Giant cell tumor of tendon sheath: study of 64 cases and review of literature

Abstract

Giant cell tumor of the tendon sheath (GCTTS) is the second most common tumor of the hand after ganglion cysts (1,2). It is a slowly growing, usually painless benign lesion of soft tissues. The tumor affects individuals between the age of 30 and 50 years old and is found more often in women than men (3-6). Despite its benign character, local recurrence after excision has been reported in up to 45% of cases (7); there isn't still a defined treatment protocol and local excision with or without radiotherapy is the treatment of choice to date (1,2,7-13).We made a retrospective study of literature of the last 15 years and evaluated the demographic, clinical and histological aspects of the GCTTS of the hand and compared the results with our experience in a series of 64 cases from 2000 to 2012 to assess the factors that mostly contribute to incidence and recurrence of this tumor. Patients and methodsWe searched for published articles regarding the GCTTS from 1998 using the PubMed search engine. The keywords used were as follows: "giant cell tumor, tumor tendon, hand tumor"; all retrieved papers were analysed and their reference list were also screened if relevant. For each report, information was gathered on characteristics of the trial and study population, location and multicentricity of lesion, kind and severity of symptoms. We also recorded the applied treatment modality, histopathological examination of the excised tumor and recurrence rate.A retrospective study was conducted in our Department of Plastic and Reconstructive Surgery and all data were collected from medical records of 64 GCTTS patients within this Department from 2000 to 2012. Medical record included the age, gender, tumor location, presentation and size, clinical features, treatment modality, histopathological report and neurovascular or tendon involvement.All cases were operated under tourniquet control, using a magnifying loupe. Special care was taken to excise the tumor in total, retaining the capsule, if present, with margin of normal tissue. The operating field is searched for presence of satellite lesions.The histopathological diagnosis and immunohistochemical studies were conducted by the Department of Pathology within the same Hospital. Follow-up ranged from 2-153 months.

Giant cell tumor of tendon sheath—Use of fine-needle aspiration cytology for diagnosis

“…It is the second most common tumour of the hand after ganglion cysts. It affects individuals between the age of 30 and 50 years old and is more common in females [1] . GCTTs presents as a firm, nodular mass occurring more commonly on the volar aspect of fingers and hands [2] .…”

“…The various etiological factors include trauma, neoplastic, inflammatory and metabolic disease, but it is best considered idiopathic [2] . Histologically, GCTTs is composed of multinucleated giant cells, histiocytes polyhedral, fibrotic material and hemosiderin deposits [1] . There is no report of GCTTs becoming malignant.…”

“…Giant cell tumour of the tendon sheath (GCTTs) is a slowgrowing, usually painless benign lesion of soft tissues [1] . We report the case of a 38-year-old male with a painless, slowly enlarging swelling on right thumb in order to highlight the role of fine-needle aspiration cytology (FNAC) in diagnosing GCTTs.…”

“…FNAC was suggestive of giant cell tumor of tendon sheath. Giant cell tumour of the tendon sheath (GCTTs) is a slowly growing, usually painless benign lesion of soft tissues [1] . It is the second most common tumour of the hand after ganglion cysts.…”

“…rate of recurrence is reported up to 45% of cases. excision is the treatment of choice [1] . Byers et al classified GCTTS into two types: localized nodular (common in hand) and diffuse (common in joints) [3] .…”