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

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.

MR Imaging–Ultrasonography Correlation of Acute and Chronic Foot and Ankle Conditions

Foot and ankle injuries are common musculoskeletal disorders. In the acute setting, ligamentous injuries are most common, whereas fractures, osseous avulsion injuries, tendon and retinaculum tears, and osteochondral injuries are less common. The most common chronic and overuse injuries include osteochondral and articular cartilage defects, tendinopathies, stress fractures, impingement syndromes, and neuropathies. Common forefoot conditions include traumatic and stress fractures, metatarsophalangeal and plantar plate injuries and degenerations, intermittent bursitis, and perineural fibrosis. Ultrasonography is well-suited for evaluating superficial tendons, ligaments, and muscles. MR imaging is best for deeper-located soft tissue structures, articular cartilage, and cancellous bone.

Bilateral Mirror-Symmetrical Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: A Case Report

Giant cell tumor of the tendon sheath is a slowly growing benign tumor. It usually arises from the tendon sheath and periarticular soft tissue of small joints. However, it may infrequently involve the large joints emerging around the knee, elbow, and hip joints. Giant cell tumor of the tibialis tendon sheath is rarely reported in the foot and ankle joint. Here, we report the first case in the medical literature of bilateral mirror-symmetrical giant cell tumor of the tendon sheath in the foot and ankle. A 12-year-old male presented with a bilateral and mirror-image mass on his ankles extending to the foot. It was painless but affected his gait and footwear. Staged complete resection was done first on the right then on the left side, with no recurrence after 1 year. The role of genes can be argued for this presentation and giant cell tumor's etiology, owing to the bilateralism and mirror-image presentation. Studies are needed to explore this genetic aspect and its role in management.

Atypical Tenosynovial Giant Cell Tumor of the Foot and Ankle: A Case Report

Tenosynovial giant cell tumor, also known as giant cell tumor of the tendon sheath (GCT-TS), is a solitary, nodular, firm, benign, soft-tissue tumor that arises from the synovial lining of a tendon. The etiology is unknown. It is a rare soft-tissue tumor, with an overall incidence of one in 50,000 individuals, and usually affects people aged between 30 and 50 years. Magnetic resonance imaging tends to be the imaging modality of choice, used for surgical preparation. Widely accepted treatment involves local excision with or without radiotherapy. The author presents a case study involving a patient with an abnormally large, longstanding GCT-TS, diagnosed with clinical examination and imaging modalities, surgically excised, and further confirmed by pathology reports. Topic of discussion includes a review of GCT-TS.

A rare localized giant cell tumor of the tendon sheath originating from the ligamentum mucosum: A case report

Giant cell tumor of the tendon sheath (GCTTS) occurs most often in the hand and rarely in the feet, and as an extremely uncommon presentation in the knee joint. Case reports involving GCTTS in the knee joint generally describe it originating from the nearby anterior cruciate ligament, posterior cruciate ligament, patellar tendon, and medial plica. To the best of our knowledge, there are no previously reported case reports involving GCTTS originating in the ligamentum mucosum. In this article, we describe a 27-year-old male patient who was admitted to the orthopedic emergency room with a painful locked knee. He had severe pain that was worse with activity and a decreased range of motion. Magnetic resonance imaging (MRI) indicated massive swelling and a well- circumscribed lobulated intraarticular mass at the distal one third of the ligamentum mucosum. The mass was removed successfully with arthroscopic-assisted mini-open excision, and histological analysis subsequently diagnosed it as a localized type of GCSTT. The patient remained asymptomatic and a follow-up MRI two years after surgery did not show any recurrence of the lesion.

Ultrasound Evaluation of Pediatric Orthopaedic Patients

Ultrasonography is a valuable tool that can be used in many capacities to evaluate and treat pediatric orthopaedic patient. It has the capability to depict bone, cartilaginous and soft-tissue structures, and provide dynamic information. This technique can be readily applied to a wide range of pediatric conditions, including developmental dysplasia of the hip, congenital limb deficiencies, fracture management, joint effusions, and many other musculoskeletal pathologies. There are many benefits of implementing ultrasonography as a regular tool. It is readily accessible at most centers, and information can be quickly obtained in a minimally invasive way, which limits the need for radiation exposure. Ultrasonography is a safe and reliable tool that pediatric orthopaedic surgeons can incorporate into the diagnosis and management of a broad spectrum of pathology.

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.

Ganglion cysts developed from the flexor tendon sheaths in the fingers: Clinical and sonographic features

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.

Desmoplastic fibroblastoma mimicking tenosynovial giant cell tumor encasing a tendon of the foot

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.

Giant cell tumour of tendon sheath and synovial membrane: A review of 26 cases

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.

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

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.

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.

Giant cell tumour of the flexor tendon sheath of the hand: analysis of 27 cases

Giant cell tumour of the tendon sheath (GCTTS) is a slowly progressing benign tumour arising from synovial cells of tendon sheaths. It is one of the most common soft tissue tumours in the hand. We report a retrospective study of 27 proven GCTTS of the hand. The mean length of follow-up was 4.5 years (17 months-8.5 years). Radiographic findings are useful and may prove of great diagnostic value. The positive diagnosis was provided by the pathology examination after complete excision that was performed in all patients. The recurrence was noted in two surgically managed cases. The excision should be meticulous and complete in order to avoid recurrence.

Giant cell tumor of a tendon sheath mimicking an axillary lymph node

A giant cell tumor of the tendon sheath (GCTTS) is 1 of the most common soft-tissue tumors of the hand and wrist, while the 2nd most frequent site is the ankle-foot complex. Although various solid tumors can develop in the axilla, GCTTS has not yet been reported. We describe the sonographic appearance of GCTTS in the axilla.

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.