Giant cell tumor of tendon sheath: Largest single series in children

Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Journal of Pediatric Orthopaedics (Impact Factor: 1.47). 01/2007; 27(1):67-74. DOI: 10.1097/01.bpo.0000242380.95348.8b
Source: PubMed


Giant cell tumors of tendon sheath (GCTTS) are rare in children. We hypothesized that GCTTS in children probably behave in a similar manner to the adult lesions, with regard to clinical features, imaging characteristics, histology, and recurrence rates after surgical excision. We retrospectively reviewed 29 children diagnosed and treated for GCTTS during a 16-year period and evaluated the above characteristics to compare these results with published data for adult patients. A telephone questionnaire survey was also conducted to assess the current symptoms and function, satisfaction with procedure, and incidence of recurrence. In children, we noted similar predilection for lesions in both upper and lower extremities. Most cases, 28 (96%) of 29, presented with a gradual enlarging soft tissue mass. Plain radiography demonstrated soft tissue swelling in 50% of cases. Magnetic resonance imaging features were noted to be variable, although low signal intensity on T1- and T2-weighted images was noted in most lesions. Incisional biopsy with intraoperative frozen section and histological evaluation was the gold standard for accurate diagnosis. We noted no recurrence at final follow-up in any of our cases. Twenty-two (75%) of these 29 patients had follow-up of more than 2 years, with no recurrence, and the remaining 7 had follow-up between 1 to 2 years, which may seemingly be adequate from perspective of expected time interval for early recurrences. Meticulous dissection and excision with appropriate use of magnifying surgical loupes are likely factors that may help to minimize the recurrence rate.

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    • "The tumor is most commonly diagnosed in the fourth and fifth decades of life (range, 4-82 years),13,14 with women affected more commonly than men (64.3% women).2,3,15 Although GCTTS most commonly presents in a digit of the hand, it may also present in the palm,1,16 wrist,2,17 foot,7,13,18 knee,7,13,18 ankle,13 elbow,13 or hip.2 Grossly, GCTTS is a multilobular and generally well-circumscribed tumor. It may be partially or completely encapsulated and may have extensions and/or satellite lesions connected by as little as a few strands of fibrous tissue.6,15 "
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    ABSTRACT: Objective: No consensus exists on the etiology, prognostic factors, or recurrence rate of giant cell tumors of the tendon sheath. This article presents a series of 65 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of giant cell tumor of the tendon sheath. Methods: The authors completed a retrospective review of one surgeon's practice from 1976 to 2001, evaluating 65 cases of giant cell tumor of the tendon sheath. The authors conducted a literature search and compared the case series with historical data. Results: The tumor most commonly presented as a firm, nontender mass in the dominant hand. Our cases showed a slight female predominance of 54%, compared with the literature average of 64%. A pseudocapsule was present in 51% of cases. Overall recurrence rate was 10%. No association was noted between recurrence and pseudocapsule presence, rheumatoid arthritis, or osteoarthritis. Satellite lesions at the first excision were noted in 80% of recurrent cases; however, satellite lesions were not a risk factor for recurrence per se. Conclusions: Our study shows similar findings to the literature, with the notable addition of satellite lesions in recurrent tumors. Marginal excision is the treatment of choice, but may be complicated when the tumor is attached to vital structures. Therefore, an appropriate balance between resection of tumor and maintenance of function must be achieved due to the possibility of recurrence.
    Eplasty 11/2012; 12:e50.
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    ABSTRACT: Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.
    Journal of the Chinese Medical Association 01/2010; 73(1):47-51. DOI:10.1016/S1726-4901(10)70022-8 · 0.85 Impact Factor
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    ABSTRACT: Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.
    La radiologia medica 02/2010; 115(1):141-51. DOI:10.1007/s11547-010-0515-2 · 1.34 Impact Factor
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