Giant Cell Tumor of the Tendon Sheath

Description: Introduction Relevant Anatomy And Contraindications Workup Treatment Outcome And Prognosis Pictures Bibliography Introduction Giant cell tumors of the tendon sheath are the second most common tumors of the hand, with simple ganglion cysts being the most common. Chassaignac first described these benign soft-tissue masses in 1852, and he overstated their biologic potential in referring to them as cancers of the tendon sheath. Giant cell tumors of the soft tissue are classified into the common localized type and the rare diffuse type. The rare diffuse form is considered the soft tissue counterpart of diffuse pigmented villonodular synovitis (PVNS). The diffuse form typically affects the lower extremities. Its anatomic distribution parallels that of PVNS, with lesions most commonly found around the knee, followed by the ankle and foot. However, the diffuse form occasionally affects the hand. Typically, these lesions, like those of PVNS, occur in young patients; the condition is diagnosed in one half of the patients before they are aged 40 years. The diffuse form is often locally aggressive, and multiple recurrences after their excision are common. Because of the similarity in patients' ages, tumoral locations, clinical presentations, and symptoms in PVNS and the diffuse form of giant cell tumors of the tendon sheath, the diffuse form probably represents an extra-articular extension of a primary intra-articular PVNS process. Findings from flow cytometric DNA analysis suggest that PVNS and giant cell tumors of the tendon sheath are histopathologically similar but clinically distinct lesions. When the origin of these poorly confined soft-tissue masses is uncertain, Enzinger and Weiss classify these tumors as the diffuse type of giant cell tumors of the tendon sheath, whether or not they involve the adjacent joint. This article focuses on the common localized form of giant cell tumors, that is, the giant cell tumors of the tendon sheath that often are found in the hands and feet. Author: James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic & Neurosurgical Center of the Cascades Coauthor(s): Timothy A Damron, MD, David G Murray Professor, Department of Orthopedic Surgery, Upstate Medical University; Professor, Orthopedic Oncology and Adult Reconstruction, Department of Orthopedics, State University of New York at Syracuse eMedicine 2002