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Background: The wrist and hand joints are complex structures with an extensive differential diagnosis for a pre-senting mass. However, the vast majority of wrist and hand masses are benign. Magnetic Resonance Imaging (MRI) by virtue of its ability to provide detailed soft tissue characteri-zation is the preferred method of imaging the problematic soft tissue masses. Aim of Study: To evaluate the role of MRI in diagnosis of the most commonly encountered soft tissue masses of the wrist and hand, describing their main features; specifically the signal characteristics and location that helps to differentiate them. Methods: This cross section study included 42 patients (22 females and 20 males), their ages range between 1 year and 79 years, with mean age of 32.24 year. The study was performed in Radiology Department El-Demerdash Hospital between March 2018 and September 2019. Results: Benign and malignant lesions represented (97.6%) and (2.4%) respectively of the encountered lesions. The most commonly found lesions were ganglia (33.3%). The most frequently seen solid tumors, included Giant Cell Tumor of the Tendon Sheath (GCTTS) (9.5%), benign Nerve Sheath Tumors (NST) (4.8%), lipoma (2.4%), hemangioma (4.8%)/ vascular malformation (9.5%), fibroma of the nerve (4.8%) and malignant lesions (2.4%). Joint and soft tissue infection were encountered in (2.4%) of cases. A specific diagnosis was made, or strongly suspected, from the MRI features found in certain conditions like ganglion, hemangioma, arteriovenous malformation, giant cell tumor of the tendon sheath, lipoma, fibroma, and soft tissue infections. MR imaging of the wrist and hand provides a wealth of information regarding the status of and the relationship of the osseous and soft tissue compo-nents, both of which are necessary to confirm the clinical diagnosis and manage the patient in the most efficient way possible. Conclusion: Magnetic resonance imaging is the imaging method of choice for evaluating the presence and extent of soft tissue masses. It is particularly useful for assessing masses in the wrist and hand, where lesions are predominantly benign.By noting the signal characteristics and determining the lesion location, a specific diagnosis of the mass can often be made. unfortunately, when lesion doesn't exhibit typical features, differentiation from malignancy can't be categorically made.

Giant cell tumor of the tendon sheath is a tumor, which affects mainly the hands of people aged 30 to 50 years with a female prevalence. Magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. The aim of this study is to evaluate the efficacy of multiecho gradient-echoes (MeGE) sequence in detecting hemosiderin which is the hallmark of this tumor. MRIs were performed in a sample of 11 patients with a mean age of 45. With the proposed protocol, all readers were able to detect the susceptibility artifacts due to the presence of hemosiderin. MeGE sequence allows to highlight the presence of hemosiderin, and the use of 3 echo times (ET) (8, 16, and 24 ms) is suggested.

Tenosynovial giant cell tumor (TSGCT) represents a family of benign tumors that arise from the synovial tissue of a joint, tendon sheath, or bursa. It usually involves the joints of the extremities and rarely occurs in the head and neck region. Here, we describe a case of a 32-year-old man with a submucosal mass bulging in the posterior pharyngeal wall since one month. The lesion was removed and diagnosed with localized type of TSGCT based on histopathological investigations and clinical presentation. It is very rare that TSGCT occurs in the retropharynx, which reminds clinicians to consider this entity as a possible diagnosis.

lt;bgt;Introduction:lt;/bgt; Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterized by relatively high recurrence rate after surgery.lt;brgt;lt;bgt;Aim:lt;/bgt; The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumors, in a longterm (a mean of 4,2 year) follow-up.lt;brgt;lt;bgt;Material and methods:lt;/bgt; Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated patients), at a mean of 4.2-year follow-up. The final assessment was performed in a form of phone interview.lt;brgt;lt;bgt;Results:lt;/bgt; The most common site of the tumors was the fingers - 42 cases (72%). In 31 patients (53%) the lesion had a well-defined capsule, and in 11 (19%) a satellite nodule was found around the main tumor. A total of 9 relapses (21%) occurred, all within the first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with a recurrence, the primary lesion did not have a well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained of mild pain of the scar and/or numbness of a part of the involved finger.lt;brgt;lt;bgt;Conclusions:lt;/bgt; The main factor that impacted the high rate of recurrence was incomplete tumor excision, which resulted from inadequately accurate surgery and the tumor morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping a greater surgical margin at resection of the non-capsulated lesions was emphasized, as it could translate into reducing the recurrence rate.

BACKGROUND: Tenosynovial giant cell tumor (TGCT), a rare, locally aggressive neoplasm, overexpresses colony-stimulating factor 1 (CSF1). Surgery is standard with no approved systemic therapy. This phase 3 randomized, double-blind study evaluated pexidartinib, a CSF1 receptor inhibitor, in patients with TGCT. METHODS: In part 1 of this two-part study, 120 patients with symptomatic, advanced TGCT for whom surgery was not recommended were randomized (1:1) to pexidartinib (n=61) or placebo (n=59). Part 2 was open-label pexidartinib for all patients. Primary endpoint was centrally reviewed overall response rate (week 25) by RECIST, version 1.1. Secondary endpoints included range of motion, response rate by tumor volume score (TVS), patient-reported outcomes (PROs), and response duration. Emergence of mixed and cholestatic hepatotoxicity caused the Data Monitoring Committee to stop enrollment six patients short of target. FINDINGS: The overall response rate was higher for pexidartinib versus placebo at week 25 by RECIST (39 vs 0%; p

