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Kolisetty PV, Ali SS, Ahmad I, Sudhy IK, Prakash O, Kishore YR. Giant Cell Tumor of the Tendon Sheath of the Hand: Analysis of Factors Impacting Recurrence. Indian J Plast Surg 2024; 57:123-128. [PMID: 38774731 PMCID: PMC11105819 DOI: 10.1055/s-0044-1779657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Background Giant cell tumors of the tendon sheath (GCTTS) of the hand are considered the second most common benign tumors of the hand after ganglion cysts. Excision biopsy is considered the standard treatment at present. They are notorious for having a very high rate of recurrence as given in many studies. Many factors are said to be associated with recurrence of the tumors. The goal of this study is to evaluate the long-term results of a series of 48 patients operated on at a single institute and to find out if there is any correlation between the proposed risk factors with recurrence. Methods A retrospective analysis was done in cases of GCTTS operated on between 2015 and 2021. The patients were invited for follow-up for a minimum of 2 years, and the patient files were reviewed. Further data were collected at follow-up including recurrence, range of movement, sensation, skin necrosis, scarring, and digital neuropathy. A data analysis was done. The correlation between the proposed risk factors and recurrence was calculated with the Pearson correlation coefficient. A p -value of less than 0.05 was considered statistically significant. Results During the 6 years, 48 patients were operated on. Recurrence was observed in eight patients (16%) at an average of 38.7 months from the time of surgery. Of the risk factors, tumors with satellite nodules and tumor adjacency to joint correlated significantly with recurrence. No complications were observed during follow-up. Conclusion GCTTS of the hand has a high propensity to recur. The presence of satellite nodules and proximity to interphalangeal joints are two important risk factors for recurrence. Magnification during surgery ensures complete excision of the tumor and reduces the chance of recurrence.
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Affiliation(s)
- Pavan Venkateswar Kolisetty
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sheikh Sarfraz Ali
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Imran Ahmad
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Indrajith K. Sudhy
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Om Prakash
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Y. Ranga Kishore
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Khurana A, Singh JP, Preeti, Littlefield Z, Young S, Shah A. Demystifying Giant Cell Tumours of Tendon Sheath (GCTTS): A Case Series of 18 Cases with Review of Literature. Indian J Orthop 2023; 57:1858-1873. [PMID: 37881282 PMCID: PMC10593659 DOI: 10.1007/s43465-023-00990-8] [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: 02/25/2022] [Accepted: 08/29/2023] [Indexed: 10/27/2023]
Abstract
Background The giant cell tumour of the tendon sheath (GCTTS) is the second most frequent soft tissue tumour affecting the hand. No consensus exists on the etiology, prognostic factors, or recurrence rate of GCTTS. This article presents a series of 18 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of GCTTS. Methods A total of 18 patients with a histo-pathological diagnosis of a GCTTS of the hand or finger were reviewed. The location for the tumour was limited to the wrist and hand. All cases were operated under Wide Awake Local anaesthesia (WALANT), and using a magnifying loupe. Results A total of 18 patients presented at our institution with a diagnosis of GCTTS from 2016 to 2018. Of the 18 patients, 11 were female and 7 were male. The mean age of included patients was 43.6 years (31-59 years). The most common site for the lesion was the middle finger (4/18), followed by the index finger, wrist, and thumb (3/18 each). The little and ring finger were least commonly affected with one case each. The mean size of the tumour was 2.4 cm (0.5-5 cm). None of the patients reported recurrence of the lesion on an average follow-up of 18.8 months. Conclusion GCTTS is a benign, slowly growing lesion of the hand that typically does not cause any symptoms and is treated with surgical resection. Meticulous excision of the GCTTS using magnification loupes to ensure appropriate wide excision of the tumour is the treatment of choice to prevent a recurrence. In addition, a radiographic and histopathological examination must be performed on the tumour to rule out other diagnoses. Finally, the function of the hand should be reconstructed to minimize the loss of any functional unit.
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Rohini, New Delhi, Delhi India
| | - J. P. Singh
- Department of Surgery, ESIC Hospital Rohini, New Delhi, Delhi India
| | - Preeti
- Department of Pathology, ESIC Hospital Rohini, New Delhi, Delhi India
| | | | - Sean Young
- Department of Orthopaedics, UAB School of Medicine, Alabama, USA
| | - Ashish Shah
- Department of Orthopaedics, UAB School of Medicine, Alabama, USA
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Zhuang N, Lyu H, Zhao C, Zhang Y, Dong L, Luo H, Tian Y, Xie L, Wu W, Liu L, Sun D, Xie H. Ultrasound features and differential diagnosis for superficial nodular fasciitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1370-1375. [PMID: 37602559 DOI: 10.1002/jcu.23542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Nodular fasciitis (NF) has nonspecific clinical manifestations and is often misdiagnosed as sarcoma. The investigations of imaging methods for NF were limited. OBJECTIVE To analyze the ultrasound (US) features of NF, and to evaluate the diagnostic value of US for NF. MATERIALS AND METHODS A total of 61 NF patients were recruited retrospectively, and 551 lesions in the subcutaneous fat layer were included for comparison. We evaluated the ultrasound features of the patients and divided the NF cases into three types. Chi-square test or Fisher exact test were conducted to detect the potential difference in the distributions of three types in the two groups. RESULTS Among the 61 NF cases, 65.6% were in the upper extremities (n = 40). The proportion of type 1, 2, and 3 were 57.4%, 24.6%, and 18.0%, respectively. NF were significantly more likely locating in the upper extremities than the other soft tissue tumors (p < 0.001). Type 1 and type 2 of sonographic features were significantly more commonly observed in NF than other soft tissue tumors among the three types (p < 0.001). CONCLUSION The type 1 and type 2 of US features can help to distinguish NF from other lesions. US has great potential to improve the diagnostic accuracy and reduce the unnecessary surgery.
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Affiliation(s)
- Nan Zhuang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Heng Lyu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yusen Zhang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Licong Dong
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haiyu Luo
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yun Tian
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lu Xie
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wangjie Wu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - HaiQin Xie
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
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Du X, Xia A, Sun J, Ye Y. Localized tenosynovial giant cell tumor in children. J Child Orthop 2023; 17:420-427. [PMID: 37799313 PMCID: PMC10549694 DOI: 10.1177/18632521231186795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 10/07/2023] Open
Abstract
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.
