Singapore Med J 2009; 50(6) : e204
C a s e R e p o r t
Sisli Etfal Research
Aksoy B, MD
Ertürer E, MD
Seçkin F, MD
Şener B, MD
University School of
Toker S, MD
Dr Serdar Toker
Tel: (90) 274 228 0434
Fax: (90) 274 265 2277
Tenosynovial giant cell tumour of the
posterior cruciate ligament and its
Aksoy B, Ertürer E, Toker S, Seçkin F, Şener B
Tenosynovial giant cell tumours originate from
synovial tissues of the joints, tendon sheaths,
mucosal bursas or fibrous tissues adjacent to
tendons. Tenosynovial giant cell tumours are
rarely intra-articular. We report a giant cell
tumour of the tendon sheath arising from the
posterior cruciate ligament diagnosed by magnetic
resonance imaging and resected arthroscopically
in a 54-year-old woman.
Keywords: arthroscopic resection, giant cell
tumour of the tendon sheath, pigmented
villonodular tenosynovitis, posterior cruciate
ligament, tendon sheath lesion, tenosynovial
giant cell tumour
Singapore Med J 2009; 50(6): e204-e205
Tenosynovial giant cell tumours, also known as
pigmented villonodular tenosynovitis, arise from the
synovial tissue of the joint, tendon sheath, mucosal bursa
or fibrous tissue adjacent to the tendon.(1) These tumours
predominantly involve the palmar side of fingers and
toes, and seldom larger joints like the knees and ankles.(2)
Tenosynovial giant cell tumours of the tendon sheath are
rarely intra-articular.(3) In the literature, there has only
been one reported case of tenosynovial giant cell tumour
arising from the posterior cruciate ligament (PCL).(4) In
this report, we present a rare location of a tenosynovial
giant cell tumour arising from the PCL and its treatment
A 54-year-old woman was referred to our clinic for right
knee pain of two years. She did not feel any pain at rest
but in walking and climbing up and down the stairs.
She did not have knee trauma. She had active and full
range of motion of the knee. On physical examination,
there was no lateral and medial joint space tenderness.
The knee was found to be stable in Lachman, anterior
drawer, posterior drawer and medial-lateral stress tests.
No bone pathology was detected in anteroposterior and
lateral knee radiographies. All laboratory tests were
within normal ranges. On magnetic resonance (MR)
imaging, a regular contoured mass localised in the PCL
was detected (Figs.1 & 2).
In the light of these findings, we performed an
arthroscopy from standard portals. At the arthroscopy, a
soft tissue mass that was yellow, pink and partially shiny
white in colour was localised in the femoral attachment
of the PCL. There was no meniscal and articular cartilage
lesion. The mass was totally resected with a shaver
Fig. 1 Coronal T2-W MR image shows a 22 mm × 18 mm
hyperintense regular contoured mass, localised in the posterior
cruciate ligament (arrows).
Fig. 2 Sagittal T1-W MR image shows a 22 mm × 18 mm
hypointense regular contoured mass, localised in the posterior
cruciate ligament (arrows).
Singapore Med J 2009; 50(6) : e205 Download full-text
and thermal ablation device. The histopathological
examination revealed that the lesion composed of
sheets of round or polygonal cells that blended with
hypocellular collagenised zones. Multinucleated giant
cells were scattered throughout the lesion. Xanthoma
cells and haemosiderin granules were present (Fig. 3).
The lesion was diagnosed as tenosynovial giant cell
tumour. The patient had no more complaints after the
operation, and there was no recurrence at 36 months’
Tenosynovial giant cell tumours are generally
differentiated into subgroups according to the region of
occurrence and growing properties. These types have
different clinical properties and biological behaviour.(1)
Tenosynovial giant cell tumours are classified as localised
and diffuse tumours.(4) Localised tumours are benign soft
tissue tumours that predominantly involve the palmar
side of the fingers and toes. These tumours are typically
painless and grow slowly. The incidence in males is two
times that of females, and the mean age of patients is 30–
50 years.(1,2) These tumours typically do not involve the
larger joints and are very rarely placed intra-articularly.(3)
They are generally small (< 4 cm in diameter) and well-
Fig. 3 Photomicrograph shows cells with normochromatic
nucleii, with isositosis and isocaryosis, confirming giant cell
tumour of the tendon sheath (Haemotoxylin & eosin, × 40).
contoured masses, although tumours of up to 8 cm in
diameter have been reported.(1) A 10%–20% recurrence
rate has been reported after local excision.(1,2) As giant
cell tumours do not have characteristic clinical features,
they are usually diagnosed by investigations based on
suspicion.(2,3) 10%–14% of patients show cortical bone
The nature of this lesion is still controversial.
Jaffe at al considered it a reactive process, hence the
name, nodular tenosynovitis.(5) Most authors currently
regard it as being neoplastic, a hypothesis supported
by the presence in this lesion of clonal chromosomal
aberrations.(6) MR imaging has been reported to be
the best diagnostic technique for this entity.(7) In this
case, we report a histopathologically-proven giant cell
tumour of the tendon sheath arising from the PCL that
was diagnosed by MR imaging and totally resected
arthroscopically. This is the second case in the literature.
We conclude that localised giant cell tumour of the
tendon sheath can be placed as a unique lesion in the
PCL, and a total arthroscopic resection is possible.
1. Enzinger FM, Weiss SW. Benign tumors and tumor-like lesions
of synovial tissue. In: Enzinger FM, Weiss SW, eds. Soft Tissue
Tumors. 3rd ed. St Louis: CV Mosby, 1995: 735-55.
2. Kuhnen C, Müller KM, Rabstein S, Kasprzynski A, Herter P.
[Tenosynovial giant cell tumor]. Pathologe 2005; 26:96-110.
3. Otsuka Y, Mizuta H, Nakamura E, et al. Tenosynovial giant-cell
tumor arising from the anterior cruciate ligament of the knee.
Arthroscopy 1996; 12:496-9.
4. Sheppard DG, Kim EE, Yasko AW, Ayala A. Giant-cell tumor of
the tendon sheath arising from the posterior cruciate ligament of
the knee: a case report and review of the literature. Clin Imaging
5. Jaffe HL, Lichtenstein L, Sutro CJ. Pigmented villonodular
synovitis, bursitis, and tenosynovitis. Arch Pathol 1941;
6. Sciot R, Rosai J, Dal Cin P, et al. Analysis of 35 cases of localized
and diffuse tenosynovial giant cell tumor: a report from the
Chromosomes and Morphology (CHAMP) study group. Mod
Pathol 1999; 12:576-9.
7. Kitagawa Y, Ito H, Amano Y, Sawaizumi T, Takeuchi T. MR
imaging for preoperative diagnosis and assessment of local tumor
extent on localized giant cell tumor of tendon sheath. Skeletal
Radiol 2003; 32:633-8.