Locking of the knee is a one of the commonest orthopedic outpatient presentation. This patient usually need magnetic resonance imaging (MRI) when there is suspected lesion in the soft tissue clinically. Meniscal tears is the first differential diagnosis when accompany with painful knee. (1, 2)Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath , Mostly involve the hand tendons in middle age group between 30 and 50 years old , female affect more than male.(3,4) The WHO defines two well-known kinds of giant cell tumor: (1) pigmented villonodular synovitis ( generalized type), which mainly involve the joints of the lower limb and (2) giant cell tumor of the tendon sheath ( localized type) , which usually involve the figures and small joints rarely the large one. (5, 6)This case presented as unusual appearance of GCT arising from the suprapatellar synovial pouch.Informed consent obtains from the patient.

Pigmented villo-nodular synovitis (PVNS), also known as giant cell tumor of the tendon sheath or benign synovial histiocytoma, is a benign yet locally aggressive tumor of the synovium that affects both the large joints and the tendon sheaths. The most common site for the tumor includes knees, hip, ankle, and wrist joints; shoulder joint being a very unusual site for the occurrence of this tumor. We present here an unusual case of diffuse PVNS of shoulder joint with eroded humerus head treated with surgical synovectomy and adjuvant radiosynovectomy to prevent recurrence. This case report highlights the natural history of this rare disease due to late presentation, difficulty in the diagnosis, and management of recurrence.

Background: giant cell tumor of the tendon sheath is the most common form of giant cell tumors and is the second most common soft tissue tumor of the hand region after ganglion cyst. Magnetic resonance imaging is the diagnostic tool of choice for both diagnosis and treatment planning. The current standard treatment of choice is simple excision. The main concern about the treatment is related to the high recurrence rates. Besides incomplete excision, there is no consensus concerning the effect of other risk factors on recurrence. The literature lacks detailed reports on surgical excision of these tumors with a standardized surgical treatment and an appropriate patient follow up. The aim of this study was to investigate the recurrence rate and the associated recurrence risk factors for giant cell tumor of tendon sheath of the hand following a standardized treatment. Methods: the records of patients treated for giant cell tumor of tendon sheath of the hand treated by the same hand surgeon were evaluated retrospectively. The features obtained from preoperative magnetic resonance imaging, final physical examination, patients' age and sex, anatomical site of the tumor, relationship of the tumor with bone, joint or neurovascular structures, bone invasion, recurrence after surgery and complications like skin necrosis, digital neuropathy or limitation in range of motion were documented. Chi-square test was used to compare categorical variables. Results: Fifty patient were included in the study. The average follow-up time was 84 months. Three recurrences (6%) were recorded. The only significant risk factor for the recurrence was tumor adjacency to the interphalangeal joints of the fingers other than thumb. No major or minor complications were encountered in the postoperative period. Conclusion: With adequate surgical exposure and meticulous dissection provided by the magnification loupes, we were able demonstrate one of the lowest recurrence rates in the literature. Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence., NA

A giant cell tumor of the tendon sheath (GCTTS) is a benign, soft tissue (synovial membrane) tumor that frequently involves the fingers. However, the localized form of the GCTTS can be rarely seen in large joints such as knees, ankles, and shoulders. GCTTS may occur due to questionable etiology that includes inflammation, trauma, or chromosomal abnormalities. This is a case of a 30-year-old female, who presented with a painful mass in her right knee. Examination revealed a palpable, tender, slightly mobile mass lateral to the patella. MRI demonstrated a cystic lesion that underwent excision. Data from the reported cases imply that local recurrence was observed in 10%-20% of patients due to incomplete primary resection. Physicians should consider the likelihood of a GCTTS when an intra-articular knee prominence is found. Early diagnosis and appropriate treatment can help with rapid clinical improvement.

Introduction and importance: Giant cell tumors of the tendon sheath in children have rarely been reported in the literature. This study aims to present a case of giant cell tumors of the tendon sheath on the big toe of a 5-year-old child. Case presentation A 5-year-old girl presented with a painless swelling over the dorsal aspect of right big toe for 2 weeks. Physical examination revealed non-tender rubbery like swelling over the dorsal aspect of the right big toe. Ultrasound scan of the swelling showed a 17 × 7 mm oval-shaped subcutaneous hypoechoic lesion. Magnetic resonance imaging showed evidence of 20× 8 mm well-defined fusiform soft tissue lesion scalloping the bone. Under general anesthesia, the mass was totally excised. Microscopic sectioning showed a mixture of fibroblasts and histiocyte like cells associated with multinucleated giant cells in the vascular connective tissue stroma with the definite diagnosis of the giant cell tumor of the tendon sheath. Discussion These tumors mostly compose of several types of cell like synovial, siderophages, foam, inflammatory and multinucleate giant cells. The major etiological factors that induce development of this tumor could be traumatic, inflammatory, metabolic or neoplastic disease. Conclusion although it is a sporadic finding, giant cell tumors of the tendon sheath might affect the lower limb in children. Complete excision is the main modality of treatment., Highlights • A giant cell tumor of tendon sheath is a painless benign soft tissue tumor. • There are only a few cases that have been reported in the feet of children. • In this study a case of giant cell tumor of tendon sheath in a 5-year-old child discussed.

