Giant cell tumor of tendon sheath: largest single series in children

Intraarticular Involvement of Extraarticular Giant Cell Tumor of the Tendon Sheath in the Thumb of a Pediatric Patient: A Case Report

Giant cell tumors of the tendon sheath (GCTTS) are locally invasive and have a high likelihood of recurrence in adults, but it is rare in children. Its potential to be invasive or recur has not been characterized. We present a 9-year-old patient with a dumbbell-shaped GCTTS that had small intraarticular and large extraarticular components with a narrow connection between them. This case suggests that GCTTS can be locally invasive in children. This case report could help hand surgeons who treat GCTTS in children.

The effect of surgical factors on recurrence of tendon sheath giant cell tumours

In this retrospective study, we evaluated the impact of tumour-related and surgical factors on the recurrence of giant cell tumours of tendon sheath. A total of 95 patients were treated at our institution between February 2012 and March 2021. We identified the factors most likely to be associated with recurrence from evaluation of classification, neurovascular invasion, bone erosion and joint invasion. Based on these criteria, we identified 49 patients with a high risk of recurrence. Of the 95 patients, recurrence was observed in 17. Among the 49 patients classified as high-risk, 13 were found to have recurrence. This study demonstrates that recurrence is more common in the high-risk patient group.Level of evidence: IV.

Localized tenosynovial giant cell tumor in children

Background

To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children.

Methods

The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis.

Results

The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations.

Conclusion

Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate.

Level of evidence

Level III.

Malignant, fungating giant-cell tumor of the tendon sheath (GCT-TS) of the foot: A case report

Giant-cell tumors of the tendon sheath (GCT-TS) are relatively common benign tumors that arise in close proximity to joints and tendons. Malignant GCT-TS are extremely rare. Surgery with wide resection remains the cornerstone for treating malignant giant-cell tumors of the tendon sheath especially in large tumor cases.

Giant cell tumor of the tendon sheath of the toe: case report of an unusual localization

INTRODUCTION AND IMPORTANCE

The purpose of this study is to highlight a rare entity of unusual location and to report our therapeutic attitude in this regard, while detailing the diagnostic criteria and therapeutic management.

CASE PRESENTATION

We describe the case of a 32 years old woman with a swelling of the big toe initially neglected by the patient, the evolution is marked by a discomfort when wearing shoes, it was a firm mass of 2 cm slightly painful without local inflammatory signs with bone lysis on radiography, The MRI showed an invasion of the flexor and extensor tendons of the hallux, our approach was a carcinological tumor exeresis and arthrodesis while preserving the toe since the pedicle was not invaded, the histological examination confirmed the diagnosis and the evolution is good without tumor recurrence.

CLINICAL DISCUSSION

A giant cell tumor of the tendon sheaths (GCTTC) usually presents as a firm slow growing mass, the radiological assessment shows bone erosions, an MRI for extension assessment and histological confirmation are mandatory, malignant degenerations are unusual but should always be investigated, treatment is based on the most complete surgical resection to avoid the risk of recurrence, adjuvant radiotherapy can be done in case of incomplete resection but it is a controversial subject.

CONCLUSION

GCTTC are benign tumors that may be locally malignant because of the invasion of noble structures, which makes their complete exeresis difficult. The diagnosis is based on clinical and radiological criteria and requires histological confirmation.

Turalio risk evaluation and mitigation strategy for treatment of tenosynovial giant cell tumor: framework and experience

For drugs with enhanced serious safety risks, Risk Evaluation and Mitigation Strategy (REMS) may be required. Pexidartinib is approved for treatment of adult symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Its approval was conditional on its prescription via a mandatory REMS due to serious and potentially fatal liver injury seen in clinical trials. Turalio^® REMS aims to mitigate this risk by ensuring provider education on pexidartinib use and required REMS components, prescriber adherence to baseline and periodic monitoring, and enrolling patients in a registry to further assess safe use and acute, chronic and irreversible hepatotoxicity. Through Turalio REMS, benefits of treating patients with pexidartinib may be preserved.

Giant cell tumor of the tendon sheath in a 5-year-old child; A case report

Introduction

and importance: Giant cell tumors of the tendon sheath in children have rarely been reported in the literature. This study aims to present a case of giant cell tumors of the tendon sheath on the big toe of a 5-year-old child.