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Affiliation(s)
| | - Anning Xia
- Anning Xia, Department of Orthopedics, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China.
| | - Junying Sun
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yinting Ye
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
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AlShamsi M, AlDhamin A. Tumoral calcinosis in the extensor indicis proprius tendon: A case report. Clin Case Rep 2023; 11:e7541. [PMID: 37397572 PMCID: PMC10307994 DOI: 10.1002/ccr3.7541] [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: 03/23/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Tumoral calcinosis is a rare clinicopathological entity characterized by the presence of calcified deposits in the periarticular soft tissue. Commonly affecting the hips, buttock, shoulders, and elbow, and less commonly in hands, wrists, and feet. We present a novel case of tumoral calcinosis in a 4-year-old female with an atraumatic wrist swelling for 2 months. It was a diagnostic enigma for the surgeon due to the peculiar site of presentation. However, with the help of a pathologist, we diagnosed and successfully treated tumoral calcinosis of the extensor indicis proprius tendon.
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Burke CJ, Fritz J, Samim M. Musculoskeletal Soft-tissue Masses. Magn Reson Imaging Clin N Am 2023; 31:285-308. [PMID: 37019551 DOI: 10.1016/j.mric.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Evaluation of soft-tissue masses has become a common clinical practice indication for imaging with both ultrasound and MR imaging. We illustrate the ultrasonography and MR imaging appearances of soft-tissue masses based on the various categories, updates, and reclassifications of the 2020 World Health Organization classification.
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Affiliation(s)
- Christopher J Burke
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA.
| | - Jan Fritz
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
| | - Mohammad Samim
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
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Aden D, Khalid S, Zaheer S, Dinkar AK, Singh M, Ranga S. FNAC
study of giant cell tumor of tendon sheath (localized tenosynovial giant cell tumor): Clinico‐radiological correlation and cytopathological features. Diagn Cytopathol 2022; 50:543-556. [DOI: 10.1002/dc.25033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/14/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Durre Aden
- Department of Pathology VMMC and Safdarjang Hospital New Delhi India
| | - Saifullah Khalid
- Department of Radiology, Jawaharlal Nehru Medical College AMU Aligarh India
| | - Sufian Zaheer
- Department of Pathology VMMC and Safdarjang Hospital New Delhi India
| | - Amit Kumar Dinkar
- Department of Pathology VMMC and Safdarjang Hospital New Delhi India
| | - Mukul Singh
- Department of Pathology VMMC and Safdarjang Hospital New Delhi India
| | - Sunil Ranga
- Department of Pathology VMMC and Safdarjang Hospital New Delhi India
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Giant cell tumor of the tendon sheath in a 5-year-old child; A case report. Ann Med Surg (Lond) 2021; 69:102599. [PMID: 34429941 PMCID: PMC8371222 DOI: 10.1016/j.amsu.2021.102599] [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: 05/10/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022] Open
Abstract
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. A giant cell tumor of tendon sheath is a painless benign soft tissue tumor. There are only a few cases that have been reported in the feet of children. In this study a case of giant cell tumor of tendon sheath in a 5-year-old child discussed.
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Singh JP, Kumar S, Kathiria AV, Harjai R, Jawed A, Gupta V. Thumb ultrasound: Technique and pathologies. Indian J Radiol Imaging 2021; 26:386-396. [PMID: 27857468 PMCID: PMC5036340 DOI: 10.4103/0971-3026.190408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.
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Affiliation(s)
- Jatinder P Singh
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Shwetam Kumar
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Atman V Kathiria
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Rachit Harjai
- Department of Imaging and Nuclear Medicine, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Akram Jawed
- Bone and Joint Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Vikas Gupta
- Bone and Joint Institute, Medanta, The Medicity, Gurgaon, Haryana, India
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Balaban M, Cilengir AH, Idilman IS. Evaluation of Tendon Disorders With Ultrasonography and Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1267-1286. [PMID: 33078869 DOI: 10.1002/jum.15520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
The frequency of musculoskeletal system ultrasonography (US) has increased over time. The most common reason for musculoskeletal US is the evaluation of tendons. The superficial location of tendons makes US the most suitable diagnostic tool, and US is generally the initial imaging modality for tendon disorders. The primary advantages of US are its low cost, easy accessibility, rapidity, repeatability, freedom from x-rays, and enabling of a dynamic inspection. In addition, Doppler US and elastography can be performed simultaneously with US. We aimed to demonstrate the US and elastographic findings of tendon disorders that we frequently encounter in different regions.
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Affiliation(s)
- Mehtap Balaban
- Department of Radiology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | | | - Ilkay S Idilman
- Department of Radiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Giant Cell Tumor of the Tendon Sheath in a Male Pediatric Patient. J Pediatr Health Care 2021; 35:430-434. [PMID: 33386197 DOI: 10.1016/j.pedhc.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022]
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Teh J, Shahabpour M, Drape JL, Feydy A, Sudoł-Szopińska I, Vanhoenacker FM. Hand Masses. Semin Musculoskelet Radiol 2021; 25:216-231. [PMID: 34082448 DOI: 10.1055/s-0041-1724017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hand and wrist soft tissue masses may be classified as pseudotumors, benign neoplasms, or malignant neoplasms. The vast majority of hand lesions are benign. Consideration of the location of the lesion and its imaging characteristics often leads to a specific diagnosis. Pseudotumors discussed in this article are ganglion cysts, accessory muscles, and inflammatory lesions. True tumors are described according to their tissue type: nerve sheath tumors, adipocytic tumors, so-called fibrohistiocytic tumors, pericytic tumors, and vascular lesions. We also outline the imaging features of masses encountered in the hand and wrist.
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Affiliation(s)
- James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, United Kingdom
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Antoine Feydy
- Department of Radiology, Cochin Hospital, Paris, France
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Córdoba-Fernández A, Sánchez-Robles LJ, Lobo-Martín A. Tenosynovial Giant Cell Tumor in the Forefoot: Two Case Reports and Literature Review. J Am Podiatr Med Assoc 2021; 111:466712. [PMID: 34144588 DOI: 10.7547/20-089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tenosynovial giant cell tumor is the common term used to describe a group of soft-tissue tumors that share a common etiologic link. These tumors are relatively infrequent in the foot and ankle, and occasionally they may be the cause of destruction of the adjacent bone structures. We report the imaging appearance and pathologic findings of two patients with localized tenosynovial giant cell tumor of the forefoot. Both of these patients underwent surgical gross total resection. However, one of the patients experienced a recurrence. Their clinical, radiologic, and pathologic features, with their treatment protocol, are summarized retrospectively, and related literature is reviewed in an attempt to enhance the understanding of these tumor lesions. Clinicians should perform a careful preoperative and postoperative examination and complete tumor surgical resection with the aim of reducing local recurrence.