This review examines the following aspects of tenosynovial giant cell tumors (TSGCTs): the use of multiple names, the complex relationship between tumor growth pattern and location, the high rate of postoperative recurrence, local invasiveness, use of nonsurgical therapy with molecularly targeted drugs, and best current treatments. This tumor has been referred to by various names, but is now most frequently referred to as TSGCT. TSGCT is classified as localized and diffuse, in accordance with its growth characteristics. Most TSGCTs of the fingers are localized. TSGCT is likely a neoplastic process arising from synovial lining cells, in which tumor cells express the colony stimulating factor 1 (CSF1) gene. The postoperative recurrence rate of TSGCT is approximately 15%. The intrinsic characteristics of recurrence are not clear, and complete resection of the lesion is still the treatment mainstay. Moreover, TSGCT commonly grows out of a pseudocapsule. Therefore, to perform complete resection of TSGCT, surgery must be performed cautiously after appropriate preparation, by using anesthesia, a tourniquet, surgical loupe, and surgical microscopy. After accurate preoperative diagnosis, meticulous planning by surgeons is necessary. The lesion should be resected along with approximately 1-mm of healthy tissue at the adhesion site. In addition, because satellite lesions might be present near the tumor, careful dissection and observation of the color of surrounding tissue are important. International clinical trials of CSF1 receptor inhibitors for TSGCT treatment are ongoing.

This report describes a 61-year-old female with a giant cell tumor of the tendon sheath (GCT-TS). MRI showed that an elliptical abnormal signal was observed over the infrapatellar region of the right knee. We directly do arthroscopy to remove the tumor. An oval irregular mass of about 2.0 cm × 1.5 cm × 1 cm in the right knee joint was found. It was hard and had a dark red surface and the pedicle of the mass was connected with the joint capsule and infrapatellar fat pad. Nodular GCT-TS occurs less frequently in large joints than the small joints of the fingers and toes. The current report demonstrates the unique characteristics of the GCT-TS that extends around the ankle and invades the knee and proximal humerus.

Dermatologic ultrasound imaging has been rapidly growing in recently years [1,2]. Currently, ultrasonography...

Objectives This study aims to evaluate the distribution and prevalence of pediatric hand tumors and tumor-like lesions according to age and gender. Patients and methods We retrospectively examined the details of hospital records of 646 patients who were operated for hand mass between January 2009 and January 2019 and whose pathological diagnosis was established in the same hospital. A total of 54 patients (18 males, 36 females; mean age 12.07 years; range, 3 month to 17 years) under 18 years of age who had been operated for the wrist or hand mass were included in the study. Results Out of 54 tumors, 53 were benign (98%) and one was malignant (2%). There were 42 soft tissue tumors (78%) and 12 bone tumors (22%). The most common soft tissue mass was ganglion cyst (n=12). Six out of 12 ganglion cysts were on the dorsal side of hand or wrist and six were on the volar side. The distribution of the tumors according to gender was not statistically significant (p=0.73). We had two recurrences: one patient with giant cell tumor of the tendon sheath and one with palmar fibromatosis. Conclusion Pediatric hand/wrist masses are mostly benign tumorous conditions. The location of the pathologies may be different from the adults. Diagnosis of the tumor should be established carefully clinically and radiologically while malignant tumors should be kept in mind by both pediatricians and orthopedic surgeons.

In this study, we report the case of a patient with a lobulated expansile lesion of 16.6 cm in its largest diameter, who was referred as having a simple “synovial cyst” in the foot that actually was a giant cell tumor of the tendon sheath along the extensor hallucis longus. Conducting a differential diagnosis of a “synovial cyst” in the foot and ankle, performing adequate surgical planning and using imaging tests, such as nuclear magnetic resonance, increases the probability of treatment success. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Background: Emerging literature introduces radiation therapy for benign hand conditions. However, hand surgeons are wary recommending radiation therapy for nonmalignant conditions. In our practice, we have used radiation therapy for patients who present with infiltrative or recurrent giant cell tumor of the tendon sheath (GCTTS) since 1998. The purpose of this study is to examine the secondary effects of radiation to the hand through the critical lens of a hand surgeon. Methods: A case series of patients who received radiation therapy for GCTTS were reviewed. The Radiation Oncology/Toxicity Grading Late Radiation Morbidity Scoring Schema was used, and patients were questioned about symptoms and examined for physical findings involving their irradiated digits. Results: A total of 8 patients with GCTTS presented for follow-up. The average patient age was 59.1 years, and the average time since radiation therapy was 5.4 years. Patients had an average of 2.3 surgeries on the affected digit prior to receiving radiation therapy. The average Disabilities of the Arm, Shoulder, and Hand score was 8.1. The most common sign of radiation was nail changes. All patients complained of sensibility changes, although only 2 of the 8 patients had abnormal moving 2-point discrimination tests. There were no confirmed recurrences of GCTTS and no skin cancers. Conclusions: Patients who received radiation therapy to the hand report high levels of satisfaction with the therapy. Radiation therapy is tolerated well by these patients and has a low level of morbidity in our population.