Case presentation

A 5-year-old girl presented with a painless swelling over the dorsal aspect of right big toe for 2 weeks. Physical examination revealed non-tender rubbery like swelling over the dorsal aspect of the right big toe. Ultrasound scan of the swelling showed a 17 × 7 mm oval-shaped subcutaneous hypoechoic lesion. Magnetic resonance imaging showed evidence of 20× 8 mm well-defined fusiform soft tissue lesion scalloping the bone. Under general anesthesia, the mass was totally excised. Microscopic sectioning showed a mixture of fibroblasts and histiocyte like cells associated with multinucleated giant cells in the vascular connective tissue stroma with the definite diagnosis of the giant cell tumor of the tendon sheath.

Discussion

These tumors mostly compose of several types of cell like synovial, siderophages, foam, inflammatory and multinucleate giant cells. The major etiological factors that induce development of this tumor could be traumatic, inflammatory, metabolic or neoplastic disease.

Conclusion

although it is a sporadic finding, giant cell tumors of the tendon sheath might affect the lower limb in children. Complete excision is the main modality of treatment.

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A giant cell tumor of tendon sheath is a painless benign soft tissue tumor.

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There are only a few cases that have been reported in the feet of children.

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In this study a case of giant cell tumor of tendon sheath in a 5-year-old child discussed.

Pediatric Tenosynovial Giant Cell Tumor of the Flexor Hallucis Longus Tendon Sheath: A Case Report

CASE

An otherwise healthy 13-year-old girl presented with a firm nodule on the plantar right forefoot that was tender after cheerleading. Initial workup was unremarkable, but magnetic resonance imaging revealed a multilobulated mass surrounding the flexor hallucis longus tendon. Surgical resection revealed a tenosynovial mass without tendon infiltration. Pathologic examination was consistent with tenosynovial giant cell tumor. The patient resumed cheerleading and remained asymptomatic after 1 year.

CONCLUSION

As far as we know, this is the first report of a tenosynovial giant cell tumor of the flexor hallucis longus in a pediatric patient; it illustrates the importance of considering this lesion when diagnosing a pediatric plantar mass.

Endoscopic resection of a localized tenosynovial giant cell tumor causing posterior ankle impingement in a 15-year-old athlete: A case report

Tenosynovial giant cell tumor (TGCT) is a systematically benign but locally aggressive lesion arising from the synovium, tendon sheath or joint bursae. Even in athletes, soft tissue tumors may be the underlying reason or a component of posterior ankle impingement, although the most common mechanism is forceful and repetitive plantar flexion. In this article, we present a case of localized TGCT in a 15-year-old female patient presenting with symptoms of posterior ankle impingement. The preferred technique for treatment was complete local resection via posterior ankle endoscopy. The patient returned to sports at three months and no recurrence was observed on the last follow-up at the first postoperative year. Although rare, soft tissue tumors should be taken into consideration in posterior ankle impingement in athletes. Such benign soft tissue tumors in the posterior ankle can be treated safely and effectively via two-portal posterior endoscopic approach.

Giant Cell Tumor of Tendon Sheath and Tendinopathy as Early Features of Early Onset Sarcoidosis

Giant cell tumor of tendon sheath (GCTTS) is characterized by diffuse proliferation of synovial-like cells and multinucleated giant cells along tendon sheaths. This benign tumor typically presents in the third to fourth decade of life and is exceeding rare in children. Here we describe a case of a 10-years-old girl with a history of soft tissue swelling involving the third digit of left hand, bilateral wrists and ankles. Pathology of the finger mass revealed abundant multinucleated giant cells consistent with GCTTS. Resection of the tendinous masses from the ankles also showed multinucleated giant cells along with chronic bursitis. She began to show features of polyarticular arthritis by age 7. Due to progression of arthritis, whole exome sequencing was performed and found a de novo heterozygous mutation in NOD2 (p. R334Q). This variant is the most common mutation responsible for early onset sarcoidosis (EOS)/Blau syndrome, an autoinflammatory disease characterized by granulomatous inflammation of joints, skin and eyes. The early onset of symptoms and presence of multinucleated giant cells and granuloma in this case are in keeping with a diagnosis of EOS/Blau syndrome. The patient responded well to treatment with methotrexate and etanercept. This case extends the clinical spectrum of EOS/Blau syndrome, which should be considered for GCTTS and other unusual presentations of tendon inflammation in children, even in the absence of the characteristic triad of arthritis, dermatitis and uveitis.

Giant Cell Tumor of Tendon Sheath in the Hand Affecting Children: Clinical and Radiological Findings, Histological Diagnosis and Treatment

Introduction

Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor, originating from proliferation of the synovial cells of a tendon sheath. It is very rare within the pediatric population.

