reparative granuloma and chondroblastoma. All patients who underwent complete tumor resection showed no evidence of recurrence at follow-up. Of the 93 reported cases, only 5 developed postoperative recurrence and distant metastasis. CONCLUSION TGCTs of the TMJ region share similar radiologic and pathologic features as other tumors, which indicates the TGCT might be a special entity within a spectrum of diseases.
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Affiliation(s)
- Ji-Gang Wang
- Associate Chief Physician and Postdoctoral Research Fellow, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingwei Liu
- Resident, Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Bing He
- Resident, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Gao
- Attending Doctor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Professor, Medical Systems Biological Center for Complex Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jihua Liu
- Professor, Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Zhao G, Wang J, Xia J, Wei Y, Wang S, Huang G, Chen F, Chen J, Shi J, Yang Y. The predictive value of preoperative neutrophil-lymphocyte ratio (NLR) on the recurrence of the local pigmented villonodular synovitis of the knee joint. BMC Musculoskelet Disord 2018; 19:339. [PMID: 30227838 PMCID: PMC6145334 DOI: 10.1186/s12891-018-2258-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background To explore and evaluate the predictive value of preoperative Neutrophil-lymphocyte ratio (NLR) on the recurrence of pigmented villonodular synovitis (PVNS) of the knee joint treated by arthroscopic surgery combining local radiotherapy. Methods Sixty pathological-proven PVNS cases of the knee joint in our department from April 2006 to March 2017 were included. All of them are treated by arthroscopic synovectomy combined with adjuvant radiotherapy. The pre-operative hematological indexes such as c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, Platelet-lymphocyte ratio (PLR) and Lymphocyte-monocyte ratio (LMR) were collected retrospectively and their relationship with postoperative recurrence was analyzed by using univariate and multivariate analysis, the receiver operating characteristic curves (ROC curve), the Kappa correspondence test and the Mc Nemar Chi-square test. Results All 60 patients were followed up for a median of 52.8 months (7–138 months) and the recurrence rate is about 23.3% (14/60). There is a significant difference in NLR between the recurrent and non-recurrent group (P = 0.002). It had a certain correlation with postoperative recurrence (correlation coefficient r = 0.438, P = 0.001). The optimal thresholds in ROC curve were 2.42 (sensitivity 71.4%, specificity 78.3% respectively). which had predictive ability for recurrence after arthroscopic treatment. Conclusion The preoperative NLR is an easy and cost-effective predictor for relapse in PVNS of the knee joint after the arthroscopic surgery combined with local radiotherapy, which is of profound significance to guide clinical work.
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Affiliation(s)
- Guanglei Zhao
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jin Wang
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jun Xia
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Yibing Wei
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Siqun Wang
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Gangyong Huang
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Feiyan Chen
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jie Chen
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jingsheng Shi
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yuanqing Yang
- Division of orthopaedic surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
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Gao M, Li H, Liang X, Fu X, Li X. Multifocal pigmented villonodular synovitis coexisting in both the knee joint and the patella: a case report and literature review. BMC Musculoskelet Disord 2017; 18:293. [PMID: 28683727 PMCID: PMC5501528 DOI: 10.1186/s12891-017-1654-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUD Pigmented villonodular synovitis (PVNS) is an uncommon entity of proliferative lesion of the synovium, presenting with different clinical signs and symptoms. PVNS rarely forms an osteolytic lesion in a bone. Here we report a unique case of PVNS with a nodular lesion in the left patella. CASE PRESENTATION A 37-year-old female was referred to our hospital with complaints of ongoing left knee pain and a painful and palpable mass in her left popliteal fossa. MRI demonstrated a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa. After a primary diagnosis of PVNS had been established, combined arthroscopic synovectomy and open resection were performed. The postoperative pathological diagnoses of the resected mass from the popliteal fossa, the affected synovial tissue and the lesion in the patella were consistent with PVNS. At 1-year follow-up, no evidence of recurrence was noted. CONCLUSIONS Based on brief literature review of PNVS, we presented a very rare case of PVNS with a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa.
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Affiliation(s)
- Mingxuan Gao
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Hong Li
- Ophthalmology Center, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xiaoyan Liang
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Xiaoyan Fu
- Ultrasonic Diagnosis Department, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xusheng Li
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China.
