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.
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    ABSTRACT: The purpose of this study was to evaluate the diagnostic value of sonography in giant cell tumors of the tendon sheath. Sonographic findings and other clinical records were retrospectively reviewed and analyzed in 30 patients (45 lesions) with pathologically proven giant cell tumors of the tendon sheath. The sonographic findings were compared with those found at surgery. The locations of the tumors included the hand (53.33%), wrist (10%), elbow (3.33%), knee (10%), and foot (23.33%). The sizes of the tumors ranged from 0.4 to 8 cm, with a mean size of 2.6 cm. All the lesions were shown as hypoechoic nodules with homogeneous or heterogeneous echogenicity. Thirty-two lesions (71.11%) had substantial flow, and 13 lesions (28.89%) had minimal flow. Thirty-four lesions were in contact with the tendon sheath; 5 were in contact with the joint; and 6 were in contact with both the tendon sheath and the joint. Bone erosions were found in 4 cases, and bone impressions were found in another 3 cases. Sonography can provide exact information about a tumor and its relationship with the surrounding tissue, which indicates that it can be used as the first method to diagnose a giant cell tumor of the tendon sheath.
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