Giant Cell Tumor Of Tendon Sheath Research Articles

ECCRINE SPIRADENOMA AS A DIFFERENTIAL FOR TENDON SHEATH GCT OF THE HAND — A DIAGNOSTIC DILEMMA

Eccrine spiradenoma is a rare tumor arising from the sweat glands. It usually presents itself in the head and neck region, with only a few reported cases in the literature of hand eccrine spiradenomas. It is usually seen in the age group of 15–35 years. Here, we report a case of a patient in her 50s presenting a mass over the dorsum of the hand and clinically closely mimicking tendon sheath giant cell tumor (GCT). Investigations supported the clinical diagnosis and provided extra information on possible malignant transformation. A surgical excision was performed and sent for histopathological examination which confirmed the diagnosis. It is also interesting to notice from our case that the need for histopathological evidence should not be neglected despite ultrasonography and Magnetic Resonance Imaging (MRI) being very useful as diagnostic investigations.

Exploration of the molecular biological mechanisms and review of postoperative radiotherapy cases in tenosynovial giant cell tumors.

Tendon Sheath Giant Cell Tumor (TGCT) is a benign tumor that primarily grows within joints and bursae. However, it has a high postoperative recurrence rate, ranging from 15% to 45%. Although radiotherapy may reduce this recurrence rate, its applicability as a standard treatment is still controversial. Furthermore, the pathogenic mechanisms of TGCT are not clear, which limits the development of effective treatment methods. The unpredictable growth and high recurrence rate of TGCT adds to the challenges of disease management. Currently, our understanding of TGCT mainly depends on pathological slice analysis due to a lack of stable cell models. In this study, we first reviewed the medical records of two female TGCT patients who had undergone radiotherapy. Then, by combining bioinformatics and machine learning, we interpreted the pathogenesis of TGCT and its associations with other diseases from multiple perspectives. Based on a deep analysis of the case data, we provided empirical support for postoperative radiotherapy in TGCT patients. Additionally, our further analysis revealed the signaling pathways of differentially expressed genes in TGCT, as well as its potential associations with osteoarthritis and synovial sarcomas.

Uncommon synovial pathologies

The synovium is a specialized tissue lining the synovial joints, bursae, and tendon sheaths of the body. It is affected by various localized and systemic disorders. Synovial diseases can be broadly classified as inflammatory, infectious, degenerative, proliferative, hemorrhagic, and neoplastic. Injuries to other structures within the joint, such as cartilage, may also be caused by pathological processes that affect the synovium. Early detection of synovial diseases is critical to avoid irreversible joint damage. Understanding the typical imaging features of synovial diseases can help in accurate diagnosis and prompt treatment. Therefore, imaging plays a crucial role in detecting synovial diseases at an early stage. This pictorial review highlights the unusual synovial pathologies, such as synovial chondromatosis, pigmented villonodular synovitis (PVNS), giant cell tumor of tendon sheath (GCTT), hemophilic arthropathy, lipoma arborescens, and synovial sarcoma.

Giant cell tumour of tendon sheath (GCTTS) – 2 Most common tumour of hand after ganglion cyst

Probably one of the most common benign neoplasm in the human hand, the Giant Cell Tumour of Tendon Sheath (GCTTS) has been studied by many authors over the years as a popular tumour. There have been studies on the etilogical factors, however, limited attention has been given to etiology, prognostic factors, and recurrence rate. Because there are several factors that predispose to recurrence, it is imperative that medical practitioners ensure complete excision of the tumour, including removal of residual satellite nodules. This study is a focus on 0.5cm swelling over dorsal part of the interphalangeal joint of middle finger of the right hand of a 55-year old female that was initially unilobulated, which eventually increased to 3cm and was bilobed over 6 months. With meticulous dissection and the use of magnification loupe to obtain a low recurrence rate, thereby emphasising the key role of surgery as the first prognostic factor of GCTTS.

