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Resume Les tumeurs a cellule geante des gaines tendineuses (TCGGT) constituent le sous-type le plus frequent de la synovite villonodulaire. Les TCGGT se situent principalement aux pieds et aux mains. Nous rapportons le cas d’un garcon de dix ans ayant une tumefaction de la plante du pied droit. L’association de la radiographie standard, de l’echographie et de l’IRM a permis d’evoquer le diagnostic de TCGGT. Les diagnostics differentiels et l’anatomopathologie sont discutes.

The purpose of this study was to determine the MR findings in patients with giant cell tumors of the tendon sheath.MR imaging findings in nine surgically proved cases of giant cell tumors of the tendon sheath were evaluated on both T1- and T2-weighted images. Of nine lesions, three involved the foot, two involved the thumb, two involved the knee, one involved the proximal part of the tibia, and one involved the proximal part of the femur.All nine lesions were hypointense on T1-weighted images; the signal intensity of most of the tumors was approximately equal to that of skeletal muscle. On the T2-weighted images, three lesions were hypointense relative to skeletal muscle, two lesions were approximately isointense relative to skeletal muscle, and two lesions were slightly hyperintense relative to skeletal muscle but hypointense relative to fat. The remaining two lesions had a more heterogeneous appearance on T2-weighted images.On both T1- and T2-weighted images, giant cell tumor of the tendon sheath has a signal intensity similar to that of its pathologic counterpart, pigmented villonodular synovitis. The decreased signal intensity on both T1- and T2-weighted images is an uncommon appearance of extraarticular soft-tissue masses, in particular when they occur in the hands or feet, and this may suggest the diagnosis of giant cell tumor of the tendon sheath.

Localized giant cell tumor of the tendon sheath (GCTTS) usually occurs in extensor an tendon sheath of the fingers and toes. It has rarely been observed in the fat pad of the knee joint. We treated a case of a 2.5×3×4 cm mass arising from the infrapatellar fat pad, which presented with extension limitation and knee pain due to lateral femorotibial joint impingement. The tumor was successfully treated using arthroscopic excision with a motorized shaver. Histologic findings were diagnosed as localized GCTTS. Herein we report this case with a literature review.

A case of malignant giant cell tumor of the tendon sheath of the right hip, which developed in a 72-year-old Japanese woman, is described. The tumor exhibited histological similarities to a benign giant cell tumor of the tendon sheath (localized nodular tenosynovitis). The resected tumor, measuring 9 x 9 x 11 cm, was located in the adductor muscle and invaded the proximal femur and acetabulum. The nodule was encapsulated with a thin membrane which was soft and gelatinous in consistency and varied in color from yellow to brown. The synovium of the hip joint was normal. The primary lesion was composed of plump polyhedral and spindle-shaped cells. The nuclei were large, irregular and hyperchromatic, and contained prominent nucleoli. A moderated number of multinucleated giant cells was scattered throughout the lesion. There was little stromal collagen. In the majority of the specimens, pseudoglandular or alveolar spaces were predominant. An ultrastructural study demonstrated three cell types: fibroblast-like, histiocyte-like and an intermediate. The patient underwent reconstructive surgery with a Dacron fabric-enveloped alumina ceramic pelvic prosthesis and total hip components after resection of the primary lesion. Unfortunately, because of a local recurrence, a hemipelvectomy was required 10 months after the initial operation. At that time the intestines were involved with the recurrent tumor, and the patient subsequently died of perforative peritonitis. An autopsy revealed distant metastases to the right pelvis, urinary bladder, right ureter, ilium, mesenterium and lungs.

The DNA content and proliferative indexes of seven cases of tenosynovial giant cell tumor of tendon sheath, diffuse type (TGCT-D); 11 cases of tenosynovial giant cell tumor of tendon sheath, localized type (TGCT-L); and seven cases of pigmented villonodular synovitis (PVNS) were analyzed by flow cytometry in an attempt to assess objectively their biologic differences. Three cases of TGCT-D manifested an aneuploid DNA content and four had a diploid DNA pattern. All cases of TGCT-L and PVNS showed a diploid DNA content. The proliferative indexes for TGCT-D were significantly higher than those found in the other two groups. There was no histopathologic feature that correlated with the aneuploid DNA pattern found in two of the three cases of TGCT-D. Only one of the three aneuploid DNA content TGCT-D cases displayed marked cellular pleomorphism with dense fibrous stroma; in that case there was recurrence 4 years after initial excision. Our data further support that TGCT-D, TGCT-L, and PVNS are histopathologically similar but clinically distinct lesions. The high proliferative indexes of TGCT-D may reflect a rapid, uncontrolled growth that may explain its aggressive biologic behavior. The presence of an aneuploid DNA pattern in some cases of TGCT-D in this study, coupled with the reported chromosomal abnormalities and occurrence of malignant transformation in these lesions, clearly supports their neoplastic nature.

Giant cell tumor of tendon sheath is the second most common tumor of the hand. It can also occur in larger joints. Radiologic features include a soft-tissue mass with or without osseous erosion. Less commonly, it can cause periostitis or permeative osseous invasion; it may rarely calcify. The entire imaging spectrum of this lesion is presented, with emphasis on atypical appearances which can mimic other lesions.