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MRI evaluation of solid soft tissue masses of the fingers with pathology correlation. Eur J Radiol 2020; 135:109465. [PMID: 33341071 DOI: 10.1016/j.ejrad.2020.109465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Space occupying lesions of the fingers are commonly encountered in clinical and radiology practice. The objective of this study was to determine the characteristics of these lesions on MRI and to correlate with surgical pathology results. MATERIAL AND METHODS This IRB-approved HIPAA-compliant study retrospectively evaluated the clinical, imaging and pathology findings of 100 consecutive patients referred for evaluation of solid soft tissue masses of the fingers. Only solid lesions with MR imaging prior to surgery were included in this study. MR images and when available corresponding radiographs were evaluated by two radiologist in regard to signal characteristics, relation to surrounding structures and enhancement. All masses were classified into different groups based on pathology results. RESULTS Tenosynovial giant cell tumor (TSGCT) and fibroma of the tendon sheath were the most common solid tumors (36 %) and malignant tumors represent only 5% of the cohort. 70 % of masses with low T2 signal were TSGCT and fibroma of tendon sheath; 100 % of masses with peripheral high T2 signal and central low T2 signal/thrombus were vascular lesions, representing 41 % of the total vascular lesions in the cohort. Additionally, 100 % of serpiginous/tubular shaped masses were vascular lesions and 67 % of masses with infiltrative borders were malignant masses. Enhancement was important in identifying solid lesions but there was no statistical difference between groups related to enhancement pattern. There was a good agreement for all analyses between both readers. CONCLUSION Typical MR findings can help to narrow the differential diagnosis in the evaluation of finger masses and provide crucial information to guide further management.
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15
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Muthu S, Annamalai S, Thakur A, Ramakrishnan E. Recurrence-free management of type 2 variant of giant cell tumour of extensor tendon sheath of thumb. BMJ Case Rep 2020; 13:13/10/e235762. [PMID: 33122225 PMCID: PMC7597518 DOI: 10.1136/bcr-2020-235762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 30-year-old woman presented with swelling in her right thumb of 3-month duration which was slow-growing in nature without a history of trauma. On examination, firm non-tender swelling with ill-defined border over the dorsomedial aspect of the first metacarpal was noted. The swelling was mobile only in the vertical plane with restricted adduction and abduction. Plain X-ray revealed mild erosion of the first metacarpal head. Diagnostic ultrasound confirmed the lesion to arise from the extensor tendon sheath of diffuse type without any bony involvement. A wide local excision biopsy of the swelling was planned. Intraoperatively, a 3×2 cm greyish-white mass, bony hard in consistency with lobulated surface was found arising from the tendon sheath of the extensor tendon of the thumb; it was completely excised with a wide margin. Histopathological examination revealed polyhedral cells admixed with osteoclastic type giant cells. Biopsy from the first metatarsal was normal. The patient is on follow-up for the last 5 years with no evidence of recurrence.
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Affiliation(s)
- Sathish Muthu
- Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Saravanan Annamalai
- Institute of Orthoapaedics & Traumatology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Aditya Thakur
- Institute of Orthoapaedics & Traumatology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Eswar Ramakrishnan
- Institute of Orthoapaedics & Traumatology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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Kang JH, Lee K, Yoo HJ, Chae HD, Hong SH, Choi JY. Ultrasound and Magnetic Resonance Imaging Features of Calcifying Aponeurotic Fibromas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1299-1306. [PMID: 31944358 DOI: 10.1002/jum.15222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To report characteristic imaging findings of calcifying aponeurotic fibromas (CAFs) on ultrasound (US) and magnetic resonance imaging (MRI). METHODS Eight patients with CAF based on our institutional pathology database from 2000 to 2019 were consecutively included. Images were assessed as follows: with plain radiographs for the presence of soft tissue calcifications; with US for the presence of microlithiasis (a nonshadowing hyperechoic focus <3 mm) and discrete calcifications, size, location, margin, echogenicity, and relationship with surrounding structures; and with MRI for the presence of MRI microlithiasis (scattered tiny signal-void dots), margin, signal intensity, contrast enhancement pattern, and relationship with surrounding structures. RESULTS Calcifying aponeurotic fibromas occurred most commonly in the foot (n = 5), followed by the hand, ankle, and knee, respectively. Half of the lesions (n = 4) showed intralesional calcifications on plain radiographs. On US, all lesions showed microlithiasis. They involved the subcutaneous (n = 5), perifascial (n = 2), and intermuscular (n = 1) layers. Margins were circumscribed (n = 3) or irregular (n = 5), whereas the echogenicity of the underlying tumor matrix was hyperechoic (n = 4), isoechoic (n = 2), or hypoechoic (n = 2). All lesions were abutting (n = 7) or encasing (n = 1) an adjacent tendon. On MRI, all CAFs showed tiny signal-void dots and irregular margins. Signal intensity was mostly hyperintense (n = 5) on T2-weighted images and all hypointense on T1-weighted images. Three lesions showed heterogeneous contrast enhancement, and 3 showed uneven marginal enhancement. CONCLUSIONS A CAF should be considered a differential diagnosis if a soft tissue mass abutting or encasing the tendon or fascia shows US or MRI microlithiasis.
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Affiliation(s)
- Ji Hee Kang
- Departments of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kyoungbun Lee
- Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hye Jin Yoo
- Departments of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hee Dong Chae
- Departments of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Hwan Hong
- Departments of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ja-Young Choi
- Departments of Radiology, Seoul National University Hospital, Seoul, Korea
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Boudier-Revéret M, Wu CH. What Could This Volar Thumb Mass Be? J Med Ultrasound 2020; 28:52-53. [PMID: 32368453 PMCID: PMC7194427 DOI: 10.4103/jmu.jmu_116_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.
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Affiliation(s)
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Abstract
Imaging studies of the hands and fingers are common, and radiologists are generally comfortable with traumatic and degenerative conditions which arise frequently in daily practice. However, a variety of common and uncommon soft-tissue tumors also occur in the hand, the appropriate diagnosis of which can be a source of confusion for both clinicians and radiologists. These lesions often have overlapping imaging characteristics; however, a structured approach can help provide a focused differential diagnosis and impact further workup and management. We discuss several such tumors, categorizing them as cystic-appearing, noncystic masses along tendons and aponeuroses, adipocytic tumors, vascular lesions, and miscellaneous lesions with imaging features that can aid diagnosis.
