Diffuse-type giant cell tumor of the tendon sheath in the temporal region incidentally diagnosed due to a temporal tumor: A report of two cases and review of the literature

Abstract

Abstract. Diffuse-type tenosynovial giant cell tumor (D-GCTS) is a rare benign lesion that not only frequently occurs in the fingers, but also along the tendon sheaths of the foot and ankle. The present study reports the cases of two middle-aged patients that were diagnosed with D-GCTS. The presentation of the D-GCTS lesions was extremely rare, as the tumors were located in the temporal fossa and threatened the skull base and external auditory canal. There were similarities and differences between the two patients in their clinical symptoms, disease progressions and invading sites. The patients' disease course occurred unnoticed with the absence of pain, was protracted and became infiltrative. However, the female patient was admitted to the hospital due to the occurrence of pain in the left temporal region, and the male patient presented at the doctor due to a painless left temporal mass and external auditory canal bleeding. Therefore, the operation area of the two patients was not the same. This type of illness should be considered in the differential diagnosis for masses occurring in the temporal region. Total tumor removal is the best treatment for D-GCTS, and the careful monitoring of recurrence can achieve a good clinical outcome subsequent to the surgical resection. IntroductionGiant cell tumor of the tendon sheath (GCTS) was initially described by Chassaignac in 1852 (1), and the lesion was defined as a malignant tumor at that time (2). Subsequently, Heurteux produced a detailed description of GCTS (3). It was found that the disease occurs more frequently in middle-aged women compared with men (4). According to the position (large or facet joint; intra-or extra-articular), characteristics (benign or malignant) and growth pattern (diffuse or localized) of the tumor, GCTS may be classified as one of four types: Localized-type tenosynovial giant cell tumor (L-GCTS); diffuse-type tenosynovial giant cell tumor (D-GCTS); pigmented villonodular synovitis (PVNS) (5,6); and malignant tenosynovial giant cell tumor (M-GCTS) (7,8).D-GCTS demonstrates invasive growth in the local region, which is considerably different from L-GCTS. D-GCTS usually develops in the synovium, and often invades the surrounding knee and soft tissue (2,9). Since it arises mainly from the soft tissue outside the joints, Weiss et al (10) regarded D-GCTS as a type of PVNS that appears in the soft tissue outside the joints, and also presents with intra-articular lesions (2,5). L-GCTS mainly occurs in the small joints, including the hand, foot and ankle. Image findings in previous studies reveal these soft tissue masses occur beside small joints (9,11). If the results of image analysis demonstrate that the lesions have invaded the joints, and if there is a concurrent weak signal of T1W and T2W on a magnetic resonance imaging (MRI) scan, D-GCTS should be considered as a probable diagnosis (12-15).GCTS usually occurs in individuals between the ages of 30 and 50 years (5). As a painless and slow-growing disease, it has been termed an innocent tumor ...

Chondroid Tenosynovial Giant Cell Tumor: A Rare Case Involving the Infratemporal Fossa

“…TGCT is a benign soft-tissue neoplasm that can be seen in the head and neck region. 2 , 3 The neoplasm can be broadly classified according to the clinical appearance and biological conduct into localized or diffused form. The localized form, also referred to as a giant cell tumor of tendon sheath, appears as isolated nodule of tendon sheath.…”

“…The diffuse, commonly referred as pigmented villonodular synovitis, is an aggressive form that classically infiltrate into the joint, often recur, and may exhibit features of malignant transformation. 2 , 3 , 6 Scientific literature states that both forms are rare with most reported case studies focusing on the diffused form. 2 , 5 - 8 Our case falls under the category of localized TGCT and was diagnosed relatively early compared to published cases.…”

“…1 TGCT usually affects patients in their third to fifth decades of life with roughly equal sex distribution. 2 , 3 TGCT has been reported to mainly involve the finger joints and tendon sheaths of the foot, ankle, and knee. The occurrence of TGCT in the head and neck region is exceedingly rare and relatively uncommon in the temporomandibular joint (TMJ) and skull base.…”

“… 4 The pathogenesis of TGCT is unknown, but studies have proposed that the neoplasm could be related to bleeding following trauma and lipid metabolism diseases. 2 , 4 …”

Scaphoid instability caused by a giant cell tumour of the tendon sheath: A case report

“…A giant-cell tumour of the tendon sheath (GCTTS), an uncommon soft tissue tumour with a pathophysiological process that has been well documented by recent literature, 1 – 4 is a benign tumour that typically presents as a localized, painless, slow-growing, nodular or polylobular mass that potentially interferes mechanically with tendon or joint function. 2 – 5 GCTTS has a high rate of recurrence (up to 30–45%). 6 , 7 This case reports on a female patient with a GCTTS in her right elbow that was excised adequately 10 years ago.…”