Updated: 6/16/2019

Giant Cell Tumor of Tendon Sheath

Topic
Review Topic
0
0
Questions
1
0
0
https://upload.orthobullets.com/topic/6092/images/gct.jpg
https://upload.orthobullets.com/topic/6092/images/pressure bone erosion gctts.jpg
https://upload.orthobullets.com/topic/6092/images/gctts histo.jpg
https://upload.orthobullets.com/topic/6092/images/gctts mri.jpg
  
Introduction
  • A benign nodular tumor that is found on the tendon sheath of the hands and feet
  • Also known as pigmented villonodular tumor of the tendon sheath (PVNTS)
  • Epidemiology
    • present in 3rd-5th decade of life
    • incidence
      • second most common soft-tissue tumor seen in the hand, following ganglion cyst
    • location
      • it is most common on palmar surface of radial three digits near DIPJ
    • no reports of metastisis in literature
Presentation
  • Symptoms
    • enlarging mass
    • pain, worse with activity (or wearing shoes, for foot lesions)
  • Physical exam
    • firm, nodular mass that does not transilluminate
  • Differential diagnosis
    • ganglion cyst
      • cystic component
    • pigmented villonodular synovitis
      • histologically identical
      • involves larger joints
    • desmoid tumor
    • fibroma/fibrosarcoma
    • glomangioma
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
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
 

Please rate topic.

Average 3.6 of 18 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Topic COMMENTS (2)
Private Note