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Affiliation(s)
| | - Jeffrey Bonham
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Anthony Chang
- Department of Radiology, Sharp Rees Stealy Medical Group, San Diego, CA, USA
| | - Stephen Thomas
- Department of Radiology, University of Chicago, Chicago, IL, USA
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Jang Y, Kang BS, Bang M, Lim S, Park GM, Lee TY, Kwon WJ. Ganglion cysts developed from the flexor tendon sheaths in the fingers: Clinical and sonographic features. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:9-13. [PMID: 31774183 DOI: 10.1002/jcu.22793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to assess the clinical and sonographic features of flexor tendon sheath ganglion cysts in the fingers. METHODS We retrospectively reviewed the clinical and sonographic features of 35 cases of flexor tendon sheath ganglion cysts in the fingers in 34 patients that were pathologically confirmed between 2003 and 2018. RESULTS The mean age of the patients was 44.2 years (range, 11-73 years). Lesions were located at the level of the metacarpophalangeal joint (n = 22 [63%]) and proximal phalanx (n = 11 [31%]), and involvement of the third finger was common (n = 19 [54%]). The mean lesion size was 6 mm and the mean volume was 90 mm3 . None of the lesions had a pedicle. Lesions were homogeneous (n = 24 [69%]) and anechoic (n = 23 [66%]). A septum was noted in 12 cases (34%). CONCLUSIONS Flexor tendon sheath ganglion cysts are most commonly located in the third finger and at the level of the metacarpophalangeal joint and proximal phalanx. It usually presents as a simple cyst without a pedicle, but occasionally exhibits a mixed echogenicity and contains a septum.
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Affiliation(s)
- Yeonjung Jang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Byeong S Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Minseo Bang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Soyeoun Lim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Gyeong M Park
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Tae Y Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Woon J Kwon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
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Ashikyan O, Chalian M, Moore D, Xi Y, Pezeshk P, Chhabra A. Evaluation of giant cell tumors by diffusion weighted imaging-fractional ADC analysis. Skeletal Radiol 2019; 48:1765-1773. [PMID: 31001688 DOI: 10.1007/s00256-019-03219-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 04/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A single ADC value is used in clinical practice on multi b-value acquisitions. Low b-value acquisitions are affected by intravoxel incoherent motion, which is dependent on perfusion. Giant cell tumors (GCTs) are known to exhibit early arterial enhancement and low ADC values. Mean, minimum and fractional ADC characteristics of osseous and tenosynovial GCTs are systematically evaluated. METHODS Tenosynovial and osseous GCTs were included. Each lesion was evaluated on conventional MRI and DWI by two musculoskeletal radiologists. ADC was measured by placing an ROI on the most confluent enhancing portion of the lesion. Fractional and best fit ADC calculations were performed using MATLAB software. RESULTS No statistically significant difference was found between tenosynovial and osseous lesions' ADC values. Mean ADC for all lesions was 1.0 × 10-3 mm2/s (SD = 0.2 × 10-3 mm2/s) and minimum ADC was 0.5 × 10-3 mm2/s (SD = 0.3 × 10-3 mm2/s). Average mean ADC value obtained from B50-B400 slope was 1.1 × 10-3 mm2/s (SD = 0.2 × 10-3 mm2/s), and the average mean ADC value obtained from B400-B800 slope was 0.8 × 10-3 mm2/s (SD = 0.1 × 10-3 mm2/s) [p-value <0.01]. CONCLUSION Tenosynovial and osseous GCTs demonstrate similar and low ADC values, which become even lower when using high b-value pairs. Our study also supports the theory of intravoxel incoherent motion that becomes apparent at low b values as related to giant cell tumors, which are known to be hyperperfused.
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Affiliation(s)
- Oganes Ashikyan
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA.
| | - M Chalian
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - D Moore
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - Y Xi
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - P Pezeshk
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - A Chhabra
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA.,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Risk Factors Associated With Postoperative Recurrence in Patients With Tenosynovial Giant Cell Tumor of the Hand: A Retrospective Cohort Study. Ann Plast Surg 2019; 83:523-528. [PMID: 31524641 DOI: 10.1097/sap.0000000000001983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Identification of risk factors for recurrence of tenosynovial giant cell tumors of the hand is crucial to provide adequate preoperative counseling and tailor surgical treatment. However, the risk factors are still controversial, which are the subject of this research.Recently, we conducted a retrospective cohort study of 135 consecutive patients with giant cell tumors of the tendon sheath of the hand from January 2010 to July 2016. All patients underwent surgical excision, received necessary imaging examinations, and had routine follow-up and thus were identified as those who had recurrence by confirmation of reoperation, and the duration ranged from 24 to 103 months (mean, 53.5 ± 21.4 months). There were 14 local recurrences (10.4%) within 6 to 24 months, respectively, after surgery. Data pertaining to sex, age, tumor sites, tumor size, tumor number, course of disease, bone erosion, tumor growth patterns, anesthesia mode, and the surgeon's experience were all extracted, and Cox regression models were used to estimate recurrence rate with adjustment for potential confounders.According to the Cox regression analysis, the recurrence rate after surgery was significantly higher in patients with a diffused form than in those with a localized one (P = 0.001); in addition, patients with 2 or more tumors had a much higher postoperative recurrence rate than did those with only 1 tumor (P = 0.023).This study suggested that the recurrence rate of tenosynovial giant cell tumors of the hand was closely related to the tumor number and tumor growth patterns.
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Fawi HM, Dojcinov S, Lyons K, Matthews TJ. Trauma or tumour: giant cell tumour of distal biceps tendon sheath, an unusual cause of elbow pain. Shoulder Elbow 2019; 11:137-139. [PMID: 30936953 PMCID: PMC6434961 DOI: 10.1177/1758573217701064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/28/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
We report the case of a middle-age lady who presented following minor trauma, with dominant-sided anterior elbow pain and swelling of 6 months in duration. She was assessed clinically, and underwent investigations, which confirmed features consistent with giant cell tumour (GCT) of distal biceps tendon sheath. She underwent uneventful en-bloc excisional surgery. She did not have radiotherapy. She is now 5 years postoperatively asymptomatic, with full function, and with no signs of recurrence.