Giant cell tumor of the tendon sheath is the second most frequent nonepithelial benign tumor of the hand after ganglion cyst. Although it is recognized as a condition that may involve the distal digit, there has been only 1 report of periungual involvement. We describe a second case at that site in this article.

Giant cell tumor of the tendon sheath (GCTTS) is a slowly growing, benign soft tissue tumor. The tumors occur predominantly on the hands and feet. Although the clinical and histopathologic features are well-defined, only a few reports have described the cytologic appearance of this entity. A 26-year-old woman presented with a gradually developing circumscribed soft tissue mass near the proximal phalanx of her left little finger for one year. Imprint and fine needle aspiration (FNA) smears were obtained from the excisional biopsy specimen. The imprint smears were composed of predominantly singly dispersed bland mononuclear cells and several giant cells. The mononuclear cells were polygonal to round, and they showed a histiocyte-like appearance. Osteoclast-type multinucleated giant cells of various sizes were randomly scattered throughout the smears, and these cells contained 3 to 50 nuclei. Nuclear atypia and pleomorphism were absent in both the single and giant cells. Loose aggregates of hemosiderin-laden macrophages and binuclear stromal cells were also seen. The cytologic features of the FNA smears were similar with those of the imprint, Additionally, the FNA smears contained several clumps of densely collagenous stromal tissue that were seldom noted in previously reported cytologic material. The cytologic features were well-correlated with the concurrent histologic findings and the diagnosis of GCTTS was made. When the clinical and radiologic datas are integrated, the diagnosis of GCTTS can be strongly suggested, based on the pre-operative cytologic specimen.

Pigmented villonodular synovitis (PVNS) is a rare benign proliferative growth of synovium of obscure etiology with a wide spectrum of clinical presentation. Localized PVNS, also known as giant cell tumor of the tendon sheath, is even more uncommon. Localized PVNS of the knee is a rare, idiopathic condition presenting with symptoms that can mimic other intra-articular pathologies. The condition is usually monoarticular, the knee being the most commonly affected joint. We report a rare case of PVNS arising from the quadriceps tendon sheath. It was successfully treated with arthroscopic intralesional excision. At 18 months' follow-up, there has been no recurrence.

Giant cell tumor of the tendon sheath (GCTTS) is a benign condition that involves the synovium of the tendon sheaths. Histologically, GCTTS is similar to pigmented villonodular synovitis. The MRI findings in two cases of GCTTS are reported. In both cases, predominantly low signal is seen on T1-weighted, proton density weighted, and T2-weighted images. This information may be useful in distinguishing GCTTS from other mass lesions involving the tendon sheaths.

The clinical utility of the magnetic resonance imaging (MRI) as compared with that of computed tomography (CT) and plain radiographs in patients with bone and soft tissue tumors is reported. Seven patients with soft tissue tumors (desmoid, lipoma, giant cell tumor of the tendon sheath, hemangioma, extraskeletal chondroma and synovial sarcoma), one patient with pigmented villonodular synovitis (PVS), and three patients with bone tumors (chondroblastoma, osteosarcoma and metastatic bone tumor) were examined with a Signa 1.5-tesla superconducting magnet, CT scan and plain radiographs. Advantages of MRI over CT and plain radiographs were as follows: (1) the ability to image in the sagittal, coronal and oblique planes, (2) demonstration of vessels, nerves and tendons without contrast, (3) demonstration of hemosiderin in PVS, and (4) demonstration of the intramedullar and extraosseous extent of bone tumors. However, MRI was less valuable than CT and plain radiographs for cortical destruction and small calcification.

We reviewed the cases of eighty-one patients with pigmented villonodular synovitis and giant-cell tumor of the tendon sheath. The average duration of symptoms prior to consulting a physician was twenty-seven months. The lesion was slow-growing, was located in one joint or tendon sheath, and usually was asymptomatic in a finger or thumb but painful in a knee or toe. Twenty-nine per cent of the finger or thumb lesions and 21 per cent of the knee lesions that were followed recurred. Approximately 70 per cent of the radiographs showed abnormalities that ranged from soft-tissue swelling to bone erosion. Six lesions were incidental findings during arthrotomy for some other lesion. The histological characteristics of the solitary nodular, multiple nodular, and diffuse lesions suggested that they have a common histogenesis that is characterized by proliferation of fibroblastic or histiocytic mesenchymal cells, or both, beneath the synovial or tenosynovial lining cells, and by collagen production. Foam cells and iron deposits appear to be secondary changes and are usually seen in the periphery of the expanding nodules. The centrifugal growth pattern and the distinct differences between the lesional tissue and the adjacent hyperplastic synovial tissue suggest that pigmented villonodular synovitis is a true neoplastic process.

