[Giant cell tumors of the tendon sheath of the hand: 32 cases]

Abstract

Giant cell tumors of tendon sheath (GCTTS) represent a localised form of pigmented villonodular synovitis. They are usually found in the hand (80% of cases) where it represents the second most common tumor of the soft parts after the ganglion cyst. Its surgical treatment is sometimes difficult because of local extension and the invasion of vital digital structures. We report a retrospective study over 10 years of 32 cases of GCTTS with an average age of 35 years and a sex-ratio of 1. The reason for consultation was the presence of a digital mass, associated with an impairment of finger flexion in 43,7% of patients. A palmar localisation was found in 56,2%, especially in the fifth ray (62,5%) and at the level of the distal phalanx (68,7%). Radiological changes were observed in 4 cases. All patients were treated surgically. Macroscopically the lesion presented as an encapsulated tumor, polylobulated and yellow-brownish which invaded the skin (1 case), extended into the sheath of the flexor tendons (3 cases) and under the extensor tendon (4 cases). In the post operative follow up we noted one case of hypoaesthesia of the pulp and three cases of stiffness of the proximal interphalangeal joint. No skin necrosis was found. With a 4 year average follow up (10 months - 9 years), we noted three reccurrences (9,3%) which were all surgically managed. After analysis of the literature, the authors will describe the clinical aspects and the therapeutic difficulties of this condition.