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Affiliation(s)
- Hassan M.T. Fawi
- Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK,Hassan MT Fawi, Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XW, UK.
| | - Stefan Dojcinov
- Department of Cellular Pathology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kathleen Lyons
- Department of Clinical Radiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Timothy J.W. Matthews
- Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
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Lee SM, Ha DH, Kang SH, Kim SW, Choi YR. Desmoplastic fibroblastoma mimicking tenosynovial giant cell tumor encasing a tendon of the foot. Skeletal Radiol 2019; 48:637-641. [PMID: 30229348 DOI: 10.1007/s00256-018-3068-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 02/02/2023]
Abstract
Desmoplastic fibroblastoma is an uncommon, benign fibrous soft tissue tumor that usually occurs in the arms, shoulders, neck, hands, and feet in the fifth to seventh decades of life. In general, it is commonly located in the subcutaneous tissue and skeletal muscle. The authors report an unusual case of a desmoplastic fibroblastoma mimicking tenosynovial giant cell tumor encasing a tendon of the foot in a 72-year-old woman. Ultrasonography revealed an inhomogeneously hypoechoic lobulated soft tissue lesion completely wrapped around the extensor digitorum longus tendon. Color Doppler study revealed increased vascularity in the internal and peripheral portions of the lesion. Magnetic resonance imaging revealed a well-defined, lobulated soft tissue mass encasing the extensor digitorum longus tendon with predominantly isointense signal with some areas of hypointense signal on T1-weighted images, predominantly hyperintense signal with some areas of hypointense signal on T2-weighted images, and inhomogeneous enhancement on fat-suppressed contrast-enhanced T1-weighted images. Surgical excision was performed, and the mass was diagnosed on pathological examination as a desmoplastic fibroblastoma. There has been no previously published radiologic case of a desmoplastic fibroblastoma encasing a tendon of the foot in the literature.
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Affiliation(s)
- Sang Min Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
| | - Doo Hoe Ha
- Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Seung Hun Kang
- Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Se-Wha Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Young Rak Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
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26
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Sirlyn Q, Bird S. Ultrasound of flexor digitorum apparatus in acute and chronic pathology. SONOGRAPHY 2018. [DOI: 10.1002/sono.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kant KS, Manav AK, Kumar R, Abhinav, Sinha VK, Sharma A. Giant cell tumour of tendon sheath and synovial membrane: A review of 26 cases. J Clin Orthop Trauma 2017; 8:S96-S99. [PMID: 29339850 PMCID: PMC5761697 DOI: 10.1016/j.jcot.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 02/04/2023] Open
Abstract
AIM Aim of our study is to highlight the incidence and benign nature of Giant cell tumour of tendon sheath and need for complete removal, thus minimizing the chances of recurrence. MATERIAL AND METHODS A total of 26 cases of Giant cell tumour of tendon sheath operated in the department of Orthopaedics, Patna Medical College & Hospital, Patna from 2003 to 2010 were included in this study. The surgery was performed after clinical evaluation of the lesion and Fine Needle Aspiration Cytology (FNAC). The tumour underwent en bloc marginal excision. The patients were followed up for minimum two year. RESULTS Our study population consisted of 18 females and 8 males. The mean age at the time of surgery was 38.3 years (range, 18-62 years). Twenty three cases were found in the 3rd and 4th decade. Twenty two cases involved upper extremity and only 4 cases in lower extremity. MRI was done in 2 cases where diagnosis was in doubt. Bony indentation on X-ray film was found in 7 cases and thorough curettage of cortical shell was done. All the cases were treated by marginal excision. Three cases developed post-operative stiffness but regained full range of movement with physiotherapy. Sensory impairment was seen in 3 cases. Recurrence occurred in 2 case and they were treated by repeat marginal excision. CONCLUSION Meticulous en-masse marginal excision of the giant cell tumour of tendon sheath in blood less field using magnification is the treatment of choice.
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Affiliation(s)
- Kumar Shashi Kant
- Department of Orthopaedics, Patna Medical College, Patna, India,Corresponding author at: Flat no: 305, Lalti apartment Kali Mandir Road, Hanuman Nagar Kankarbagh, Patna-800020, India.
| | | | - Rakesh Kumar
- Department of Orthopaedics, Patna Medical College, Patna, India
| | - Abhinav
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | | | - Akshat Sharma
- Department of Orthopedics, VMMC & Safdarjang Hospital, New Delhi, India
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Levi M, Crafton J. Rare Giant Cell Tumor of the Distal Flexor Digitorum Longus Tendon Sheath and Early Diagnosis with Use of Magnetic Resonance Imaging. J Am Podiatr Med Assoc 2017; 107:333-336. [PMID: 28880600 DOI: 10.7547/16-163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Giant-cell tumor of the tendon sheath (GCT-TS) is an uncommon occurrence for a foot and ankle surgeon. However, there is a need to recognize the symptoms of typical and atypical presentations of this pathology. These benign neoplasms are recognized clinically as a soft-tissue mass that is usually painless and palpable. The foot and ankle account for only 3% to 5% of all GCT-TS in the body, with most being located in the hand. Giant cell tumor in the tendon sheath occurring in the foot and ankle is usually encountered on the lateral ankle and dorsum of the foot, occupying the extensor tendons. Additionally, it is commonly misdiagnosed clinically. This case study illustrates how early use of magnetic resonance imaging decreased patient morbidity with early recognition and excision of GCT-TS.
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Affiliation(s)
- Michael Levi
- Department of Podiatric Surgery, St. John's Hospital, Santa Monica, California; Western University of Health Sciences, College of Podiatric Medicine, Pomona, California
| | - Jordan Crafton
- College of Podiatric Medicine, Western University of Health Sciences, Pomona California
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Osman W, Alaya Z, Haggui A, Rejeb MB, Jemni S, Naouar N, Ayeche MLB. [Giant cell tumors of the tendon sheaths of the hand: about 50 cases]. Pan Afr Med J 2017; 26:128. [PMID: 28533851 PMCID: PMC5429421 DOI: 10.11604/pamj.2017.26.128.9514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/09/2016] [Indexed: 11/11/2022] Open
Abstract
Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences.