Giant Cell Tumor of the Tendon Sheaths in the Foot: A Case Report

Tendon sheath giant cell tumor (TCGGT) is a benign soft tissue tumor that usually affects the tendons of the hand, but rarely affects the foot. It mainly affects young adults, but can occur between the ages of 10 and 60. It is a predominantly female tumor. Anatomopathological examination remains the key to diagnosis and prognosis. Treatment is based on surgery with complete removal of the tumour. We report a case of a giant cell tumor of the flexor sheaths localized in the sole of the foot.

Demystifying Giant Cell Tumours of Tendon Sheath (GCTTS): A Case Series of 18 Cases with Review of Literature.

The giant cell tumour of the tendon sheath (GCTTS) is the second most frequent soft tissue tumour affecting the hand. No consensus exists on the etiology, prognostic factors, or recurrence rate of GCTTS. This article presents a series of 18 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of GCTTS. A total of 18 patients with a histo-pathological diagnosis of a GCTTS of the hand or finger were reviewed. The location for the tumour was limited to the wrist and hand. All cases were operated under Wide Awake Local anaesthesia (WALANT), and using a magnifying loupe. A total of 18 patients presented at our institution with a diagnosis of GCTTS from 2016 to 2018. Of the 18 patients, 11 were female and 7 were male. The mean age of included patients was 43.6years (31-59years). The most common site for the lesion was the middle finger (4/18), followed by the index finger, wrist, and thumb (3/18 each). The little and ring finger were least commonly affected with one case each. The mean size of the tumour was 2.4cm (0.5-5cm). None of the patients reported recurrence of the lesion on an average follow-up of 18.8months. GCTTS is a benign, slowly growing lesion of the hand that typically does not cause any symptoms and is treated with surgical resection. Meticulous excision of the GCTTS using magnification loupes to ensure appropriate wide excision of the tumour is the treatment of choice to prevent a recurrence. In addition, a radiographic and histopathological examination must be performed on the tumour to rule out other diagnoses. Finally, the function of the hand should be reconstructed to minimize the loss of any functional unit.

Cytomorphologic panorama of giant cell tumour of tendon sheath.

Giant Cell Tumour of Tendon Sheath (GCTTS) is a slow growing benign soft tissue tumour arising from synovium of tendon sheath or joint. These tumours occur more frequently in upper limbs, especially hands. In the present study, we aimed to evaluate the cytomorphological spectrum of GCTTS. This retrospective study includes a total of 56 cases of GCTTS diagnosed over a period of 8 years. The clinical and radiological details of these cases were retrieved from the cytopathology records and detailed cytomorphological features were studied and analysed. Histopathological correlation was done in 16/56 cases, where follow-up was available. The mean age of patients at the time of presentation was 32 years and were predominantly females (68%). The most common site of GCTTS was fingers (76%), followed by foot, wrist and toes. The most consistent finding on cytology was stromal cells (100%) of polygonal, spindle and plasmacytoid morphology with interspersed multinucleated osteoclastic giant cells (100%), followed by binucleated stromal cells (75%), xanthoma cells (61%) and hemosiderin laden macrophages (52%). Presence of proteinaceous fluid background was also observed in 50% of the cases. GCTTS can be diagnosed with certainty on FNAC based on characteristic cytomorphological features in an appropriate clinical and radiological setting. FNAC plays a pivotal role in diagnosing GCTTS and differentiating it from other giant cell rich lesions, thus obviating the need of tissue biopsy for diagnosis, which in turn helps the clinician in timely and adequate management of the patient.

Pexidartinib hydrochloride exposure induces developmental toxicity and immunotoxicity in zebrafish embryos via activation of Wnt signaling.