Tenosynovial giant cell tumor (TSGCT) is a rare benign tumor arising from joint synovia, bursae and tendon sheaths. Their variable clinical presentation is related to variations in site and progression. Localized forms are most frequent in the hands, and diffuse forms in the knee. MRI is necessary and sometimes sufficient for diagnosis. Treatment strategy is guided by progression, symptomatology, location and diathesis. Optimally complete resection is the principle of first-line treatment. Radiation therapy is effective and targeted therapies are promising; both should especially be considered in case of relapse.

WOS: 000521139200025 PubMed: 32160509 Giant cell tumor of the tendon sheath (GCTTS) occurs most often in the hand and rarely in the feet, and as an extremely uncommon presentation in the knee joint. Case reports involving GCTTS in the knee joint generally describe it originating from the nearby anterior cruciate ligament, posterior cruciatc ligament, patellar tendon, and medial plica. To the best of our knowledge, there are no previously reported case reports involving GCTTS originating in the ligamentum mucosum. In this article, we describe a 27-year-old male patient who was admitted to the orthopedic emergency room with a painful locked knee. He had severe pain that was worse with activity and a decreased range of motion. Magnetic resonance imaging (MRI) indicated massive swelling and a wellcircumscribed lobulated intraarticular mass at the distal one third of the ligamentum mucosum. The mass was removed successfully with arthroscopic-assisted mini-open excision, and histological analysis subsequently diagnosed it as a localized type of GCSTT. The patient remained asymptomatic and a follow-up MRI two years after surgery did not show any recurrence of the lesion.

Giant cell tumor of the tendon sheath (GCTTS) in the foot is a rare pathology and is involved in the differential diagnosis of soft-tissue tumors of the foot and ankle. Although it can affect any age group, GCTTS mainly occurs at the 3rd and 5th decade and is more common in females. Histopathologic examination is a major definitive method for diagnosis, although physical examination and radiologic imaging are helpful in reaching a diagnosis preoperatively. Many treatment options exist but marginal excision is the most commonly used treatment. We describe the case of a 26-year-old pregnant woman with a multi-fragmented mass extending from the first web space to the plantar aspect of the metatarsophalangeal joint (MTP) of the left great toe associated with flexor hallucis longus tendon after trauma. She had pain that worsened with activity and wearing shoes. After pregnancy, a marginal excision with dorsal longitudinal incision in the first web space was performed under spinal anesthesia. The lesion was diagnosed as a localized type tenosynovial giant cell tumor. At the last follow-up appointment in the 23rd month, the patient was doing well and there was no recurrence of the lesion. GCSST should be considered in the differential diagnosis of plantar masses of foot. Although, GCTTS is frequently seen in females, it has not been previously reported in a pregnant woman with an extremely rare condition after trauma.

This article describes a rare case of giant cell tumor of the tendon sheath (GCTTS) that was developed over the substance of chimeric-free latissimus dorsi and ­serratus ­anterior muscle flaps performed for lower limb reconstruction. To our knowledge, development of GCTTS over a free flap is first described in the literature. A 71-year-old ­woman was presented with a large protuberant ulcerated tumor mass that was developed over the substance of chimeric free muscle flaps at the foot and ankle. We performed an extensive tumor resection, and the pathology report confirmed the presence of a primary giant cell tumor. The patient was advised to have a below-knee amputation. However, the patient refused the amputation, and 4 months later, she was presented with a metastatic mass proximally at the upper thigh. We believe that the GCTTS was associated with the chronic inflammation of the soft tissue and bones along with the recurrent episodes of infection, mainly due to proteus mirabilis and proteus syndrome (PS). PS may lead to the development of malformations and overgrowth of different tissues in unusual locations. In cases resistant to antibiotics, the radical surgical debridement should be considered as the most effective treatment.

Background Tenosynovial giant cell tumor (TSGCT) originates from the synovial cells of the tendon sheath and is the most common soft tissue tumor of the foot and ankle. Due to the lack of clinical data about TSGCT in the foot and ankle, this study was performed with the aim of investigating the clinical characteristics, and surgical outcomes that might predict the likelihood of recurrence. Methods Clinical data, obtained from the pathology records and the clinic files, along with the tumor subtype, local recurrence, and patient functional status among 26 cases of TSGCT were evaluated with the mean 73 months follow-up period. Results There were 26 patients including 16 males and 10 females with a mean age of 40 years, who underwent surgery. There were 15 localised TSGCT and 11 diffuse TSGCT. The diffuse TSGCT was more likely to be in the hindfoot dorsum (54,5%, 6/11). The localised TSGCT was mostly located in the forefoot (80%, 12/15). The recurrence rate in the diffuse TSGCT was 27,3% (3/11). In the localised TSGCT, recurrence was seen in 6,6% of patients (1/15). The mean AOFAS score was 79. Conclusion Diffuse TSGCT is more likely to occur in the hindfoot and localised TSGCT is more common in the forefoot. Excision with clear margins is an effective treatment for TSGCT, with good oncological and clinical outcomes. But the orthopaedic surgeons should consider the equilibrium between surgical margins and the functional status of the patient.

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.

