Giant cell tumor of tendon sheath: case series and review of literature

Abstract

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.

Keywords: Giant cell tumor; Hand; Recurrence; Tendon sheath.

Fig. 1

Mass over the little finger in a patient with antecedent trauma

Fig. 2

Type I c lesion: Multi-lobulated lesion surrounded by a common pseudocapsule, excised specimen from volar aspect of the ring finger, in a patient with antecedent trauma

Fig. 3

Mass over the fifth metacarpal

Fig. 4

Postero anterior radiograph of the patient in Fig. 3, showing the soft tissue shadow [white arrow heads] and scalloping of the shaft of the 5th metacarpal [black arrow]

Fig. 5

Fine needle aspiration cytology slide showing scattered groups of mononuclear cells with occasional osteoclast like giant cells