Pexidartinib, a macrophage colony-stimulating factor receptor (CSF-1R) inhibitor, is indicated for the treatment of tendon sheath giant cell tumor (TGCT). However, few studies on the toxicity mechanisms of pexidartinib for embryonic development. In this study, the effects of pexidartinib on embryonic development and immunotoxicity in zebrafish were investigated. Zebrafish embryos at 6h post fertilization (6 hpf) were exposed to 0, 0.5, 1.0, and 1.5μM concentrations of pexidartinib, respectively. The results showed that different concentrations of pexidartinib induced the shorter body, decreased heart rate, reduced number of immune cells and increase of apoptotic cells. In addition, we also detected the expression of Wnt signaling pathway and inflammation-related genes, and found that these genes expression were significantly upregulated after pexidartinib treatment. To test the effects of embryonic development and immunotoxicity due to hyperactivation of Wnt signaling after pexidartinib treatment, we used IWR-1, Wnt inhibitor, for rescue. Results show that IWR-1 could not only rescue developmental defects and immune cell number, but also downregulate the high expression of Wnt signaling pathway and inflammation-related caused by pexidartinib. Collectively, our results suggest that pexidartinib induces the developmental toxicity and immunotoxicity in zebrafish embryos through hyperactivation of Wnt signaling, providing a certain reference for the new mechanisms of pexidartinib function.

Giant cell tumor of tendon sheath: A report of 216 cases.

In this article on giant cell tumor of tendon sheath (GCTTS), we intend to summarize and analyze the clinical and pathological features of GCTTS hoping to improve clinical management and patient treatment. The study retrospectively reviewed 216 patients of GCTTS, registered at the Affiliated Hospital of Southwest Medical University from January 2010 to December 2020. These cases were diagnosed by surgical excision. The clinicopathological features and the prognosis were reviewed in the light of the current literature. Of these 216 GCTTS patients, 72 were males (33.3%) and 144 females (66.7%), with a ratio male-to-female of 1:2. The patients' age ranged from 5 to 82, the average being 41.5 years at diagnosis. A total of 96 cases (44.4%) occurred in the hand region, followed by 35 cases (16.2%) in the knee, 32 cases (14.8%) in the foot, 25 cases (11.6%) in the ankle, 12 cases (5.6%) in the wrist, 12 cases (5.6%) in the leg, 2 cases (0.9%) in the head, 1 case (0.5%) in the forearm, and 1 case (0.5%) inside and outside the spinal channel. Histopathology mainly revealed large synovial-like monocytes, small monocytes, and osteoclast-like giant cells. Our results confirm that GCTTS predominantly occurs in the hands of young women. Complete surgical resection with long-term follow-up is the preferred management.

GIANT CELL TUMOR OF TENDON SHEATH AT THE HAND: A CASE REPORT

The study investigates the Giant Cell Tumor of Tendon Sheath (GCTTS), which is the second most prevalent soft tissue tumor after ganglion cysts. It is a benign nodular tumor found on the tendon sheath of the hands and feet. An atypical case of GCTTS with an abnormal location away from the tendon sheath has been reported. A 23-year-old Libyan man visited the Zliten Teaching Hospital with a history of first web space left-hand swelling since 6 months, increased in size, not tender on examination, hard mobile swelling not attached to underlying tissue, with the full range of motion in adjacent joints, and neurological deficit in the ulnar side of the thumb. The diagnosis was made clinically with a firm, nodular mass that does not transilluminate and had decreased signal intensity on both T1-and-T2-weighted MR imaging. Radiographic and histopathological examinations confirmed the benign nodular mass and the treatment modality. Marginal excision was performed and the tumor was completely removed to prevent a recurrence.

FNAC study of giant cell tumor of tendon sheath (localized tenosynovial giant cell tumor): Clinico-radiological correlation and cytopathological features.

Localized tenosynovial giant cell tumor (GCT) or giant cell tumor of tendon sheath (GCTTS), is a benign nodular lesion that arises from the synovium of the tendon sheath of the hands and foot. GCTTS is characterized by the presence of multinucleated giant cells and proliferation of synovial-like mononuclear cells. A clinical diagnosis of GCTTS is kept as a differential when a firm, nodular mass shows decreased signal intensity on both T1-and T2-weighted MR imaging. Treatment is usually marginal excision of the mass. It is a retrospective study, observed in the past 3 years at a tertiary care hospital. Those cases were included in the study in which histopathological confirmation was available or if clinico-radiological features were confirmatory of the diagnosis of GCTTS when correlated with cytological features. There was a total of 24 cases, out of which 16 were females and 8 males. The tumor was located in the upper limb in 21 cases and in 3 cases the tumor was present in the lower limb. In the upper limb, 18 cases were on the right side and three cases were on the left side. In the lower limb, 1 case was present on the left and 2 on the right side. The cytomorphology consisted of mononuclear stromal cells, multinucleated giant cells, and hemosiderin-laden macrophages in variable numbers. It is important to accurately diagnose and categorize giant cell-containing lesions because their prognosis depends on the exact categorization of the tumor.