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Affiliation(s)
- Walid Osman
- Service de Chirurgie Orthopédique. Hôpital Sahloul, Sousse, Tunisie
| | - Zeineb Alaya
- Service de Rhumatologie, Hôpital Farhat Hached, Sousse, Tunisie
| | - Ali Haggui
- Service de Chirurgie Générale, Hôpital Régional de Kasserine, Tunisie
| | | | - Sonia Jemni
- Service de Médecine Physique et Rééducation Fonctionnelle, Hôpital Sahloul, Sousse, Tunisie
| | - Nader Naouar
- Service de Chirurgie Orthopédique. Hôpital Sahloul, Sousse, Tunisie
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Solomou A, Kraniotis P. Giant cell tumor of the tendon seath of the tendinous insertion in pes anserinus. Radiol Case Rep 2017; 12:353-356. [PMID: 28491187 PMCID: PMC5417722 DOI: 10.1016/j.radcr.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Aikaterini Solomou
- Magnetic Resonance Imaging Unit, Department of Radiology, University Hospital of Patras, Patras 26504, Greece
| | - Pantelis Kraniotis
- Magnetic Resonance Imaging Unit, Department of Radiology, University Hospital of Patras, Patras 26504, Greece
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Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res 2017; 103:S91-S97. [PMID: 28057477 DOI: 10.1016/j.otsr.2016.11.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 02/02/2023]
Abstract
Tenosynovial giant cell tumor (TSGCT) is a rare benign tumor arising from joint synovia, bursae and tendon sheaths. Their variable clinical presentation is related to variations in site and progression. Localized forms are most frequent in the hands, and diffuse forms in the knee. MRI is necessary and sometimes sufficient for diagnosis. Treatment strategy is guided by progression, symptomatology, location and diathesis. Optimally complete resection is the principle of first-line treatment. Radiation therapy is effective and targeted therapies are promising; both should especially be considered in case of relapse.
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Affiliation(s)
- F Gouin
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, place A.-Ricordeau, 44093 Nantes cedex, France; LPRO, Inserm UI957, Laboratoire de la Résorption Osseuse et des Tumeurs Osseuses Primitives, Faculté de Médecine, Université de Nantes, 44000 Nantes, France.
| | - T Noailles
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, place A.-Ricordeau, 44093 Nantes cedex, France
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Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR Imaging and US of the Wrist Tendons. Radiographics 2016; 36:1688-1700. [DOI: 10.1148/rg.2016160014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tumor de células gigantes de la vaina tendinosa de la mano. Estudio de la epidemiología, eficacia de las pruebas de imagen en su diagnóstico y análisis de la recidiva. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2016. [DOI: 10.1016/j.ricma.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivos: Conocer la capacidad diagnóstica de las diferentes pruebas de imagen empleadas en nuestro centro. Valorar si la distribución de las diferentes variables que definen la tumoración es la misma en los tumores con y sin recidiva.Material y método: Se valoraron 54 casos de tumor de células gigantes de la vaina tendinosa de la mano. En todos se realizó una radiografía, en 19 ecografía y en 7 resonancia magnética. Los datos analizados fueron: sexo, edad, antecedente traumático, dedo afecto, localización, resultado de las pruebas de imagen, características anatomopatológicas de la tumoración (tamaño y número de nódulos), y presencia o no de recidiva.Resultados: Se objetivó 1,7 mujeres por cada varón. La mano derecha y el segundo dedo fueron las localizaciones más frecuentes. Ninguna radiografía fue diagnóstica; la ecografía tuvo un valor predictivo positivo de 36,8% y la resonancia magnética de 71,4%. Hubo 6 casos de recidiva, sin relación estadísticamente significativa entre la recidiva y el tamaño, el número de nódulos o la artrosis.Conclusión: La resonancia magnética tiene una capacidad diagnóstica superior a la ecografía, y esta, superior a la radiografía simple. No se ha encontrado ninguna asociación estadísticamente significativa entre la recidiva de la lesión y los factores estudiados.
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Chen YU, Yu XC, Xu SF, Wang B. Giant cell tumor of the tendon sheath originating from the ankle capsule: A case report and literature review. Oncol Lett 2016; 11:3461-3464. [PMID: 27123136 DOI: 10.3892/ol.2016.4377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 01/18/2016] [Indexed: 01/27/2023] Open
Abstract
Giant cell tumor of the tendon sheath (GCTTS), also termed tendosynovial giant cell tumor, is a benign, slow-growing tumor that originates from the tendon sheath or bursa. GCTTS of the foot and ankle is much less frequently reported compared with GCTTS of the hand and knee. However, GCTTS should be considered as a differential diagnosis of soft tissue tumors of the foot and ankle. The optimal treatment strategy for GCTTS in the foot and ankle is controversial due to a scarcity of cases. The present study reports the case of a patient that presented with localized intra-articular GCTTS originating from the capsule of the ankle, which is a rare anatomical location for this tumor. Considering the proximity of the tumor to the adjacent non-tumorous structures, a less radical but complete resection of the tumor was performed, followed by a hydrogen peroxide lavage. There was no evidence of recurrence during a follow-up period of 12 months, and adjuvant radiotherapy was not administered to the patient. A pre-operative diagnosis for GCTTS in the foot and ankle is mainly based on the findings of clinical examination and magnetic resonance imaging, which also facilitates the determination of a surgical strategy. For a localized tumor, an integral resection, as opposed to a radical resection, with a hydrogen peroxide lavage may result in a favorable prognosis. However, the optimal treatment for diffuse GCTTS remains to be identified.
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Affiliation(s)
- Y U Chen
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Region, Jinan, Shandong 250031, P.R. China
| | - Xiu-Chun Yu
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Region, Jinan, Shandong 250031, P.R. China
| | - Song-Feng Xu
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Region, Jinan, Shandong 250031, P.R. China
| | - Bing Wang
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Region, Jinan, Shandong 250031, P.R. China
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Lu H, Shen H, Chen Q, Shen XQ, Wu SC. Artificial finger joint replacement due to a giant cell tumor of the tendon sheath with bone destruction: A case report. Oncol Lett 2015; 10:3502-3504. [PMID: 26788157 PMCID: PMC4665261 DOI: 10.3892/ol.2015.3813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 09/25/2015] [Indexed: 11/06/2022] Open
Abstract
The current study presents the case of a 25-year-old male who developed tumor recurrence of the proximal phalange of the ring finger on the right hand 4 years after partial tumor resection surgery. An X-ray of the right hand showed that the distal bone of the proximal phalange on the ring finger was destroyed. An artificial finger joint replacement was performed using a silicone joint for this unusual tumor recurrence. The pathological findings were indicative of a giant cell tumor of the tendon sheath. As a result of surgery, the patient's proximal interphalangeal point motion recovered to the pre-operative level. The pre-operative and post-operative disabilities of the arm, at shoulder and hand and total activity measurement values were 1.67 and 3.33, and 255 and 243°, respectively. Complications such as tumor recurrence, joint dislocation and the requirement for prosthetic training were not observed during the 5-year follow-up period.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hui Shen
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qiang Chen
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Xiang-Qian Shen
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shou-Cheng Wu
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Pozzatti RR, Cordeiro CP, da Cruz JDMA, de Araújo GCS. Leiomyoma in the thumb causing trigger finger. BMJ Case Rep 2015; 2015:bcr-2015-209449. [PMID: 26240097 DOI: 10.1136/bcr-2015-209449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyoma is a generally benign tumour and common in the uterine smooth muscle. In some cases, it is found in other parts of the human body. In our study, we report the case of a 61-year-old woman with a painless cystic lesion on the first left thumb associated with trigger finger. The first diagnostic hypotheses were ganglionic cyst and giant cell tumour, however, after surgical excision and histological analysis, it was revealed to be a rare leiomyoma of the hand. We report a clinical case and detailed histopathological study, with 12 high-resolution images stained with: H&E, Smooth Muscle Actin, Desmin, S-100 and CD34.
