Infiltration of the pes anserinus complex by an extraarticular diffuse-type giant cell tumor (D-TGCT)

Abstract

This report describes the case of a 26-year-old woman with a recurrent extraarticular diffuse-type tenosynovial giant cell tumor (D-TGCT) of the medial region of the knee affecting the pes anserinus and hamstring tendons. Presurgical MRI did not exclude infiltrative properties of the tumor. In the histological evaluation, the tumor showed an aggressive dispersion by infiltrating the collagenous tissue of the hamstring tendons. The treatment included a resection of the pes anserinus complex with distal semitendinosus and gracilis tendons. Regarding extraarticular D-TGCT a review of the literature showed a predominant affection of the medial region of the knee and thigh.

Giant cell tumor of the tendon seath of the tendinous insertion in pes anserinus

“…There have been few reports about GCTTS/PVNS involving the pes anserine tendon/bursa complex in the modern literature [6], [7], [8], [9], [10], [11], [12], [13], [14], with maximum diameter of the lesions ranging from 4 to 8 cm. In one case, bone extension is reported [15].…”

Giant Cell Tumor of the Pes Anserine Bursa (Extra-Articular Pigmented Villonodular Bursitis): A Case Report and Review of the Literature

“…The age range of PVNB of pes anserine has varied from 11–63 years with a mean of 31 years with no predilection for either sex or side [1–11]. Only one case was associated with a history of trauma 13 years previously [4]. Direct mechanical pressure to the bone and direct vascular foramina involvement was suggested as possible cause of bone involvement in one case [9].…”

Giant Cell Tumors in the Patellar Tendon Area

“…GCTTS rarely involves the patellar tendon, but it has been previously described as arising around the knee and involving the cruciate ligaments and pes anserinus. [8][9][10] Localized nodular PVNS in the knee is more often found in the anterior compartment or infrapatellar fat pad. 1 Other than GCTTS and PVNS, the differential diagnosis of soft tissue mass around the knee includes synovial cyst, synovial sarcoma, malignant fibrous histiocytoma, fibrosarcoma, lipoma, ganglion, desmoid tumor, fibroma, cavernous hemangioma, granuloma, chondroma, and tophaceous gout.…”

“…2 Both a common localized type and a rare diffuse type of GCTTS are described, with the latter being a more aggressive and destructive tumor and more commonly involving large joints, such as the knee and ankle. 8 Diffuse-type GCTTS shares similar histopathologic features with PVNS, hence these tumors are related as intra-articular and extra-articular counterparts. 5,8 Furthermore, some authors suggest GCTTS to be a proliferative pseudoneoplastic inflammatory response to soft tissue trauma rather than a true neoplasm, and a demonstration of a polyclonal cellular proliferation pattern supported this theory.…”

“…8 Diffuse-type GCTTS shares similar histopathologic features with PVNS, hence these tumors are related as intra-articular and extra-articular counterparts. 5,8 Furthermore, some authors suggest GCTTS to be a proliferative pseudoneoplastic inflammatory response to soft tissue trauma rather than a true neoplasm, and a demonstration of a polyclonal cellular proliferation pattern supported this theory. 11,12 MRI findings in localized GCTTS are typically of a round or lobular mass with low-intensity signal in both T1 and T2 and enhancement after gadolinium administration (either homogenous or non-homogenous).…”