Fine Needle Aspiration Cytology of Giant Cell Tumour of Tendon Sheath

Introduction: Giant Cell Tumour of Tendon Sheath (GCTTS), also known as localised nodular tenosynovitis, is a slow growing benign soft tissue tumour arising from synovium of tendon sheath, bursa or joint. Clinically, the lesions occur as skin-coloured nodules typically on the extremities. These tumours occur more frequently on the upper limbs especially hands (77%) where they form the second most common tumour following simple ganglion cyst. Aim: To describe the cytomorphologic findings in GCTTS and their histopathological features. Materials and Methods: This retrospective study was conducted at Department of Pathology, ESI Hospital, Delhi, India, in 12 diagnosed GCTTS cases for their cytological features from January 2015 to December 2017. Fine Needle Aspiration Cytology (FNAC) was performed with a 22-gauge needle attached to a 10 mL syringe. Smears were air-dried and stained with Giemsa stain. Cytomorphology of all the selected cases were analysed and descriptive statistics were used to evaluate the cases. Results: A total of 12 cases of GCTTS were retrieved. Diagnosis of GCTTS was made by FNAC in all the cases and confirmed by histopathological examination in half of the cases. The mean age of presentation was 39 years. Of these, 8 (66.67%) were women and 4 (33.33%) were men. The lesions were found most commonly over the index finger (n=5) followed by the ring finger (n=3), thumb (n=2), middle finger (n=1) and little finger (n=1). The most frequent clinical presentation was a painless, nodular, slow growing firm swelling over the finger. FNAC revealed cellular smears with few clusters and numerous scattered stromal cells along with interspersed multinucleated giant cells. Conclusion: A definitive preoperative diagnosis of GCTTS obtained through FNAC helps in formulating appropriate treatment plan. Histopathologic examination will confirm the cytological diagnosis and can help to predict recurrence by providing information on the resection margin, any satellite nodules, variable cell types and mitotic activity.

Cytological diagnosis of soft-tissue lesions: A study of variation in site of occurrence

Objectives: Fine-needle aspiration cytology is a useful diagnostic tool for soft-tissue lesions, which helps in further management of patient. Although, various soft-tissue lesions have preference for particular site of human body, yet usefulness/role of site in cytological diagnosis in the published literature is not very well highlighted. In this study, our aim was to analyze the location of soft-tissue lesions as encountered in cytology practice. Material and Methods: Details of soft-tissue lesions who underwent fine-needle aspiration in a period of 12 months were analyzed. Age, gender, and site of soft-tissue lesion were noted. All the soft-tissue cases were divided into two categories. Group 1 – soft-tissue lesions situated at elbow, forearm, wrist, and hand for upper extremities; and knee, lower leg, ankle, and foot for lower extremities. Group 2 – soft-tissue lesions occurring at other sites. Pearson’s Chi-square test and significance of difference between proportions were analyzed to assess the significance. Results: A total of 928 cases were reported over a period of 12 months. Soft-tissue lesions in Group 1 and Group 2 were 172 and 756 cases, respectively. All the soft-tissue lesions except ganglion cyst (GC) and giant cell tumor (GCT) of tendon sheath are more prevalent in Group 2. There was a statistically significant association (P < 0.001) between cytological diagnosis of soft-tissue lesion and site of lesion. The difference in occurrence of epidermal inclusion cyst, GC, and GCT of tendon sheath between Groups 1 and 2 was found to be statistically significant (P < 0.001). Conclusion: We found significant difference in occurrence of some of the soft-tissue lesion at distal extremity as compared to other location. This may be helpful in arriving at a proper cytological diagnosis.