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Tambe SA, Bhobe M, Jerajani HR. Giant cell tumor of the tendon sheath mimicking a plexiform neurofibroma. Indian Dermatol Online J 2015; 6:201-3. [PMID: 26009718 PMCID: PMC4439752 DOI: 10.4103/2229-5178.156407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Giant-cell tumor of the tendon sheath (GCTTS) is a benign soft tissue tumor of the limbs arising from the complex of the tendon sheath and periarticular soft tissues of small joints. It is the second most common benign space occupying lesion in the hand and usually presents as a painless soft tissue mass, which grows slowly in size for many years. We present an interesting case of an enormous GCTTS presenting as a slowly growing mass over left sole of a 52-year-old woman. The duration of GCTTS may range from a few weeks to 30 years but in our case the duration of tumor was almost 48 years, which could be the longest reported duration of GCTTS.
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Affiliation(s)
- Swagata Arvind Tambe
- Department of Dermatology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
| | - Mayur Bhobe
- Department of Dermatology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
| | - Hemangi R Jerajani
- Department of Dermatology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
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Abstract
There have been immense technical innovations and broadened clinical applications of ultrasound in the musculoskeletal system over the past 20 years. Specifically with regard to the hand and wrist, the advent of higher resolution transducers and postprocessing software applications have resulted in overall enhanced visualization of soft tissue structures (tendons/ligaments) as well as surface osseous lesions such as subclinical erosions in rheumatoid arthritis. Quantitative ultrasound, using either power Doppler or contrast-enhanced imaging, has become a central outcomes measure used to evaluate and document patient response to treatment in inflammatory arthropathies such as rheumatoid arthritis. This review will summarize the current state of clinical applications of ultrasound in the evaluation of the hand and wrist, with a summary of technical advances and specific applications in rheumatologic conditions.This review was exempt from institutional review board approval.
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Affiliation(s)
- Paul DiDomenico
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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Sonography of Musculoskeletal Soft-Tissue Masses: Techniques, Pearls, and Pitfalls. AJR Am J Roentgenol 2014; 202:1281-90. [DOI: 10.2214/ajr.13.11564] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rapipong J, Chang KV. Giant Cell Tumor of the Finger. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Di Grazia S, Succi G, Fragetta F, Perrotta RE. Giant cell tumor of tendon sheath: study of 64 cases and review of literature. G Chir 2013; 34:149-52. [PMID: 23837951 DOI: 10.11138/gchir/2013.34.5.149] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The giant cell tumor of tendon sheath (GCTTS) is the most common benign neoplasm in the hand after the ganglion cyst. Several hypotheses were formulated about the etiological factors of these tumors, but still there is not a common opinion on etiology, prognostic factors and recurrence rate. This article presents a review of literature of the last 15 years about GCTTS to assess the demographic, clinical and histological profile. We compared the information obtained from literature with our experience of 64 cases between 2000 and 2012. Our study showed similar results to those reported in literature, except for the recurrence rate: only 3 cases (4.7%) of 64 patients reported recurrence (versus about 15% on average in literature). Among the various possible factors that predispose to recurrence, it is necessary that the surgeon ensures complete excision of the tumor and removal of any residual satellite nodules. Although the marginal excision is the treatment of choice, it is often difficult to perform due to for the location and the strict adherence of the tumor to the tendon or neurovascular bundles. We used in all cases a magnifying loupe to help a careful research of satellite lesions and to respect surrounding structures.
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Neglected ruptured flexor carpi ulnaris tendon mimics a soft tissue tumor in the wrist. Am J Phys Med Rehabil 2013; 93:355-8. [PMID: 24247758 DOI: 10.1097/phm.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A wrist mass is rarely caused by a ruptured tendon in the forearm. The common pathologies are ganglia, tendon tenosynovitis, and giant cell tumors of tendon sheaths. Less common causes are nerve sheath tumors, vascular lesions, or an accessory muscle belly. The authors investigated a case of neglected ruptured flexor carpi ulnaris tendon that mimics a mass in the wrist. To the authors' knowledge, this is the first case report in relevant literature. During investigation, the high-resolution musculoskeletal ultrasound suggested a soft tissue tumor or a ruptured flexor carpi ulnaris tendon. The magnetic resonance imaging scan indicated an accessory flexor carpi ulnaris muscle belly. The diagnosis of ruptured flexor carpi ulnaris tendon was confirmed by surgical exploration. This case indicates that ultrasound may be better suited than magnetic resonance imaging in evaluating a wrist mass for its accuracy, availability, and portability.
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Abstract
Chondroid syringoma (CS) is an uncommon, benign epithelial skin mixed tumor. It is often located in the head and neck and is unusual in other parts of the body. It may be seen as a skin or soft tissue tumor. We present findings on high-resolution ultrasound and histology in a case of benign CS located on the right index finger. High-resolution ultrasound showed a solid hypoechoic, well-defined subcutaneous mass, adjacent to the tendon. Complete surgical excision was performed, and histopathology demonstrated an apocrine mixed tumor (CS). Although CS histological findings are well described, radiological features have been reported only in few cases and mainly in magnetic resonance. Chondroid syringoma should be suspected by high-resolution ultrasound as a differential diagnosis for a solid slow-growing soft tissue nodule in a finger, especially if the lesion has no contact with the underlying tendon.