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Pigmented Villonodular Synovitis of the Temporomandibular Joint With Petrous Bone Invasion. Otol Neurotol 2017; 38:e58-e59. [DOI: 10.1097/mao.0000000000001390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol 2016; 17:10. [PMID: 26820289 DOI: 10.1007/s11864-015-0385-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Adequate surgical resection remains the treatment of choice for tenosyovial giant cell tumor (TGCT). However, diffuse type TGCT (D-TGCT) is more difficult to resect and has a higher rate of recurrence (up to 50 %), which is often multiple. D-TGCT is rarely lethal and only rare cases of metastases have been described. Nevertheless, patients might have a significant decline in their quality of life due to multiple operations, which may sometimes result in a partial loss of function of the affected joint and may also be associated with perioperative morbidity and secondary arthrosis. As of today, no systemic treatment is approved for this rare disease. The aims of systemic therapy in the context of a non-lethal tumor are to reduce surgical morbidity and to preserve function and patient quality of life. Because TGCT is associated with characteristic cytogenetic abnormalities resulting in the overexpression of CSF1, systemic therapies targeting the CSF1/CSF1R axis (imatinib, nilotinib, emactuzumab, and PLX3397) have been tested in patients with locally advanced or relapsed D-TGCT. The more recent and more specific CSF1R inhibitors have shown a very interesting clinical activity with acceptable toxicity in early phase trials. These results will need to be confirmed in larger, ideally randomized, trials. But the high rate of clinical and functional improvement seen in some patients with advanced D-TGCT, often after multiple operations, suggests that these inhibitors will likely have a role in the management of patients with an inoperable disease; the definition of "inoperable TGCT" still requires refinement to reach a consensus. Another point that will need to be addressed is that of "the optimal duration of therapy" for these patients. Indeed, we and others have observed often prolonged clinical benefit and symptomatic relief even after treatment was stopped, with both monoclonal antibodies and tyrosine kinase inhibitors. Responses were observed very early on with emactuzumab and PLX3397, and patients experienced significant symptom improvement within a few weeks of starting therapy (2-4 weeks). Another possible application of CSF1R inhibitors could be used either as a preoperative or postoperative therapy for patients with operable TGCT. However, we currently lack sufficient follow-up to adequately address these questions which will each require specific trial designs. Overall, the striking clinical activity of CSF1R specific inhibitors in TGCT has created great enthusiasm among clinicians, and further development of these agents is clearly medically needed. Nevertheless, further investigations are necessary to validate those treatments and assess how to best incorporate them among other treatment modalities into the overall therapeutic strategy for a given patient.
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Conrad F, Winkens T, Kaatz M, Goetze S, Freesmeyer M. Retrospektive Analyse von Zufallsbefunden, die bei Patienten mit kutanem malignen Malignom durch (18) F-Fluordeoxyglucose-PET/CT erhoben wurden. J Dtsch Dermatol Ges 2016; 14:807-17. [PMID: 27509417 DOI: 10.1111/ddg.12924_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
HINTERGRUND UND ZIELE Bei der (18) F-Fluordeoxyglucose-Positronenemissionstomographie/Computertomographie (FDG-PET/CT) ergeben sich häufig Zufallsbefunde. In der vorliegenden Studie konzentrierten wir uns auf mittels FDG-PET/CT erhaltene Zufallsbefunde bei Patienten mit kutanem Melanom und überprüften deren Relevanz hinsichtlich weiterer diagnostischer Maßnahmen und Interventionen. PATIENTEN UND METHODEN Die Krankenakten von 181 konsekutiven Melanom-Patienten wurden retrospektiv ausgewertet, um das Management von Zufallsbefunden zu dokumentieren. Der Schwerpunkt lag dabei auf den histologischen Befunden. ERGEBNISSE Bei 33 von 181 (18 %) Patienten lagen 39 relevante Zufallsbefunde vor, und zwar im Kolorektalbereich (n = 15 Patienten), in der Schilddrüse (n = 8), der Prostata (n = 2), dem Bewegungsapparat (n = 2), in Lymphknoten (n = 2), der Parotis (n = 1), den Mandeln (n = 1), den Nieren (n = 1) und der Gallenblase (n = 1). Bei 25 Patienten schlossen sich weitere diagnostische Verfahren an, wobei in 21 Fällen ein klinisches Korrelat nachgewiesen wurde. Bei 16 von 21 Patienten ergab sich eine Neoplasie, darunter fünf maligne Läsionen (vier Kolonkarzinome und ein Prostatakarzinom). Die Malignome wurden frühzeitig diagnostiziert und in der Mehrzahl der Fälle erfolgreich entfernt. SCHLUSSFOLGERUNGEN Der Einsatz der FDG-PET/CT als Routine-Diagnostik wird in den Leitlinien empfohlen und ist indiziert bei malignem Melanom ab Stadium IIC. In dieser Studie wurden auf effektive Weise ansonsten nicht erkannte Krebserkrankungen, insbesondere Kolonkarzinome, detektiert. In den meisten Fällen war eine frühe Intervention möglich. Zufallsbefunde durch FDG-PET/CT sollten, unter Berücksichtigung des Zustands und der Wünsche des Patienten, mit den geeigneten diagnostischen Maßnahmen abgeklärt werden.