Surgical Strategy of Pediatric Benign Sacral Tumors

Background: Primary benign osseous tumors and tumor-like lesions at the sacrum are rare in the pediatric population and exact surgical strategy is still unclear. In this study, we evaluate the outcome for pediatric patients with benign tumors and tumor-like lesions at the sacrum who were receiving surgical treatment according to our proposed surgical strategy and classification. Methods: We analyzed 49 pediatric patients with sacral benign tumors or tumor-like lesions aged 18 years and below from 2005 to 2018. There were 23 men and 26 women with a mean age of 14.0±3.8 years. Nineteen patients had giant cell tumors (GCTs), 9 aneurysmal bone cysts, 5 osteoblastomas, 5 neurogenic tumors, 3 hemangiomas, 3 teratomas, 2 Langerhans cell histiocytosis, 1 chondroblastoma, 1 fibrous dysplasia, and 1 GCT of tendon sheath. We proposed our surgical plan and surgical classification for pediatric patients with sacral benign tumors or tumor-like lesions. Results: The mean follow-up duration was 6.2 years (range, 1.0 to 18.9 y). GCTs (39%, 19/49) and primary aneurysmal bone cysts (18%, 9/49) are the top 2 common histologic types. Preoperative selective arterial embolization (SAE) was performed in 12 cases and 24 patients received intraoperative aortic balloon occlusion (ABO) as the preoperative surgical plan. Furthermore, according to tumor location at the sacrum, we classified surgical excision of sacral benign tumors and tumor-like lesions into 3 types. Fourteen cases were classified as type I, 27 as type II, 3 as type III, and 5 patients with neurogenic tumors cannot be classified into this surgical classification. Ten patients had wound complications. Two had femoral artery thrombosis because of ABO application. One had mechanical failure. Rate of local recurrence was 16%. Seven patients with GCTs and 1 with neurogenic tumor had local recurrence. No patient died of disease at the last follow-up. For the assessment of neurological function, the rate of neurological dysfunction was 12% (6/49). Four cases had urinary incontinence, 3 fecal incontinence, and 3 had bowel obstruction. Next, univariate analysis for influence of preoperative SAE and intraoperative ABO on complications demonstrated that both of them exerted no significant influence on the occurrence of oncological and nononcological complications. Conclusions: The proposed surgical strategy can provide an excellent therapeutic effect for pediatric benign tumors and tumor-like lesions at the sacrum. Preoperative SAE and intraoperative ABO can safeguard pediatric patients with high vascularity of benign tumor at the sacrum during the operation. Level of Evidence: Level IV.

Differential diagnosis of fibroma of tendon sheath and giant cell tumor of tendon sheath in the finger using signal intensity on T2 magnetic resonance imaging.

The differential diagnosis of fibroma of tendon sheath (FTS) and giant cell tumor of tendon sheath (GCTTS) on the basis of clinical and radiographic characteristics remains difficult. To evaluate the quantitative measurement of signal intensity (SI) obtained by magnetic resonance imaging (MRI) for the differential diagnosis of FTS and GCTTS in just the finger. We retrospectively identified patients with FTS (n = 6) and GCTTS (n = 22) of the finger who were treated at our hospitals between April 2011 and August 2019. Two researchers independently reviewed the MRIs and measured the regions of interest (ROIs) in the tumor and flexor tendon from the same image. The SI ratio obtained for the tumor and tendon ROIs was measured and compared using receiver-operating characteristic curve analyses. Sensitivity and specificity analyses were performed. The SI ratios (mean ± SD) of FTS and GCTTS were 1.83 ± 0.64 and 6.34 ± 3.16 for researcher 1 and 1.82 ± 0.60 and 6.10 ± 3.22 for researcher 2, respectively. The areas under the curve were 0.970 and 0.970 for researchers 1 and 2, respectively. The cut-off values of the SI ratio as determined by researchers 1 and 2 for differentiating FTS from GCTTS were 3.00 and 3.00, respectively (sensitivity = 95.5%, specificity = 100%). The SI ratio is useful for differentiating FTS from GCTTS independent of a combination of tumor signal and shape.