INTRODUCTION: The giant cell tumor of tendon sheath is among the more common soft tissue tumors of the hand. It is a slowly progressive, usually painless, rubbery mass predominating on the radial three digits of the hand and is typically identified adherent to the digital flexor tendon sheath of the hand. The histology is variable but the tumors consistently contain multinucleated giant cells and xanthoma cells. CASE PRESENTATION: A case report of a 57 years old female patient who came with a diffuse, painless swelling on the radial aspect of middle finger of the right hand at the Orthopedic OPD of our institution. MANAGEMENT & OUTCOME: A planned operative procedure was done. After clinical examination and other investigations, a careful excision of the mass was done by detaching it from the underlying tendon sheath. The tissue was sent for biopsy to two different labs for examination. The reports were confirmed as Giant Cell tumor of the tendon Sheath. DISCUSSION: A giant cell tumors of the tendon sheath (GCTTS) is an uncommon and usually benign lesion that arises from the tendon sheath though they are the second most common tumors of the hand. Recurrence rates are as high. A recent study found that following surgical excision, the only lesions that recurred were those that originally had multiple discrete tumors. Tumors composed of single masses did not recur following surgical excision. MRI may be helpful in determining the anatomic extent of the lesion.

Giant cell tumor of the tendon sheath (GCTTS), also termed tendosynovial giant cell tumor, is a benign, slow-growing tumor that originates from the tendon sheath or bursa. GCTTS of the foot and ankle is much less frequently reported compared with GCTTS of the hand and knee. However, GCTTS should be considered as a differential diagnosis of soft tissue tumors of the foot and ankle. The optimal treatment strategy for GCTTS in the foot and ankle is controversial due to a scarcity of cases. The present study reports the case of a patient that presented with localized intra-articular GCTTS originating from the capsule of the ankle, which is a rare anatomical location for this tumor. Considering the proximity of the tumor to the adjacent non-tumorous structures, a less radical but complete resection of the tumor was performed, followed by a hydrogen peroxide lavage. There was no evidence of recurrence during a follow-up period of 12 months, and adjuvant radiotherapy was not administered to the patient. A pre-operative diagnosis for GCTTS in the foot and ankle is mainly based on the findings of clinical examination and magnetic resonance imaging, which also facilitates the determination of a surgical strategy. For a localized tumor, an integral resection, as opposed to a radical resection, with a hydrogen peroxide lavage may result in a favorable prognosis. However, the optimal treatment for diffuse GCTTS remains to be identified.

BackgroundGiant cell tumor of the tendon sheath (GCTTS) is a benign soft tissue (synovial membrane) tumor that rarely involves the hands or wrists. And Tendon impairment caused by GCTTS is extremely rare.Case presentationHere, we reported a case of a 60-year-old female with a 10-year history of gradually increasing mass in her left dorsal wrist. The EIP tendon was partially impaired by the mass.The patient was treated with surgical excision of the mass and reconstruction of the EIP tendon. The histopathological examination suggested the presence of GCTTS. After surgery, the patient had adequate functional recovery and no tumor recurrence after 2 years’ follow-up.ConclusionGCTTS in hands and wrists rarely damages the tendon. Early diagnosis and proactive interventions may likely contribute to good prognostic outcomes.

Localized tenosynovial giant cell tumor (L-TGCT), formerly called giant cell tumor of the tendon sheath, is one of the benign proliferative diseases of the synovium of a joint, bursa, or tendon sheath. L-TGCT occasionally involves a large joint such as the knee, and rarely it is combined with infarction by pedicle torsion. Neither the prevalence of torsion of L-TGCT nor the mechanism involved are known, but it is thought to be uncommon progress. Herein, we describe a rare case of infarcted L-TGCT in the knee involving torsion of a mass pedicle in a 47-year-old man. We utilized magnetic resonance imaging including diffusion-weighted imaging and axial apparent diffusion mapping, and sonographic appearance during the course of investigations, because radiologic findings showed characteristic features of infarcted L-TGCT.

Giant cell tumor of the tendon sheath is a type of slow-growing benign soft tissue tumor that typically arises from the synovium of the tendon sheath. Enchondroma is a benign bone tumor comprising of mature hyaline cartilage that centrally develops within the tubular bone. While giant cell tumor of the tendon sheath or enchondroma are common benign soft tissue and bone tumors, respectively the simultaneous occurrence of these tumors in the same region of the hand is exceedingly rare, and it can mimic a malignant tumor, thereby making the diagnosis more challenging. Herein, we report an unusual imaging presentation of the coexistence of these tumors in the middle phalanx of the little finger, which to the best of our knowledge has not been previously reported, and this initially present as a single intrinsic osseous lesion mimicking malignancy. The coexistence of these tumor types must be considered in the differential diagnosis of an intramedullary lytic lesion with a poor margin associated with a soft tissue mass of the fingers, and a meticulous preoperative magnetic resonance imaging investigation was required.

Diffuse-type tenosynovial giant cell tumor (D-GCTS) is a rare benign lesion that not only frequently occurs in the fingers, but also along the tendon sheaths of the foot and ankle. The present study reports the cases of two middle-aged patients that were diagnosed with D-GCTS. The presentation of the D-GCTS lesions was extremely rare, as the tumors were located in the temporal fossa and threatened the skull base and external auditory canal. There were similarities and differences between the two patients in their clinical symptoms, disease progressions and invading sites. The patients' disease course occurred unnoticed with the absence of pain, was protracted and became infiltrative. However, the female patient was admitted to the hospital due to the occurrence of pain in the left temporal region, and the male patient presented at the doctor due to a painless left temporal mass and external auditory canal bleeding. Therefore, the operation area of the two patients was not the same. This type of illness should be considered in the differential diagnosis for masses occurring in the temporal region. Total tumor removal is the best treatment for D-GCTS, and the careful monitoring of recurrence can achieve a good clinical outcome subsequent to the surgical resection.