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Di Grazia S, Succi G, Fragetta F, Perrotta RE. Giant cell tumor of tendon sheath: study of 64 cases and review of literature. G Chir 2013. [PMID: 23837951 DOI: 10.11138/gchir/2013.34.5.149.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The giant cell tumor of tendon sheath (GCTTS) is the most common benign neoplasm in the hand after the ganglion cyst. Several hypotheses were formulated about the etiological factors of these tumors, but still there is not a common opinion on etiology, prognostic factors and recurrence rate. This article presents a review of literature of the last 15 years about GCTTS to assess the demographic, clinical and histological profile. We compared the information obtained from literature with our experience of 64 cases between 2000 and 2012. Our study showed similar results to those reported in literature, except for the recurrence rate: only 3 cases (4.7%) of 64 patients reported recurrence (versus about 15% on average in literature). Among the various possible factors that predispose to recurrence, it is necessary that the surgeon ensures complete excision of the tumor and removal of any residual satellite nodules. Although the marginal excision is the treatment of choice, it is often difficult to perform due to for the location and the strict adherence of the tumor to the tendon or neurovascular bundles. We used in all cases a magnifying loupe to help a careful research of satellite lesions and to respect surrounding structures.
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Lautenbach M, Kim S, Millrose M, Eisenschenk A. Nodular giant cell tumour of the tendon sheath of the hand: analysis of eighty-four cases: diagnostic decisions and outcome. INTERNATIONAL ORTHOPAEDICS 2013; 37:2211-5. [PMID: 23835561 DOI: 10.1007/s00264-013-1994-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The giant cell tumour of the tendon sheath (GCTTS) of the hand is a benign tumour of unknown origin. The clinical diagnosis is supported by preoperative imaging. But the ideal imaging methods necessary for the diagnosis, preoperative planning and total tumour resection are still debated. Standard treatment is surgical resection with histological confirmation. METHODS We followed up 84 patients who were operated upon for a histologically confirmed nodular type GCTTS for an average of 4.7 years (range four to eight). The preoperative symptoms and radiological findings of X-ray, ultrasound and MRI were reviewed and the surgeon asked for their impact on the surgical procedure. RESULTS The average age at operation was 50.9 years, 65.5% of the patients were female and 61.9% of the lesions were located on the palmar aspect. Most tumours were found on the first three fingers. Two patients had tumours at two separate sites (2.4%). After an average follow up of 31.5 months two recurrences were observed (2.4%). In addition to X-ray and ultrasound, the preoperative findings of the MRI had no influence on the surgical procedure. CONCLUSION Our data on the nodular GCTTS are in accordance with published data concerning the age distribution, gender distribution, and localisation. No soft-tissue imaging method is superior for the diagnosis of nodular GCTTS or for the preoperative planning. A preoperative MRI may not be necessary as clinical and ultrasound examination are sufficient. To exclude bony erosions, a preoperative X-ray is necessary.
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Affiliation(s)
- Martin Lautenbach
- Department for the Upper Extremity, Hand-, and Microsurgery, Immanuel Hospital, Königstr. 63, 14109, Berlin, Germany
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Olubaniyi BO, Bhatnagar G, Vardhanabhuti V, Brown SE, Gafoor A, Suresh PS. Comprehensive musculoskeletal sonographic evaluation of the hand and wrist. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:901-914. [PMID: 23716510 DOI: 10.7863/ultra.32.6.901] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sonography is widely used for evaluation of hand and wrist lesions. The easy accessibility, cost-effectiveness, and good diagnostic accuracy of sonography coupled with the numerous benefits of real-time imaging make it desirable. The aim of this article is to describe the typical sonographic appearances of lesions in the hand and wrist that are encountered frequently in routine clinical practice, such as inflammatory arthropathies, tumors, traumatic injuries, foreign bodies, and nerve entrapment syndromes. Relevant anatomy, scanning methods, and recent developments in musculoskeletal sonography are also discussed.
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Affiliation(s)
- Babajide O Olubaniyi
- Department of Radiology, Plymouth Hospitals National Health Service Trust, Derriford Hospital, Plymouth, Devon, England.
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Giant cell tumors of the tendon sheaths in the hand: review of 96 patients with an average follow-up of 12 years. Orthop Traumatol Surg Res 2013; 99:S251-4. [PMID: 23623439 DOI: 10.1016/j.otsr.2013.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Giant cell tumors (GCT) of the hand are relatively common and have a good prognosis, but the risk of recurrence is high. The goal of this study was to evaluate the long-term clinical results of a consecutive series of patients and to determine the risk factors for recurrence. MATERIAL AND METHODS This was a retrospective study of 96 patients (57 women, 39 men) operated between February 1982 and October 2005 for GCT of the tendon sheaths in the hand. The average age at the time of the procedure was 47.7±14.5 years (range 13-75). All the patients were reviewed by an independent surgeon. The following were recorded: clinical result (QuickDASH, satisfaction), recurrence, histological appearance of tumor, location of tumor, excision margins and extension into the neighboring anatomical structures (tendon, joint). The tumor was located in the index finger in 29 cases, middle finger in 23 cases, thumb in 21 cases, ring finger in 11 cases, little finger in 11 cases, hypothenar area in two cases and thenar area in one case. In all cases, the lesion was isolated. The swelling was palmar in 27 cases, dorsal in 20 cases and medial or lateral in 59 cases. The most common joint location was the DIP joint (35% of cases). The swollen area was sensitive in 12 cases. The time from the appearance of the tumor to physician consultation ranged between 1 month and 7 years. Before the surgery, standard X-rays were taken in all patients; ultrasonography was also performed in eight patients and MRI in one patient. The tumor had an average diameter of 15.8±2.6mm (range 5-30). Histological analysis revealed a multilobed lesion with multinucleated giant cells, with or without encapsulation. RESULTS The average follow-up at the time of review was 12.1±3.8 years (range 5-29). There were eight recurrences in seven patients (8.3%). The average time to recurrence was 2.75±2 years (range 1-6.5). In every case of recurrence, there had been intra-articular tumor development and/or tendon destruction (P<0.01). There was one functional complication: one DIP joint fusion secondary to one of the recurrences. The average QuickDASH was 2.3/100 (range 0-31). CONCLUSION Giant cell tumors of the synovial sheaths in the hand are benign lesions where recurrence is the primary risk. The recurrence typically occurred within 36 months of the excision. Intra-articular tumor development, marginal resection and tendon involvement seem to contribute to recurrence. There was no correlation found between the histological type of tumor (encapsulated or not) and recurrence. LEVEL OF PROOF IV.
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