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Updated: Jul 1 2021

Giant Cell Tumor of Tendon Sheath

Images bone erosion gctts.jpg histo.jpg mri.jpg
  • summary
    • Giant Cell Tumor of Tendon Sheath, also known as pigmented villonodular tumor of the tendon sheath, is a benign nodular tumor that is found on the tendon sheath of the hands and feet
    • Diagnosis is made clinically with a firm, nodular mass that does not transilluminate with MRI studies showing decreased signal intensity on both T1-and T2-weighted MR imaging.
    • Treatment is usually marginal excision of the mass. 
  • Epidemiology
    • Incidence
      • common
        • second most common soft-tissue tumor seen in the hand, following ganglion cyst
    • Demographics
      • present in 3rd-5th decade of life
    • Anatomic location
      • it is most common on palmar surface of radial three digits near DIPJ
  • Presentation
    • Symptoms
      • enlarging mass
      • pain, worse with activity (or wearing shoes, for foot lesions)
    • Physical exam
      • firm, nodular mass that does not transilluminate
  • Imaging
    • Radiographs
      • pressure-type bone erosion can be seen in up to 5% of patients on radiographs
    • Ultrasound
      • able to demonstrate relationship of lesion with adjacent tendon
      • homogeneously hypoechoic, although some heterogeneity may be seen in echo-texture in a minority of cases
      • most have some internal vascularity
    • MRI
      • MRI may be helpful diagnostically
      • appearance of the focal form is generally decreased signal intensity on both T1-and T2-weighted MR imaging
  • Histology
    • Characterized by
      • proliferating histiocytes, moderately cellular (sheets of rounded or polygonal cells)
      • hemosiderin (brown color) may be present, but typically less than seen with PVNS
      • multinucleated giant cells are common
  • Differential 
    • Ganglion cyst
      • cystic component
    • Pigmented villonodular synovitis (PVNS)
      • histologically identical
      • involves larger joints
    • Desmoid tumor
    • fibroma/fibrosarcoma
    • glomangioma
  • Treatment
    • Operative
      • marginal excision
        • 5-50% recurrence rate
          • more common if tumor extends into joints and deep to the volar plate
          • tendon involvement associated with high recurrence rate
          • local recurrence is usually treated with repeat excision
        • operative approach is dependant on location and extent of the tumor
  • Prognosis
    • No reports of metastasis in literature
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