Giant cell tumors of the tendon sheath are the second most common type of subcutaneous benign tumors found in the hand. These tumors are slow growing soft tissue mases that develop over a long period of time and can occur at any age. Although such lesions are usually painless, there is a possibility of recurrence of the tumor. Patients should seek postoperative management in order to prevent any possibility of recurrence. In view of the current literature, we present a case involving a patient suffering from a multifocal giant cell tumor of the tendon sheath that restricted movement of the interphalangeal joints of the thumb. [Hand Microsurg 2015; 4(1.000): 16-19]

Giant cell tumors of the tendon sheath (GCT-TS) are one of the most common tumors of the hand, along with ganglions. However, occurrence in the toes is far less common. Here we present a rare case of GCT-TS at the middle phalanx level of the flexor digitorum longus tendon sheath. Magnetic resonance imaging showed low intensity both on T1 and T2 weighted images. To the best of our knowledge, our case is the first report of a GCT-TS arising at the middle phalanx level of the flexor digitorum longus tendon sheath of the fourth toe. Although GCT-TS are rare in the toe, they must be included in the differential diagnoses of soft tissue tumors arising in the toes.

WOS: 000429961400021, Giant cell tumors of the tendon sheath are the second most common neoplasms of hand and one of the rare reasons of carpal tunnel syndrome. Usually, the findings include swelling, tingling, pain, and loss of sense associated with the mass. A 54-year-old female patient with recurrent carpal tunnel syndrome had a massive lesion that was not detected on physical examination, but carpal tunnel compressed by the giant cell of the tendon sheath was detected through advanced investigations. Symptoms were resolved after surgical excision.

Patient: Male, 26 Final Diagnosis: Giant cell tumor of the patella tendon seath Symptoms: Efusion • locking knee • pain Medication: None Clinical Procedure: Arthroscopy and open resection of the tumor Specialty: Orthopedics and Traumatology Objective: Rare disease Background: The giant cell tumor of the tendon sheath (GCT-TS) is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. When it involves the infrapatellar fat pad it can present acutely as a painful locked knee. Case Report: A 26-year-old white male presented with a 2-week history of painful locking in his right knee. Clinical examination revealed lack of extension by approximately 20°. To help establish the diagnosis, an MRI scan of the right knee was performed, showing a large (5×4×2 cm), oval, well-circumscribed mass with a low-intensity homogenous signal. The size of the mass prohibited the removal by arthroscopy and we therefore proceeded with an open arthrotomy. Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath. At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence. Conclusions: These rare tumorous lesions should be included in the differential diagnosis of painful locking knee, especially in the absence of definite traumatic history.

Little is known about the burden of illness in patients with tenosynovial giant cell tumors (TGCT), which are rare, typically benign, lesions of the synovial tissue including giant cell tumor of the tendon sheath (GCT-TS) and pigmented villonodular synovitis (PVNS). The objective of this study was to describe health care resource use and costs for patients with GCT-TS and PVNS, which are rare and typically benign TGCT.A retrospective cohort study design was used to analyze administrative claims for adult commercial and Medicare Advantage health plan enrollees with evidence of GCT-TS and PVNS from January 1, 2006 through March 31, 2015. Participants were continuously enrolled for 12 months before (pre-index period) and 12 months after (post-index period) the date of the first tenosynovial giant cell tumor (TGCT) claim (index date). Preindex and postindex measures were compared using the McNemar test and Wilcoxon signed-rank test. Results were stratified by TGCT type.The study identified 4664 patients with TGCT, 284 with GCT-TS, and 4380 with PVNS. Mean age (GCT-TS group: 50 years; PVNS group: 51 years) and sex distributions (GCT-TS group: 60.2% female; PVNS group: 59.5% female) were similar for each group. Most patients with GCT-TS (78.2%) had at least one postindex surgery, compared with 38.7% of patients with PVNS. Mean total health care costs increased from $8943 in the preindex period to $14,880 in the postindex period (P0.001) for GCT-TS and from $13,221 in the preindex period to $17,728 in the postindex period (P0.001) for PVNS. Preindex to postindex ambulatory costs increased nearly 120% for patients with GCT-TS ($4340 to $9570, P0.001) and 50% for patients with PVNS ($6782 to $10,278, P0.001), and physical therapy use increased significantly during the same period (GCT-TS: 18% to 40%, P0.001; PVNS: 38% to 60%, P0.001).Costs increased substantially 1 year after the first TGCT claim, with more than half the costs covering ambulatory care. These results suggest a high health care burden once TGCT is identified.

Giant cell tumor of the tendon sheath (GCTTS) is a benign, proliferative lesion of the synovium of the joint, the bursa, and the tendon sheath. We report a case of intra-articular, localized GCTTS arising from the patellar tendon, which is a rare cause of anterior knee pain. The diagnosis may be delayed due to non-specific symptoms and normal plain radiographic findings. Magnetic resonance imaging (MRI) is diagnostic to detect the lesion, but several other clinical entities and lesions should be evaluated in the differential diagnosis. The treatment of choice is a total excision of the lesion without leaving residual tumor tissue, in order to reduce the risk of recurrence. We present a patient with GCTTS of the patellar tendon and discuss its clinical and radiographic characteristics, differential diagnosis, pathology, and treatment.