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Affiliation(s)
- Franziska Conrad
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Winkens
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Martin Kaatz
- Fachabteilung für Hautkrankheiten und Allergologie, SRH Wald-Klinikum Gera GmbH, Gera, Deutschland
| | - Steven Goetze
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Deutschland
| | - Martin Freesmeyer
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland
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Conrad F, Winkens T, Kaatz M, Goetze S, Freesmeyer M. Retrospective chart analysis of incidental findings detected by18F-fluorodeoxyglucose-PET/CT in patients with cutaneous malignant melanoma. J Dtsch Dermatol Ges 2016; 14:807-16. [DOI: 10.1111/ddg.12924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Franziska Conrad
- Clinic of Nuclear Medicine; Jena University Hospital; Jena Germany
| | - Thomas Winkens
- Clinic of Nuclear Medicine; Jena University Hospital; Jena Germany
| | - Martin Kaatz
- Department of Dermatology and Allergology; SRH Wald-Klinikum Gera GmbH; Gera Germany
| | - Steven Goetze
- Department of Dermatology; Jena University Hospital; Jena Germany
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Jendrissek KA, Hotfiel T, Swoboda B, Söder S, Janka R. [Pigmented villonodular synovitis. A rare differential diagnosis of synovial joint swelling]. Z Rheumatol 2016; 75:157-65. [PMID: 26768272 DOI: 10.1007/s00393-015-0028-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) describes a rare disease caused by an abnormal proliferation of the synovial membrane in large and small joints. In order to achieve an optimal result of treatment it is necessary to carry out specific diagnostics and a targeted therapy approach. OBJECTIVE This article gives a review of the epidemiology, etiopathogenesis and diagnostic management of PVNS as well as presenting the current therapy and treatment recommendations. MATERIAL AND METHODS A systematic search of the literature was performed in the databank of the National Center for Biotechnology Information ( http://www.ncbi.nlm.nih.gov/pubmed ). The search targeted randomized clinical and experimental studies, systematic and non-systematic review articles, expert opinions and case reports related to PVNS, independent of the level of evidence attained by each study. RESULTS The differential diagnosis of PVNS should be considered in cases of recurrent hemorrhagic joint effusions. The cause of the disease has not yet been exactly clarified. The final diagnosis can ultimately only be confirmed by histological investigations. In order to obtain representative histological tissue samples for the diagnosis, magnetic resonance imaging (MRI) with the appropriate heme sequences should be carried out prior to taking samples. The management of PVNS is often difficult due to the high risk of recurrence depending on the various forms. In view of the high rate of recurrence, therapy should include a complete synovectomy. CONCLUSION For the surgical approach arthroscopic and open procedures have been described, which are currently controversially discussed with respect to the complication and recurrence rates. Adjuvant interventional therapy forms, such as radiosynoviorthesis are recommended to reduce the recurrence rate.
