Giant Cell Tumors of the Synovial Sheaths (TCGGS) of the Hand: About 15 Cases

Abstract

Giant cell tumor is a benign tumor mainly affecting the epiphyses of the long bones. It mainly affects young adults between the ages of 20 and 40. Its origin remains uncertain. It is a purely lytic and usually aggressive tumor that destroys bone, possibly even leading to a fracture. Occasionally, there may be invasion of the soft tissues. Axial computed tomography or magnetic resonance are very useful in determining tumor extension. The differential diagnosis mainly includes lesions affecting the epiphyseal regions of the bones such as chondroblastoma and clear cell chondrosarcoma. The treatment of giant cell tumor is first and usually surgical. It consists of an extensive curettage under direct vision through a large bone window. Curettage can be made more effective by using physicochemical means such as phenol or liquid nitrogen to sterilize the tumor bed and reduce the risk of local recurrence. The risk of recurrence is significant, even with modern means of curettage and is typically around 30%. Large resection of the diseased bone segment is indicated for regions where it does not cause significant functional deficit. The risk of recurrence is then much lower. Although presenting a benign appearance on histopathological examination, “benign” pulmonary metastases can sometimes be seen. Recent studies suggest the presence of chromosomal abnormalities or the expression of certain genes, which could explain the behavior, sometimes even malignant, of these tumors.