Case Report

In this case presentation, we describe two cases of GCTTS in the hand, in a 7-year-old female and a 6-year-old male.

Conclusion

GCTTS occurs very uncommonly in children. It is difficult to accurately diagnose on clinical examination and radiological investigation alone, and thorough and complete excision is important to avoid recurrence of the lesion. The two cases presented in this report help further define this condition, in terms of diagnosis and management, in the pediatric population.

Tenosynovial Giant Cell Tumors in Children: A Similar Entity Compared With Adults

BACKGROUND

Tenosynovial giant cell tumor (TGCT) is a rare, benign, monoarticular entity. Many case-series in adults are described, whereas TGCT is only incidentally reported in children. Therefore, its incidence rate and natural history in children are unknown.

QUESTIONS/PURPOSES

(1) How many cases have been reported of this condition, and what were their characteristics? (2) What is the standardized pediatric incidence rate for TGCT? (3) Is there a clinical difference in TGCT between children and adults? (4) What is the risk of recurrence after open resection in children compared with adults?

METHODS

Data were derived from three sources: (1) a systematic review on TGCT in children, seeking sources published between 1990 and 2016, included 17 heterogeneous, small case-series; (2) the nationwide TGCT incidence study: the Dutch pediatric incidence rate was extracted from this nationwide study by including patients younger than 18 years of age. This registry-based study, in which eligible patients with TGCT were clinically verified, calculated Dutch incidence rates for localized and diffuse-type TGCT in a 5-year timeframe. Standardized pediatric incidence rates were obtained by using the direct method; (3) from our nationwide bone and soft tissue tumor data registry, a clinical data set was derived. Fifty-seven children with histologically proven TGCT of large joints, diagnosed and treated between 1995 and 2015, in all four tertiary sarcoma centers in The Netherlands, were included. These clinically collected data were compared with a retrospective database of 423 adults with TGCT. Chi-square test and independent t-test were used to compare children and adults for TGCT type, sex, localization, symptoms before diagnosis, first treatment, recurrent disease, followup status, duration of symptoms, and time to followup. The Kaplan-Meier method was used to evaluate recurrence-free survival at 2.5 years.

RESULTS

TGCT is seldom reported because only 76 pediatric patients (39 female), 29 localized, 38 diffuse, and nine unknown type, were identified from our systematic review. The standardized pediatric TGCT incidence rate of large joints was 2.42 and 1.09 per million person-years in localized and diffuse types, respectively. From our clinical data set, symptoms both in children and adults were swelling, pain, and limited ROM with a median time before diagnosis of 12 months (range, 1-72 months). With the numbers available, we did not observe differences in presentation between children and adults in terms of sex, symptoms before diagnosis, first treatment, recurrent disease, followup status, or median time to followup. The 2.5-year recurrence-free TGCT survival rate after open resection was not different with the numbers available between children and adults: 85% (95% confidence interval [CI], 67%-100%) versus 89% (95% CI, 83%-96%) in localized, respectively (p = 0.527) and 53% (95% CI, 35%-79%) versus 56% (95% CI, 49%-64%) in diffuse type, respectively (p = 0.691).

CONCLUSIONS

Although the incidence of pediatric TGCT is low, it should be considered in the differential diagnosis in children with chronic monoarticular joint effusions. Recurrent disease after surgical treatment of this orphan disease seems comparable between children and adults. With targeted therapies being developed, future research should define the most effective treatment strategies for this heterogeneous disease.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Giant cell tumor of the tendon seath of the tendinous insertion in pes anserinus

A 56-year-old woman with a palpable lump in the medial surface of her left knee was referred for diagnostic workup with magnetic resonance imaging. The lesion was pathogically confirmed to be a giant cell tumor of the tendon seath. The MR features of the lesion are presented.

Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

Giant cell tumor of tendon sheath is one of the most common soft tissue tumors of the hand. These tumors typically occur in the third or fourth decade of life and present as solitary nodules on a single digit. Currently, the greatest reported number of lesions found within a single digit is five. Although uncommon, giant cell tumor of tendon sheath does occur in the pediatric population. Herein we present a report of a rare case of GCTTS in a child in which seven lesions were identified within a single digit—the greatest number of lesions within a single digit reported to date.