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Affiliation(s)
- K A Jendrissek
- Abteilung für Orthopädische Rheumatologie in der Orthopädischen Universitätsklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
| | - T Hotfiel
- Abteilung für Orthopädische Rheumatologie in der Orthopädischen Universitätsklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - B Swoboda
- Abteilung für Orthopädische Rheumatologie in der Orthopädischen Universitätsklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - S Söder
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Janka
- Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Brahmi M, Vinceneux A, Cassier PA. Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol 2016. [PMID: 26820289 DOI: 10.1007/s11864-015-0385-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OPINION STATEMENT Adequate surgical resection remains the treatment of choice for tenosyovial giant cell tumor (TGCT). However, diffuse type TGCT (D-TGCT) is more difficult to resect and has a higher rate of recurrence (up to 50 %), which is often multiple. D-TGCT is rarely lethal and only rare cases of metastases have been described. Nevertheless, patients might have a significant decline in their quality of life due to multiple operations, which may sometimes result in a partial loss of function of the affected joint and may also be associated with perioperative morbidity and secondary arthrosis. As of today, no systemic treatment is approved for this rare disease. The aims of systemic therapy in the context of a non-lethal tumor are to reduce surgical morbidity and to preserve function and patient quality of life. Because TGCT is associated with characteristic cytogenetic abnormalities resulting in the overexpression of CSF1, systemic therapies targeting the CSF1/CSF1R axis (imatinib, nilotinib, emactuzumab, and PLX3397) have been tested in patients with locally advanced or relapsed D-TGCT. The more recent and more specific CSF1R inhibitors have shown a very interesting clinical activity with acceptable toxicity in early phase trials. These results will need to be confirmed in larger, ideally randomized, trials. But the high rate of clinical and functional improvement seen in some patients with advanced D-TGCT, often after multiple operations, suggests that these inhibitors will likely have a role in the management of patients with an inoperable disease; the definition of "inoperable TGCT" still requires refinement to reach a consensus. Another point that will need to be addressed is that of "the optimal duration of therapy" for these patients. Indeed, we and others have observed often prolonged clinical benefit and symptomatic relief even after treatment was stopped, with both monoclonal antibodies and tyrosine kinase inhibitors. Responses were observed very early on with emactuzumab and PLX3397, and patients experienced significant symptom improvement within a few weeks of starting therapy (2-4 weeks). Another possible application of CSF1R inhibitors could be used either as a preoperative or postoperative therapy for patients with operable TGCT. However, we currently lack sufficient follow-up to adequately address these questions which will each require specific trial designs. Overall, the striking clinical activity of CSF1R specific inhibitors in TGCT has created great enthusiasm among clinicians, and further development of these agents is clearly medically needed. Nevertheless, further investigations are necessary to validate those treatments and assess how to best incorporate them among other treatment modalities into the overall therapeutic strategy for a given patient.
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Affiliation(s)
- Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, Lyon, 69008, France
| | - Armelle Vinceneux
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, Lyon, 69008, France.,Department of Medical Oncology, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - Philippe A Cassier
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, Lyon, 69008, France.
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Xie GP, Jiang N, Liang CX, Zeng JC, Chen ZY, Xu Q, Qi RZ, Chen YR, Yu B. Pigmented villonodular synovitis: a retrospective multicenter study of 237 cases. PLoS One 2015; 10:e0121451. [PMID: 25799575 PMCID: PMC4370558 DOI: 10.1371/journal.pone.0121451] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/01/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose To review clinical characteristics of pigmented villonodular synovitis (PVNS) in China. Methods Electronic medical records (EMR) of four Chinese institutes were queried for patients with histologically proven PVNS between January 2005 and February 2014. Their data were collected including gender, age at diagnosis, clinical presentation, affected site, symptom duration, comorbidities, treatment strategy, recurrence and routine laboratories. Results A total of 237 patients with biopsy-proven PVNS were investigated. The gender ratio was 1.35 for a female predominance (101 males and 136 females). The average age was 36 years (range, 2 to 83 years). The median delay from initial clinical symptom to diagnosis was 18 months. Main affected areas were the knee (73.84%) and the hip (18.14%). Forty patients had a clear history of joint trauma. Six patients were concurrently diagnosed with PVNS and avascular necrosis (AVN). Five patients suffered from PVNS following implantation of orthopaedic devices including artificial prosthesis, plate and wire. One hundred and twenty-nine patients underwent arthroscopic synovectomy and 108 open synovectomy. Altogether 48 patients (26 males and 22 females) had recurrence of disease. The relapse rate was 24% (knee) and 6.98% (hip), 20.93% (open surgery) and 19.44% (arthroscopy), respectively. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rate were elevated in 45.83% and 38.41% of the patients respectively. Conclusions To our knowledge, this study is the largest sample size of PVNS patients reported as well as the largest sample of PVNS with concurrent AVN reported to date. Our outcomes suggest that PVNS shows a female predominance, occurs mostly between 20–40 years and favors the knee and hip. Recurrence is frequent, particularly in the knee. Serum ESR and CRP may be elevated in some patients. Additionally, the present study supports the theory of an association between PVNS and orthopedic surgery, which is not limited to joint replacement.
