Tenosynovial Giant Cell Tumor in the Hand: Experience with 173 Cases

Abstract

Background: Tenosynovial giant cell tumor (TSGCT) is the second most common benign tumor of the hand. Even though it is a benign lesion there is still a high incidence of local recurrence (range, 7%–44%) according to data in published papers. In this study, the clinical and epidemiological features of 173 patients who underwent excision of localized TSGCT, the recurrence rates and possible reasons for recurrence were examined in the light of current literature. Methods: Medical records of 173 patients with TSGCT were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Patients were asked about the recurrence of the TSGCT and the QuickDASH scoring was applied at the final clinical evaluation after mean follow-up of 81 months. Results: Females were predominantly involved (73%). Patients aged mean 44 years at the time of surgery. There were 93 tumors in flexor zones and 80 tumors in extensor zones of the hand. Of the tumors with flexor zone localization, zone II was most predominantly involved with 46 tumors, and 18 of these were on the index finger. The extensor zones III and IV were mostly involved with 9 tumors each on the middle and ring fingers. A total of 12 recurrences (6.9 %) were determined over the mean follow-up period of 81 months. Conclusions: The characteristics of our patients identified were similar to the previous studies. Surgical excision provides good outcomes in the treatment of TSGCT especially when clear margins are obtained.

Locally Invasive Pigmented Villonodular Synovitis of the Wrist Treated by Arthroscopic Resection and Bone Grafting

“…In a study of 35 patients, most report a period of progressive pain, followed by diminished range of motion, and a possible mass effect 1 . By contrast, a large case cohort study 3 of 173 cases of PVNS showing a large female predominance (73%) with an initial presentation of a painless growing tumor (96%). Only two cases complained of tenderness likely due to proximity to a digital nerve.…”

Tumor de células gigantes de la vaina tendinosa

“…La edad de presentación del TCGVT oscila entre los 30 y 50 años de edad, afecta principalmente a mujeres, en una proporción 2:1. [3][4][5] Su manifestación en la infancia es excepcional, en estos casos se le asocia con síndromes. 6 El TCGVT corresponde a 1.6% de todos los tumores de partes blandas, y es el segundo en frecuencia de las neoformaciones en manos, ocupando el primer lugar el quiste sinovial.…”

“…Se afectan en orden de frecuencia: índice, pulgar y dedo medio, con predominio en la cara palmar. 5 En la forma difusa se pueden afectar las articulaciones de los miembros inferiores; ésta cursa con comportamiento más agresivo. 3,4 Algunas topografías atípicas del TCGVT localizado son la articulación temporomandibular y la rodilla.…”

“…La tomografía computarizada muestra una tumoración con imágenes quísticas subcondrales, y la resonancia magnética una tumoración con radiolucidez leve, en comparación con el músculo en T1, heterogéneo en T2 y sin realce al administrar gadolinio. [4][5][6][7][8][9][10][11][12][13]…”

“…El índice de recidiva de estos tumores es de 6 a 45%; es directamente proporcional a si la extirpación fue completa o no. 3,5,22 Otros factores relacionados con la recidiva del tumor son: cursar con osteoartritis, ubicación en la articulación interfalángica del primer ortejo, o en la articulación interfalángica distal de los otros dedos, erosión ósea, infiltración del tendón, de la cápsula sinovial o de la articulación, invasión neurovascular y diseminación fuera de la pseudocápsula. [22][23][24] Algunos autores han reportado que la ausencia del gen NM23, detectado por inmunohistoquímica, y el alto índice mitótico es probable que estén asociados a la recurrencia.…”