Nerve-Adherent Giant Cell Tumors of Tendon Sheath: A New Presentation

BACKGROUND

Tenosynovial giant cell tumors are a group of slowly growing benign neoplasms of synovial membrane of joints, tendons, and bursae. The localized type or giant cell tumor of tendon sheath (GCTTS) is the extra-articular form of tenosynovial giant cell tumors. We describe two patients with a GCTTS, confirmed histologically at the time of surgical resection, that was adherent to peripheral nerves. Rare GCTTS can cause extrinsic compression of major nerves.

CASE DESCRIPTIONS

The first patient was a 36-year-old man with a left wrist mass associated with pain and paresthesia in the radial three digits. On ultrasound and magnetic resonance imaging (MRI), the mass appeared arising from the left median nerve with a picture suggestive of an atypical neurogenic tumor; however, the possibility of GCTTS could not be excluded. Intraoperatively, the tumor was adherent to the median nerve without a connection to nearby intercarpal joints. The second patient was a 25-year-old woman with a history of malignant melanoma and an incidentally discovered mass on routine follow-up. MRI of the pelvis showed an ovoid mass related to the right sciatic nerve. The MRI picture was suggestive of a GCTTS, although a benign neurogenic tumor was favored given the anatomic relation to the sciatic nerve. Intraoperatively, the tumor appeared as a nodule implanted on the nerve, and it was easily peeled off.

CONCLUSION

We present a new, rare presentation of GCTTS adherent to peripheral nerves with extrinsic compression. We suggest either an implantation mechanism or an unrecognized extrasynovial origin for such tumors.

Primary Tumors of the Foot and Ankle

Tumors of the foot and ankle are rarely encountered in the general patient population. Even among studies of tumor patients, foot and ankle neoplasms are uncommon. Given the weight-bearing demands of the foot and its relatively small area, even small masses are likely to be symptomatic and/or palpable to both patient and physician. Only 3% of osseous neoplasms are found in this region, while 8% of benign soft tissue tumors and 5% of malignant soft tissue tumors are localized to the foot and ankle. Despite the rarity of presentation, it is important for orthopaedic surgeons to be familiar with the diagnostic criteria and therapeutic options for these patients, as each tumor varies in its presentation, level of aggressiveness, and natural history of the disease. With appropriate diagnostic tests and treatment, patients can anticipate a reasonable chance of survival and preservation of function. In this review article, the authors survey the current literature regarding the presentation, diagnostic workup, and treatment for the most common benign and malignant tumors of the foot and ankle.

LEVELS OF EVIDENCE

Level IV: Literature Review.

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

INTRODUCTION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

A case of recurring multifocal giant cell tumour of the tendon sheath in a child

Giant cell tumour of the tendon sheath is rare in children. We present an unusual case of a recurring multifocal giant cell tumour of the tendon sheath in the hand and wrist of an 11-year-old boy. We are not aware of any similar report in the literature.

Benign soft tissue tumors in children

Soft tissue masses in children are common, yet can pose a diagnostic dilemma for the orthopedic surgeon who is asked to evaluate them. Although most lesions are dysplastic or benign, some soft tissue sarcomas are seen in the pediatric population. An understanding of the clinical presentation and imaging findings can guide the surgeon decide on the need for a biopsy and formulate an appropriate treatment plan.

Giant cell tumor of the tendon sheath mimicking a primary intramedullary metatarsal tumor

Giant cell tumor of the tendon sheath (GCTTS) is one of the most common benign soft tissue tumors in the extremities, and is frequently associated with bone abnormalities. Although extrinsic bone erosion is the most common bone abnormality associated with GCTTS, intraosseous invasion of GCTTS occurs rarely and may mimic a primary bone tumor, making diagnosis more challenging. We report an unusual imaging presentation of GCTTS mimicking a primary intramedullary metatarsal tumor and review the literature on the frequency of bone involvement of GCTTS.

Radiation therapy for infiltrative giant cell tumor of the tendon sheath

PURPOSE

Giant cell tumor of the tendon sheath (GCTTS) has a high recurrence after excision and can be a management challenge. Although experience with radiation therapy for GCTTS is limited, it is purported to control infiltrative cases and prevent recurrence. We describe our approach to primary and recurrent GCTTS, as well as our identification of infiltrative cases and their treatment with radiation therapy.

METHODS

We reviewed 58 patients (32 men and 26 women) with GCTTS in the hand excised at 1 center between 1998 and 2009. Mean age at the time of excision at our center was 50 years. A total of 14 patients who had undergone primary excision at other centers were referred to our center with recurrent disease. Intraoperatively, we found infiltrative disease in 4 patients undergoing primary excision at our center and in 10 of the 14 patients referred to our institution with recurrent disease. All infiltrative (4 primary and 10 recurrent) cases were referred for radiation therapy.