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Affiliation(s)
- Guo-ping Xie
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- Key laboratory of Bone and Cartilage Regenerative Medicine of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chang-xiang Liang
- Department of Orthopaedics, Guangdong General Hospital, Guangzhou, Guangdong, PR China
| | - Jian-chun Zeng
- Department of Third Orthopaedics, The First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Zhi-yuan Chen
- Department of Overseas Chinese Patients, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, PR China
| | - Qian Xu
- Department of Health Statistics, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Rui-zhen Qi
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yi-rong Chen
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- Key laboratory of Bone and Cartilage Regenerative Medicine of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- * E-mail:
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Richman DM, Bresler SC, Rosenthal MH, Howard SAH. Malignant tenosynovial giant cell tumor of the leg: a radiologic-pathologic correlation and review of the literature. J Clin Imaging Sci 2015; 5:13. [PMID: 25861547 PMCID: PMC4374198 DOI: 10.4103/2156-7514.152343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 02/09/2015] [Indexed: 01/24/2023] Open
Abstract
Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion. Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying. Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease. We present the multimodality appearance of a case of malignant diffuse-type TGCT that recurred 2 months after resection with subsequent rapid clinical progression.
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Affiliation(s)
- Danielle M Richman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA
| | - Scott C Bresler
- Harvard Medical School, Boston, Massachusetts, USA ; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael H Rosenthal
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA ; Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephanie Anne Holler Howard
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA ; Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Bredell M, Schucknecht B, Bode-Lesniewska B. Tenosynovial, diffuse type giant cell tumor of the temporomandibular joint, diagnosis and management of a rare tumor. J Clin Med Res 2015; 7:262-6. [PMID: 25699124 PMCID: PMC4330020 DOI: 10.14740/jocmr1872w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 11/11/2022] Open
Abstract
The purpose of this paper was to describe a rare unusual case of primary mandibular condylar tenosynovial giant cell tumor of diffuse type with predominantly intraosseous growth and its management by resection and functional reconstruction with a vascularized costochondral graft. Clinical presentation was swelling in the right condylar area and limited mouth opening with radiological evidence of central bone destruction and magnetic resonance imaging showed central hemosiderin deposition. Fine needle aspiration did not lead to a diagnosis and an open biopsy had to be performed. Management consisted of tumor resection and reconstruction with a free vascularized costochondral graft. Tenosynovial diffuse type giant cell tumor of the temporomandibular joint is very rare. Complete resection leads to a low recurrence rate and reconstruction with a costochondral free vascularized flap leads to an excellent functional outcome.
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Affiliation(s)
- Marius Bredell
- Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | | | - Baete Bode-Lesniewska
- Institute for Clinical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
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Joshi K, Huang B, Scanga L, Buchman C, Chera BS. Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint. Am J Otolaryngol 2015; 36:106-13. [PMID: 25459320 DOI: 10.1016/j.amjoto.2014.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ. METHODS We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT. RESULTS 71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled. CONCLUSIONS PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.
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Affiliation(s)
| | - Benjamin Huang
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Lori Scanga
- Department of Pathology, University of North Carolina, Chapel Hill, NC
| | - Craig Buchman
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina, Chapel Hill, NC
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Linebeger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Palmerini E, Staals EL, Maki RG, Pengo S, Cioffi A, Gambarotti M, Picci P, Daolio PA, Parafioriti A, Morris C, Antonescu CR, Gronchi A, Casali PG, Donati DM, Ferrari S, Stacchiotti S. Tenosynovial giant cell tumour/pigmented villonodular synovitis: outcome of 294 patients before the era of kinase inhibitors. Eur J Cancer 2014; 51:210-7. [PMID: 25465190 DOI: 10.1016/j.ejca.2014.11.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tenosynovial giant cell tumour/pigmented villonodular synovitis (TGCT/PVNS) is a benign neoplasm of synovium and tendon sheath. We conducted a retrospective pooled analysis in three major referral centers. METHODS Patients treated between 1998 and 2008 were examined. Only patients presenting with primary disease or first relapse were included. 5-year local failure free survival (5-year-LFFS) was analysed. RESULTS 294 patients were included: 254 with new diagnosis and 40 in 1st local recurrence (171 F/123 M; median age: 36 years; tumour size ⩽2 cm in 27% of patients, >2 to ⩽5 cm in 41%, and >5 cm in 32%). A diffuse pattern was reported in 69%, localised in 31%. No metastases were documented. Local failure (LF) was reported in 28% of patients: 36% in diffuse pattern, 14% in localised (p = 0.002); median time to LF: 16 months. With a median follow-up of 4.4 years, 5-year-LFFS was 66%, with multiple (up to five) local recurrences in 40% of relapsed patients. Size <2 cm, macroscopically complete resection, female gender and new diagnosis were associated with a better local control. After multivariate analysis, a previous relapse was independently associated with local failure. CONCLUSIONS This study underlines the propensity of TGCT/PVNS to multiple local recurrences. In absence of clinical factors, biological studies are needed to identify prognostic factors of local failure. After a first local recurrence, surgery does not seem to have a curative potential. In these high risk patients, studies addressing the role of target therapies are needed.