The present study aimed to investigate the value of magnetic resonance imaging (MRI) in the diagnosis of giant cell tumor of the tendon sheath (GCTTS), including localized (L-) and diffuse (D-) types. A total of 38 patients with GCTTS, including 31 with L-GCTTS and 7 with D-GCTTS, diagnosed by surgery and pathology, were retrospectively analyzed. All patients underwent MRI examination. Of the 31 patients with L-GCTTS, the tumors were located in the hand and wrist (18 patients), the ankle and foot (10 cases), the knee joint (2 cases) and the temporomandibular joint (1 case). All 31 lesions were either located in relation to a tendon or were partially/completely enveloping it and all were well marginated. With respect to the 7 D-GCTTS patients, the tumors were located in the ankle and foot (6 cases) or the hand and wrist (1 cases). All 7 lesions presented as an aggressive soft tissue mass infiltrating the tendon sheath and adipose tissue around the joint. The characteristic internal signal of GCTTS, including L-GCTTS and D-GCTTS, was demonstrated by MRI examination. MRI is currently the optimal modality for preoperative assessment of tumor size, extent and invasion of adjacent joint and tenosynovial space.

The localized form of giant cell tumor of the tendon sheath is one of the most common soft tissue tumors of the foot and ankle region. It is characteristically a benign, sharply localized peritendinous fibrous mass in the synovial or tendinous spaces. The purpose of this Technical Note is to present the technical details of endoscopic resection of giant cell tumor of the extensor tendon of the foot with preservation of the tendon. It is indicated in the localized form of giant cell tumor of the extensor tendon at the foot dorsum. It is contraindicated in cases with a diffuse giant cell tumor, a giant cell tumor of the extensor tendon at the phalangeal level, or involvement of the flexor tendon.

Giant cell tumor of the tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. We report the case of a giant cell tumor of the tendon sheath arising from the flexor tendon sheath of 5th finger of left hand of a 44 year old male patient. The patient underwent ultrasound examination and subsequently magnetic resonance imaging.

The current study presents the case of a 25-year-old male who developed tumor recurrence of the proximal phalange of the ring finger on the right hand 4 years after partial tumor resection surgery. An X-ray of the right hand showed that the distal bone of the proximal phalange on the ring finger was destroyed. An artificial finger joint replacement was performed using a silicone joint for this unusual tumor recurrence. The pathological findings were indicative of a giant cell tumor of the tendon sheath. As a result of surgery, the patient's proximal interphalangeal point motion recovered to the pre-operative level. The pre-operative and post-operative disabilities of the arm, at shoulder and hand and total activity measurement values were 1.67 and 3.33, and 255 and 243°, respectively. Complications such as tumor recurrence, joint dislocation and the requirement for prosthetic training were not observed during the 5-year follow-up period.

Giant cell tumor of the tendon sheath is the second most common tumor of the hand often referred to as xanthoma. Histologically these tumors are composed of multinucleated giant cells, polyhedral histiocytes, fibrosis and hemosiderin deposits. Marginal excision of giant cell tumor of the tendon sheath is the treatment of choice. We present a case of xanthoma of flexor pollicis longus tendon presented as a single enlarging mass in volar aspect of left thumb. After clinical diagnosis, work-up is done with ultrasound, FNAC and excision biopsy.

Introduction: Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor which most commonly affects hand tendons but rarely affects the large joints. GCT-TS usually occurs in individuals between the ages of 30 and 50 years, with a predominance for females, and exhibits the tendency for local recurrence following surgical resection. Marginal excision is the standard treatment of GCT-TS. Case presentation: The case studied is a 51-year-old female with a one-year history of gradual onset of pain in the left knee. She denied any history of trauma. The pain was worse at night and during walking and she was on regular pain medication. She was referred as a case of osteoarthritis not responding to conservative treatment. The purpose of this report is to emphasize the possibility of other pathologies whenever the pain is not responding to usual conservative treatment even in the presence of radiological features. Discussion: GCT-TS in large joints may be more difficult to diagnose, as there are few and nonspecific symptoms. GCTTS most frequently occurs in the digits of the hands and feet and is rarely seen in the larger joints. Although GCT-TS is a benign tumor, it has a high incidence of recurrence following resection (10–40%), Conclusion: Giant cell tumor of the suprapatellar region is unusual especially when accompanied by pain presentation in a patient who is diagnosed as another case of osteoarthritis. Careful surgical excision is effective in preventing recurrence despite relatively high recurrence rates.

Giant cell tumor of the tendon sheath (GCTTS) predominantly occurs in the tendon sheaths of the hand, but rarely in those of the knee. The current study reports the case of a 36-year-old male patient presenting with anterior knee pain. The patient was ultimately diagnosed with GCTTS in the knee mimicking patellar tendinopathy. To the best of our knowledge, this is the first case of its kind. Magnetic resonance imaging revealed a well-defined oval intra-articular lesion located at the proximal segment of the infrapatellar fat pad. The lesion was completely excised under arthroscopy and pathological examination confirmed the diagnosis of GCTTS. There was no evidence of recurrence at the 2-year follow-up examination. The findings of the present study suggest that, despite its rarity, GCTTS should be considered in the differential diagnosis of patellar tendinopathy.

