Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract

Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Chondroid tenosynovial giant cell tumour: a rarity in the temporomandibular joint

“…Due to the destructive potential of CTGCTs, complete surgical resection is the ideal treatment, as seen in this case. In some cases, particularly in severe cases or incomplete resections, adjuvant treatment including radiotherapy may need to be considered (2,4). Though there was a lack of clarity of the resection margins in our case, close clinical followup was recommended.…”

“…In the literature, various differential diagnoses have been considered, however, preauricular swellings are often benign but in many instances they can be malignant, including adenoid cystic carcinomas, mucoepidermoid carcinomas, primary and metastatic squamous cell carcinomas hence requiring thorough consideration (7). Additionally, due to presence of chondroid metaplasia in CTGCTs, other lesions such as chondroblastomas and chondrosarcomas should also be considered (2).…”

Calcified chondroid mesenchymal neoplasms with FN1-receptor tyrosine kinase gene fusions including MERTK, TEK, FGFR2, and FGFR1: a molecular and clinicopathologic analysis

“…Chondroid tenosynovial giant cell tumor (TGCT) is a rare tumor with a predilection for the TMJ region and skull base that often demonstrates locally aggressive growth including bone destruction (5,6,(32)(33)(34). Histologically, chondroid TGCT shows features of conventional TGCT, such as sheet-like proliferation of large epithelioid to histiocytoid mononuclear cells, some with hemosiderin deposition often in a ring like deposition around the cytoplasm, and multinucleated giant cells; however, geographic or nodular areas of metaplastic chondroid matrix are also present and frequently associated with grungy, lace-like calcifications.…”

Tenosynovial Giant Cell Tumor, Localized Type With Extensive Chondroid Metaplasia: A Case Report With Immunohistochemical and Molecular Genetic Analysis

“…There have been some reports of PVNS exhibiting chondroid metaplasia with nearly all of these reported cases involving temporomandibular joints. [2][3][4][5][6][7][8] Only a single case involving the wrist of TSGCT of localized type with chondroid metaplasia has been previously reported. 9 However, the latter report was mainly focused on the cytological features observed on fine needle aspiration.…”

“…Nineteen of the 20 reported cases of TSGCT with extensive chondroid metaplasia were of the diffuse type, preferentially involving the temporomandibular joints. [2][3][4][5][6][7][8] Only a single case of localized TSGCT with chondroid metaplasia involving the wrist has been reported. 9 Recently, immunohistochemistry (IHC) with clusterin has been found to be useful in the diagnosis of TSGCT.…”