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Affiliation(s)
- Emanuela Palmerini
- Chemotherapy, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L Staals
- Orthopaedic Surgery, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Robert G Maki
- Departments of Medicine, Pediatrics, and Orthopaedics, Mount Sinai School of Medicine, NY, USA
| | - Stefano Pengo
- Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angela Cioffi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY, USA
| | - Marco Gambarotti
- Surgical Pathology, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Picci
- Laboratory of Experimental Oncology, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Carol Morris
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY, USA
| | | | - Alessandro Gronchi
- Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Davide M Donati
- Orthopaedic Surgery, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Stacchiotti
- Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
Introduction: Malignant pigmented villonodular synovitis (PVNS) or Malignant giant cell tumour tendon sheath (MGCTTS) is a controversial and debatable lesion. Few case reports have indicated the potential for metastasis.1These aggressive cases are designated malignant giant cell tumour tendon sheath or malignant PVNS. Less than 20 cases are described in literature. We report a case of 65 year old lady who was diagnosed eight years back as pigmented villonodular synovitis. She had multiple local recurrences and now presented with lymphnodal metastases, which is extremely rare. Case Report: Sixty five year old lady presented with swelling in left inguinal region of six months duration. She gave a past history of swelling around medial condyle of left femur eight years back. Swelling was excised three times. At the time of third recurrence, swelling was extensive, infiltrating surrounding tissues and underlying bone, encasing femoral and popliteal vessels for which she underwent an above knee amputation. She now presented with inguinal swelling measuring 5.7×3.0 cms. Positron Emission Tomography Scan (PET-CT) revealed multiple enlarged left common iliac, internal and external iliac nodes, largest measuring 7.0 cms. Both the inguinal and pelvic nodes were excised. Lesion was diagnosed as metastatic deposits of Malignant pigmented villonodular synovitis based on morphological and Immunohistochemical findings. Conclusion: It is important to have a high index of clinical suspicion because these lesions can have an aggressive behaviour even with bland cytological features. Our experience suggests that in a recurrent lesion for GCTTS. A wide surgical excision with safe surgical margins and close follow up with radiological evaluation might help to diagnose these lesions early and be amenable to limb salvage surgeries.
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Affiliation(s)
- Radha Sistla
- Department of Anatomical Pathology and Cytology, Aware Global Hospitals, L.B Nagar, Hyderabad-500035, Andhra Pradesh. India
| | - Vidyasagar J V S
- Department of Anatomical Pathology and Cytology, Aware Global Hospitals, L.B Nagar, Hyderabad-500035, Andhra Pradesh. India
| | - Tameem Afroz
- Department of Anatomical Pathology and Cytology, Aware Global Hospitals, L.B Nagar, Hyderabad-500035, Andhra Pradesh. India
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Safaee M, Oh T, Sun MZ, Parsa AT, McDermott MW, El-Sayed IH, Bloch O. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review. Head Neck 2014; 37:1213-24. [PMID: 24764167 DOI: 10.1002/hed.23717] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/15/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. METHODS Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. RESULTS Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. CONCLUSION PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Michael W McDermott
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Ivan H El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Pina S, Fernandez M, Maya S, Garcia RA, Noor A, Pawha PS, Som PM. Recurrent temporal bone tenosynovial giant cell tumor with chondroid metaplasia: the use of imaging to assess recurrence. Neuroradiol J 2014; 27:97-101. [PMID: 24571839 DOI: 10.15274/nrj-2014-10011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/14/2013] [Indexed: 11/12/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a benign proliferative lesion of unclear etiology. It is predominantly monoarticular and involves the synovium of the joint, tendon sheath, and bursa. TGCT of the temporomandibular joint (TMJ) is rare and aggressive resulting in destruction of surrounding structures. The diagnosis may be suggested by imaging, mainly by the MR features and PET/CT, and confirmed by histopathology. We describe the case of a 50-year-old man who presented with right-sided hearing loss, tinnitus and TMJ pain. Pathology revealed tenosynovial giant cell tumor with chondroid metaplasia. Six years later he developed a recurrence, which was documented to our knowledge for the first time with CT, MR and FDG PET/CT imaging.
