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Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10-53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.

Giant cell tumors of the tendon sheath are common lesions and are the second most frequent tumors in the hand, after synovial cysts. They are diagnosed by means of clinical examination and complementary examinations (simple radiography and magnetic resonance). Erosion and invasion of the phalangeal bone affected may be seen on radiological examination. Magnetic resonance may show a “fluorescent or radiant effect” may be observed, caused by the high quantity of hemosiderin inside the tumor. Surgical treatment is the commonest practice, and complete excision is important for avoiding recurrence of the tumor, especially when bone invasion is observed on imaging examinations, which is generally related to greater tumor recurrence. In this paper, a case of a giant cell tumor of the tendon sheath in the middle phalanx of the third finger of a 45-year-old female patient is presented. This was successfully treated by means of surgery using a double access approach (dorsal and volar).

Giant cell tumor of the tendon sheath is a benign tumor typically presenting as a nontender mass around the hand and wrist. Giant cell tumor of the tendon sheath in large joints is typically larger and shows higher rates of local recurrence, as well as common features with pigmented villonodular synovitis. We describe two cases of giant cell tumors in the patellar tendon area that were treated successfully with arthroscopically assisted complete excision. Orthopedic surgeons must be aware of this entity to prevent unnecessary adjuvant therapy or recurrent excision.

This article discusses several benign tumors and proliferative processes of the synovium including giant cell tumor of the tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, and synovial hemangioma, lipoma, and fibroma. We review the clinical features and imaging characteristics of each entity, with a special focus on the unique imaging findings that can enable a confident diagnosis or a limited differential diagnosis.