Giant-cell tumor of the tendon sheath (GCTTS) is a benign soft tissue tumor of the limbs arising from the complex of the tendon sheath and periarticular soft tissues of small joints. It is the second most common benign space occupying lesion in the hand and usually presents as a painless soft tissue mass, which grows slowly in size for many years. We present an interesting case of an enormous GCTTS presenting as a slowly growing mass over left sole of a 52-year-old woman. The duration of GCTTS may range from a few weeks to 30 years but in our case the duration of tumor was almost 48 years, which could be the longest reported duration of GCTTS.

Introduction Giant cell tumor of the tendon sheath usually occurs in the tendon sheath of the hand, fibrous tissue surrounding the joints, mucosal bursa, but rarely in those of the knee. Tenosynovial GCT are rarely intraarticular. We describe a case of an intra-articular localized Tenosynovial giant cell tumor arising from the anterior cruciate ligament (ACL) in a 30 year female who presented with pain and recurrent swelling of her left knee without prior history of a trauma. Materials and methods The case involves a 30-year-old female patient. She presented with sudden onset of recurrent left knee swelling for 18 months without any history of preceding trauma. Tests for internal derangement of the left knee yielded negative finding. MRI however was reported as localized extra articular PVNS of left knee joint. Arthrotomy surgery of the left knee was decided and it revealed a purple colour mass attached to the distal 2/3 of the lateral and posterior lateral of the ACL. Results Histopathology revealed hyper cellular areas, composed of sheets of rounded or polygonal cells with a variable admixture of giant cells containing fat and rimmed hemosiderin pigments. It revealed a benign giant cell tumor of tendon sheath. Discussions MRI had been reported as the best to diagnose this tumor, however correlation with histopathology is also a must. On MRI, GCTTS appears as a heterogeneous mass in soft parts, with a low T1 and T2 signal which corresponds to the hemosiderin deposit. Left knee arthrotomy via lateral approach was performed in our case. Another method that can be used is arthroscopic excision, however there is no standard treatment protocol but excision with or without radiotherapy is the treatment option. Conclusion GCTTS is a rare tumor involving large joints especially in the knee. Diagnosis can be confirmed with MRI and excision of the tumor can be done via arthrotomy or via arthroscopy.

Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor and is the second most common tumor of the hand after ganglion cysts. It is a slow-growing benign lesion of the soft tissues. The etiology of GCTTS is not clear. Although GCTTS most commonly presents in a digit of the hand, it may also present in the palm, wrist, foot, knee, ankle, elbow, or hip. Here, we present a rare case of GCTTS originating at the inguinal region, which has not been previously reported. A 52-year-old male presented with a 2 cm × 1 cm swelling at the right inguinal region. The clinical impression was inguinal lymph node enlargement. Ultrasonography (USG) showed the presence of large inguinal lymph node. Fine-needle aspiration cytology (FNAC) showed the features suggestive of giant cell lesion, possibly GCTTS. Repeat ultrasound revealed a large oblong-shaped hypoechoic lesion with mild internal vascularity in the right inguinal region above the external oblique aponeurosis, suggestive of aponeurotic giant cell tumor. Histopathology was confirmatory. Here, we report this case to highlight the role of FNAC in diagnosing GCTTS at a rare site, i.e., inguinal region. Due to its location at inguinal region, along with clinical suspicion of tubercular lymphadenitis and USG findings showing large inguinal lymph node in the right inguinal area, it needs to be differentiated from other causes of lymph node enlargement. It would be prudent to state that FNAC along with radiology can help reach the final diagnosis.

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).

The current report presents the case of a 41-year-old male exhibiting a giant cell tumor of the tendon sheath (GCT-TS) arising from the patellar tendon sheath. Plain radiography and magnetic resonance imaging revealed a well-localized mass that wrapped around the patellar tendon, and extended from the subcutis into the infrapatellar fat pad and tibia. Following histopathological determination of the diagnosis, a piecemeal resection was performed. Nodular-type GCT-TS occurs less frequently in large joints compared with the small joints of the fingers and toes. The current report presents the unique features of a case of GCT-TS extending around the patellar tendon, and invading into the knee joint and proximal tibia bone.

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.

手根骨部に発生し，手根骨，中手骨に骨浸潤像を示した腱鞘巨細胞腫の2例を報告する．症例1は26歳女性，2週間前に左手背部の無痛性腫瘤を自覚した．単純X線像にて第4・第5 CM関節部にpunched-out様の骨透亮像，MRIにて腫瘤の骨内浸潤を認め，悪性腫瘍を疑われたため針生検を行った結果，腱鞘巨細胞腫と診断され腫瘍切除術を施行した．術後1年5カ月で腫瘍の再発はない．症例2は60歳男性，6年前左手関節部腱鞘巨細胞腫の診断にて近医で切除術を施行したが，3年前より同部位に腫瘤を自覚し徐々に増大した．単純X線像にて第3・第4CM関節部の骨透亮像，MRIにて腫瘍の骨内浸潤を認めたため切除術を施行した．再手術後2年2カ月で腫瘍の再発はない．