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Affiliation(s)
- Sofia Pina
- Department of Neuroradiology, Hospital Santo António - CHP; Porto, Portugal -
| | - Maria Fernandez
- Department of Radiology, Virgen de la Salud Hospital; Toledo, Spain
| | - Silvia Maya
- Department of Radiology, Valencia Clinical University Hospital; Valencia, Spain
| | - Roberto A Garcia
- Department of Pathology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Ali Noor
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Puneet S Pawha
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
| | - Peter M Som
- Department of Radiology, The Icahn School of Medicine at Mount Sinai; New York, USA
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Theunissen CIJM, Bras J, Lienden KPV, Obdeijn MC. Malignant giant cell tumor in the carpal tunnel: a case report and review of literature. J Wrist Surg 2013; 2:271-275. [PMID: 24436827 PMCID: PMC3764239 DOI: 10.1055/s-0033-1350087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant tenosynovial giant cell tumors (GCTs) are extremely rare, and their etiology is unknown. However, this type of malignancy is associated with high metastasis and mortality rates. Therefore, the treatment of choice is wide excision. Case Description A 66-year-old man complained of tingling and loss of sensation in the left hand, caused by a tumor that compressed the median nerve. The tumor was excised. Histopathologic examination revealed a ganglion cyst. Two years later, the patient visited our clinic with recurrent and similar complaints of the left hand. This time, however, the lesion turned out to be a malignant tenosynovial GCT and was treated by amputation of the forearm. Literature Review Since 1979, only 37 malignant tenosynovial GCTs have been reported in literature. Follow-up of these patients showed that 11 patients died of the disease, 4 patients were still living with the disease, and 14 patients had no evidence of disease after treatment. The other seven patients were lost to follow-up, and one patient died of other causes. In these 37 patients, a high incidence of lymph node metastasis (41%) and a high mortality rate (30%) were seen. Clinical Relevance Although this malignant tenosynovial GCT is very rare, high mortality rates have been observed because of the high incidence of lymph node metastases. Therefore, more awareness has to be created, to recognize and treat this tumor timely.
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Affiliation(s)
- Carla I. J. M. Theunissen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Bras
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Ma X, Shi G, Xia C, Liu H, He J, Jin W. Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints). INTERNATIONAL ORTHOPAEDICS 2013; 37:1165-70. [PMID: 23503697 DOI: 10.1007/s00264-013-1858-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Pigmented villonodular synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints, but there is not much information available about the disease's aetiology, clinical history, differential diagnosis, treatment, and long-term effects. We conducted a study to analyse these aspects of PVNS. METHODS We reviewed all clinical data for 75 patients with PVNS (81 joints) who were treated either by synovectomy alone or synovectomy plus arthroplasty. RESULTS In all cases, the diagnosis of PVNS was confirmed by pathological examination. The ratio of males to females was 27:48, and the average age of patients was 46 years (range, 15-80 years). Lesions were located in the knee, hip, or ankle, and pain and swelling were the main symptoms. Of 75 patients, 42 had a history of trauma to the involved joint. Forty-one patients (43 joints) underwent synovectomy alone, and 34 patients (38 joints) underwent synovectomy and arthroplasty together. Of the 75 patients, 61 had full follow-up data. Twelve patients had recurrent legions detected by pathological examinations; four patients had more than two recurrences. Moreover, five patients developed PVNS after arthroplasty. CONCLUSIONS PVNS occurs most often in middle-aged women and most frequently involves the knee, followed by the hip and ankle. The disease's etiology is varied and unclear. Surgical excision alone or with arthroplasty is an effective treatment, but there is a high rate of recurrence.
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Affiliation(s)
- Xiaomei Ma
- Department of Pathology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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