One hundred seventeen patients with 118 fibrous xanthomas of synovium were studied. Ninety-one of these xanthomas were in the fingers. The most common site was the dorsal surface of the distal joints of the index, long, ring, and little fingers. Fourteen tumors were found in the knee joint; four each, in the hand, wrist, and foot; and one tumor was in the hip joint. There was clinical or roentgenographic evidence that the joint from which the tumor arose or the joint nearest the tumor was damaged by traumatic or idiopathic degenerative joint disease in fifty-three patients. All of the tumors in this study were locally excised; 17 per cent recurred one or more times. All of the recurrences were in the fingers. From our material it could not be determined whether or not incomplete excision of the tumors accounted for these recurrences. Fibrous xanthoma, xanthoma due to disturbed systemic lipid metabolism, tumors of histiocytes, pigmented villonodular synovitis, and synovitis due to traumatic or idiopathic degenerative joint disease were compared with respect to some of their clinical and pathological characteristics.

Tumors of the upper extremity are common and usually benign. The most commonly diagnosed are ganglion cysts: specific, non-neoplastic swellings localized mostly around the wrist.The objective of this retrospective study was to determine the proportion of various types of nonganglionic hand tumors operated on at the authors' institution in 2014.A total of 246 patients, 141 women (57 %) and 105 men (43 %), with a mean age of 53 years and with tumorsof the upper extremity, were identified and treated in the authors' institution in 2014.Almost half of the lesions were localized in the fingers (A brief review of the literature is made referring to the data presented here.Tumoren der oberen Extremität sind häufig und meistens gutartig. Die häufigsten Diagnosen betreffen Ganglionzysten: typische, nichtneoplastische Schwellungen, die zumeist im Bereich des Handgelenks lokalisiert sind.Ziel der vorliegenden retrospektiven Studie war es, den Anteil der verschiedenen Typen von Handtumoren zu ermitteln, die keine Ganglionzyste darstellen und 2014 an der Klinik der Autoren operativ versorgt wurden.Insgesamt wurden 246 Patienten, 141 Frauen (57 %) und 105 Männer (43 %), mit einem Durchschnittsalter von 53 Jahren und Tumoren der oberen Extremität erfasst und 2014 in der Klinik der Autoren behandelt.Fast die Hälfte der Läsionen waren an den Fingern lokalisiert (Abschließend wird eine kurze Übersicht über die Literatur zu den hier vorgestellten Daten gegeben.

One hundred fifteen cases of localized nodular synovitis (giant cell tumor of the tendon sheath) were reviewed. The optimal treatment for these lesions is unknown, and a high recurrence rate exists. Growths arose from most of the synovial sites of the hand, including joints, capsular ligaments, and tendon sheaths. Deformation of the bone surface was commonly seen; however, bone invasion was uncommon. The histologic features may vary, but the lesions are always benign and do not metastasize. Treatment consisted of thorough local excision and adjacent joint exploration when appropriate. Recurrence occurred in 10 cases (9%) with one to five additional surgical procedures needed to eradicate the lesion.

The first reported case of an intraarticular malignant giant cell tumor of synovium studied with electron microscopic and immunohistochemical examination is presented, together with a case of diffuse intraarticular pigmented villonodular synovitis with extensive bone destruction. The malignant case was dominated by uniform cells positive for histiocytic markers, the fine structure showing a gradual change from cells dominated by organelles serving a secretory function to cells with phagocytic activity. The reported cases of giant cell tumor of the tendon sheath indicate that the pertinent histologic changes regarding malignancy are an increase in cell polymorphism and in the number of mitoses, and a decrease in the number of multinucleated giant cells.

Electrophysiologic studies indicated a lesion of the deep branch of the ulnar nerve in the palm of a 42-year-old man with painless weakness and wasting of ulnar-innervated intrinsic hand muscles. Magnetic resonance imaging of this region demonstrated a soft-tissue mass in the palm distal to Guyon's canal. Surgical exploration disclosed a giant cell tumor of the tendon sheath, compressing the deep branch of the ulnar nerve.

Nine cases of acute carpal tunnel syndrome are reported. Etiologies include: bleeding secondary to chronic lymphatic leukemia; Colles' fracture of the wrist (2 cases); Epiphyseal fracture (Salter II) of the distal radius; Bleeding secondary to giant cell tumor of the tendon sheath; Unstable distal radio-ulnar joint; Displaced intra-articular fracture of the distal radius; Rheumatoid synovitis and vasculitis; Trans-scaphoid, perilunar fracture dislocation of the wrist. Early recognition of median nerve compression in the carpal tunnel is vital. The signs of median nerve compression should be looked for in all cases of wrist trauma. In our opinion, immediate surgical decompression is frequently indicated.

• Giant cell tumor of the tendon sheath is the second most common tumor of the fingers and hands but is only rarely mentioned in the dermatologic literature. Although its pathogenesis has been debated, it is probably a type of fibrous histiocytoma. This tumor is almost always benign but may locally invade the overlying dermis and be confused with a malignant neoplasm. It often extends to the synovium of the adjacent joint space and necessitates total excision to prevent local recurrence. Therefore, excision should be undertaken by a physician who is surgically qualified for such procedure. We report a case that illustrates the clinical and pathologic aspects of this lesion. (Arch Dermatol114:944-946, 1978)