RESULTS

Of 14 patients with infiltrative tumors, 10 received radiation therapy (3 patients declined and 1 had a major comorbidity that precluded therapy). Radiation dose was either 35 Gy in 14 fractions or 48 Gy in 24 fractions. At 3.1 years' follow-up, none of the 10 patients treated with radiation therapy had recurrence. No long-term complications were associated with radiation therapy, and hand function was not adversely affected. We identified 4 recurrences, 2 of which were in patients with primary tumors without infiltrative features. Of the 4 patients who were referred for radiation but did not receive it, 2 patients developed recurrence by 2 years after referral.

CONCLUSIONS

In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function. Radiation therapy may be particularly helpful when further surgery is not a good option.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

GIANT CELL TUMOURS OF TENDON SHEATH OF HAND: CAUSES AND STRATEGIES TO PREVENT RECURRENCE

Giant cell tumours of tendon sheath of hand present a surgical dilemma due to their high incidence of local recurrence. We present a case series of 46 patients with 47 histologically confirmed giant cell tumours of tendon sheath over a ten-year period from 1998 to 2008. The mean follow-up was 47 months (range 25–124 months). We identified tumours with bony erosions and piecemeal resections as predictors of recurrence. Our recurrence rate of 9% was at the lower end of spectrum of previously published reports (range 7%–44%). We recommend "en-masse" excision of these tumours. All the patients with suspicion of these tumours should have preoperative radiographs to identify erosions. A thorough curettage of the bone should be done in cases with osseous erosion to prevent recurrence. Patients with these risk factors should be followed up annually for five years and be warned about recurrence.

Giant cell tumor of tendon sheath: case series and review of literature

Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10-53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.

Imaging of giant cell tumour of the tendon sheath

Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.

Giant cell tumor of the tendon sheath in the knee of an 11-year-old girl

Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.

Imaging of soft tissue lesions of the foot and ankle

Differential diagnosis of soft tissue lesions of the foot can be narrowed with imaging. The cystic nature of ganglia, synovial cysts, and bursitis can be confirmed with MR imaging or sonography. Location and signal characteristics of noncystic lesions can suggest Morton's neuroma, giant cell tumor of tendon sheath, and plantar fibromatosis. Synovial-based lesions of the foot and ankle can be differentiated based on presence or absence of mineralization, lesion density, signal intensity, and enhancement pattern. Knowledge of the incidence of specific neoplasms of the foot and ankle based on patient age aids in providing a limited differential diagnosis.

Giant cell tumor of the rib occupying the entire hemithorax

The authors report the case of a 28-year-old female patient with a giant cell tumor originating from the rib. The tumor, measuring 25 x 17 cm, occupied the entire hemithorax and caused atelectasis of the left lung. This tumor was a benign mesenchymal neoplasm, which rarely affects the ribs. A thoracotomy involving en bloc resection of the chest wall and tumor was performed. Despite the large dimensions of the tumor, complete resection was possible, and lung function was restored.

The value of sonography in diagnosing giant cell tumors of the tendon sheath

OBJECTIVE

The purpose of this study was to evaluate the diagnostic value of sonography in giant cell tumors of the tendon sheath.

METHODS

Sonographic findings and other clinical records were retrospectively reviewed and analyzed in 30 patients (45 lesions) with pathologically proven giant cell tumors of the tendon sheath. The sonographic findings were compared with those found at surgery.

RESULTS

The locations of the tumors included the hand (53.33%), wrist (10%), elbow (3.33%), knee (10%), and foot (23.33%). The sizes of the tumors ranged from 0.4 to 8 cm, with a mean size of 2.6 cm. All the lesions were shown as hypoechoic nodules with homogeneous or heterogeneous echogenicity. Thirty-two lesions (71.11%) had substantial flow, and 13 lesions (28.89%) had minimal flow. Thirty-four lesions were in contact with the tendon sheath; 5 were in contact with the joint; and 6 were in contact with both the tendon sheath and the joint. Bone erosions were found in 4 cases, and bone impressions were found in another 3 cases.

CONCLUSIONS

Sonography can provide exact information about a tumor and its relationship with the surrounding tissue, which indicates that it can be used as the first method to diagnose a giant cell tumor of the tendon sheath.