Abstract
The tenosynovial giant cell tumor (TGCT) is a usually benign lesion which arises from the synovium. It affects joints, tendon sheaths and bursae. The clinical course is often unpredictable, and local recurrences frequently occur. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions. 1284 studies published between 01/1966 and 06/2021 were identified. 25 met the inclusion criteria, with a total of 382 patients. Of these, 212 patients had a diffuse (dTGCT) and 170 a localized (lTGCT) TGCT. Patients with a dTGCT had a mean age of 36.6±8.2 years, and 55% were female. The overall complication rate was 24% in dTGCT, irrespective of the therapeutic procedure; the mean follow-up was 37.9±27.4 months with a recurrence rate of 21%, and recurrences occurred between 3 and 144 months, the vast majority (86%) within the first 5 years following intervention. Patients with a lTGCT had a mean age of 31.2±5.7 years, and 53% were female. Complications occurred in 12%. The mean follow-up was 51.1±24.6 months, the recurrence rate was 7%, and recurrence occurred between 1 and 244 months after intervention. Diffuse TGCTs of the foot and ankle region have a remarkable recurrence rate irrespective of therapeutic procedures, and most lesions reoccurred within 5, with more than half of these in the first 2 years. The lTGCTs are well treatable lesions, with a low recurrence and a moderate complication rate. Based on these findings, we propose a follow-up regime for the dTGCT including a clinical survey and MR imaging 3 months after surgical intervention (baseline), followed by twice-yearly intervals for the first 2 years, yearly intervals up to the fifth year, and further individual follow-up due to the fact that recurrences can even occur for years later. For the lTGCT a clinical survey and MRT is proposed after 3-6 months after intervention (baseline), followed by annual clinical examination for 3 years, and in case of symptoms MR-imaging. Larger prospective multi-center studies are necessary to confirm these results and recommendations.
Highlights
The tenosynovial giant cell tumor Tenosynovial Giant Cell Tumor (TGCT), formerly known as pigmented villonodular synovitis (PVNS), is a rare, usually benign lesion of the synovium, which affects joints, tendon sheaths and bursae
It is divided according to site, to the affected location, and growth pattern (localized, versus diffuse) [1]
12 studies referred to dTGCTs [14, 15, 17, 26,27,28,29,30,31,32,33,34], 3 study examined subjects with lTGCTs [11, 12, 35] and 10 studies described the diffuse and localized form, respectively [9, 16, 19, 22, 36
Summary
The tenosynovial giant cell tumor TGCT, formerly known as pigmented villonodular synovitis (PVNS), is a rare, usually benign lesion of the synovium, which affects joints, tendon sheaths and bursae. The incidence rates range from estimated 30.3–39 per million person-years for lTGCT and 4–8.4 per million person-years for dTGCT [2, 3], but despite the rarity of these tumors, the diffuse and the localized form are one of the most common soft-tissue tumors of the foot and ankle region [4, 5]. In both forms patients are mainly affected in their 3rd - 5th decade of life [6, 7]. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions
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