Isolated tuberculous peroneal tenosynovitis—A rare case report

Tuberculous peroneal tenosynovitis is a rare disease. The disease develops insidiously, and there will be a progressive inflammation of tendon sheath with limitation of excursion of inflamed tendons. We report a case of a 55-year-old man who was initially diagnosed as tendon sheath giant cell tumor clinically and radiologically, and after biopsy, it turned out to be tuberculous peroneal tenosynovitis.

Giant cell tumor of tendon sheath: An institutional experience

Giant Cell Tumor of Tendon Sheath (GCTTS) is the second most common benign tumour affecting hand after ganglion. It more commonly affects middle aged women with index finger being the most commonly affected site. There is high propensity of recurrence following surgical excision. The objective of this study was to review all cases of GCTTS received in our department and to study the age and gender distribution, location and histological features of the same.

Giant Cell Tumor of Tendon Sheath in Supraclavicular Region: Cytological Aspect of a Common Tumor in an Uncommon Location

Giant cell tumor of tendon sheath (GCTTS) is a common neoplasm, frequently developed around small digital joints of hand, and less commonly in wrist, ankle, foot and knee. GCTTS of other locations are very rare. The cytological feature of GCTTS is unique, but it could mimic neoplasm, inflammation or other lesions when arising in unusual locations. We reported a case of a 26-year-old male who presented with a supraclavicular mass. Microscopic features of excised mass revealed well-demarcated oval nodule, composed of polymorphous population of multinucleated giant cells and mononuclear cells with fibrous septa, consistent with the diagnosis of GCTTS. Local recurrence is not occurring during five-year follow-up. The purposes of this report is to present the rarity of this tumor in an exceedingly rare location and to help avoid misdiagnosis with other mimics. Keywords: giant cell tumor of tendon sheath, cytology, localized tenosynovial giant cell tumor DOI: 10.31524/bkkmedj.2019.02.017

Endoscopic Approach for the Excision of Giant Cell Tumor of Tendon Sheath Involving the Hindfoot: A Case Report

Giant cell tumor of tendon sheath (GCT-TS) is an often benign neoplasm that is relatively uncommon in the foot and ankle when compared to the upper extremities. Magnetic resonance imaging aids in characterizing the lesion, but diagnosis is confirmed with biopsy. Surgical excision is the preferred treatment. There is a lack of studies examining the long-term outcomes of endoscopic excision of GCT-TS, especially lesions found in the foot and ankle. The present study describes a case of a 42-year-old male with GCT-TS of the hindfoot treated with an endoscopic excision through a sinus tarsi approach. The patient was asymptomatic with no local signs of recurrence at the 67-month follow-up visit.

Giant cell tumour of tendon sheath: A 10-year study from a tertiary care centre.

Cytology of giant cell tumour of tendon sheath (GCTTS) is often sufficient to diagnose this lesion and has been previously described in small series. The present study was undertaken to evaluate detailed cytomorphological features and differential diagnostic entities and pitfalls in the diagnosis. All the cases of GCTTS reported on FNAC were retrieved from July 2007 to June 2017. The cases were reviewed for various cytomorphological features, which were correlated with follow-up histopathology wherever available. A total of 72 cases of GCTTS were retrieved, follow-up histopathology was available in 20 cases. The common sites of involvement were fingers and palm followed by wrists, elbow, knee, ankle and shoulder. The characteristic cytomorphology consisted of mononuclear cells, multinucleated giant cells and pigment laden macrophages in variable numbers. There were four discordant cases that were confirmed on histopathology as sarcoidosis, melanoma, fibrous histiocytoma and eumycetoma. GCTTS can be confused cytologically with giant cell rich lesions of bone and soft tissue and pigment containing lesions including melanoma. Ladybird cell is a characteristic feature seen in this lesion. Proper clinicoradiological correlation is essential before offering a diagnosis of GCTTS on cytology.