Rare Giant Cell Tumor of the Distal Flexor Digitorum Longus Tendon Sheath and Early Diagnosis with Use of Magnetic Resonance Imaging

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 Extensor Tendon Sheath in Ring Finger: A Case Report

Giant cell tumour of the tendon sheath (GCTTS) is a rare benign soft tissue tumour with no known cause. It is more prevalent in the hand than in the ankle and foot. It appears as a non-painful, perceptible enlargement. Although pre-operative imaging and fine-needle aspiration cytology (FNAC) corroborate suspicion, histology following surgical resection is used to confirm the diagnosis. Due to its rarity, a case of giant cell tumour (GCT) of the extensor tendon sheath of the left ring finger is reported here. A 39-year-old female presented with a six-month history of painless swelling over left ring finger. The swelling was spontaneous, slowly progressive and painless. On clinical examination, a 1.5 cm x 1 cm firm swelling was seen on the dorsal surface of the left ring finger extending from the distal portion of the middle phalanx to the proximal half of the distal phalanx. The swelling was well-defined, smooth, firm, and uniform in consistency. The swelling was movable sideways with no attachment to the bone when examined clinically. X-ray of the hand showed soft tissue mass without the involvement of the bone. Soft tissue mass was seen on ultrasonography. An excisional biopsy was done. Histopathology showed typical features of GCTTS. Our case is a rare example of GCTTS in a single digit of the hand. Furthermore, considering its high recurrence risk, the tumour should be totally excised. Finally, if required, the hand's function should be recreated to minimise the loss.

Treatment of Giant Cell Tumor of Soft Tissue Disguised as Giant Cell Tumor of the Bone Involving the Distal and Proximal Phalanges of the Great Toe

Giant cell tumors are benign tumors that are locally aggressive and rare in the foot. Giant cell tumors involving bone in the foot have an incidence of 1.2% to 2.8%, whereas giant cell tumors of the tendon sheath constitute 3% to 5% of all giant cell tumors in the foot and ankle. We present a case of giant cell tumor of the soft tissue disguised as a giant cell tumor of bone in a healthy 29-year-old male patient. Through radiographic and magnetic resonance imaging evaluation, it was determined that this patient had a bone tumor invading the distal and proximal phalanges of his left great toe with the involvement of soft tissue. With the use of the evidence-based medicine and patient expectation, the decision was made to amputate the digit. To much surprise, when the histopathologic results were reviewed, it was determined that the excised lesion was consistent with giant cell tumor of soft tissue that did not involve the bone.

A case report. Tenosynovial giant cell tumour in the tendon of extensor digitorium longus

Soft tissue lesions found within the foot and ankle can vary in their origin. Tenosynovial giant-cell tumours (TSGCT) are quoted as rare in their presentation yet also reported to be the sixth most common benign lesion in the foot. This article presents a case report following the patient journey suffering with a TSGCT of the fourth toe. From initial consultation, to further investigation with advanced imaging to a final decision on surgical excision following consideration of conservative management.

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.

A Case Report of Giant Cell Tumor of the Flexor Tendon Sheath in Index Finger

Introduction

Giant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue tumor of unknown etiology. It is seen more commonly in hand than ankle and foot. It presents as a painless and palpable swelling. Its diagnosis is mostly established by histopathology after surgical resection, although pre-operative imaging and fine-needle aspiration cytology (FNAC) support its suspicion. Herein, a case of GCT of flexor tendon sheath of the right index finger is reported due to its rarity.

Case Report

A 46-year-old female presented with complaints of swelling over the front of the right index finger for 1½years. The swelling was spontaneous, painless, and very slowly progressive. Examination revealed a 2 cm × 1.5 cm firm swelling situated on the palmar aspect of the right index finger over distal part of middle phalanx and proximal part of the distal phalanx. Swelling was well defined, having smooth surface, uniformly firm consistency and could be moved sideways easily. X-ray of the hand showed localized soft tissue shadow in the involved area without any bony involvement. Ultrasonography of the finger showed soft tissue mass. FNAC examination reported the swelling as GCTTS. Excisional biopsy was done. Histopathology showed typical features of GCTTS.

Conclusion

GCTTS should be kept as a differential diagnosis in soft tissue tumors of hand in adults. FNAC followed by excisional biopsy is diagnostic and curative, but the patient should be followed up for detecting and managing recurrences.

A Pregnant Woman with Multi-Fragmented Giant Cell Tumor of Tendon Sheath: A Rare Anatomical Location

Giant cell tumor of the tendon sheath (GCTTS) in the foot is a rare pathology and is involved in the differential diagnosis of soft-tissue tumors of the foot and ankle. Although it can affect any age group, GCTTS mainly occurs at the 3rd and 5th decade and is more common in females. Histopathologic examination is a major definitive method for diagnosis, although physical examination and radiologic imaging are helpful in reaching a diagnosis preoperatively. Many treatment options exist but marginal excision is the most commonly used treatment. We describe the case of a 26-year-old pregnant woman with a multi-fragmented mass extending from the first web space to the plantar aspect of the metatarsophalangeal joint (MTP) of the left great toe associated with flexor hallucis longus tendon after trauma. She had pain that worsened with activity and wearing shoes. After pregnancy, a marginal excision with dorsal longitudinal incision in the first web space was performed under spinal anesthesia. The lesion was diagnosed as a localized type tenosynovial giant cell tumor. At the last follow-up appointment in the 23rd month, the patient was doing well and there was no recurrence of the lesion. GCSST should be considered in the differential diagnosis of plantar masses of foot. Although, GCTTS is frequently seen in females, it has not been previously reported in a pregnant woman with an extremely rare condition after trauma.