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A giant cell tumor in the tendon sheath is a subcutaneous tumor (tumors) that originates in the synovium. This change occurs relatively rarely, most often in young adults (more often women). The lesion is most often located on the dorsal side of the fingers, above the interphalangeal joints. Treatment is based on surgical removal of the lesions. After removal, relapses may appear.
Giant cell tumor of tendon sheath – definition
The giant cell tumor of the tendon sheath is the second most common tumor of the hand and originates from the synovium. The disease was first described in 1852 by Chassaignac. The tumor is most common in women in their 30s. In the treatment of this condition, the method of choice is surgical excision of the lesion together with a healthy tissue margin. Even after the procedure, recurrences may occur (about 10% of cases). Occasionally, follow-up radiotherapy is implemented which, although effective, can cause a number of complications. Therefore, it is recommended in patients in whom complete tumor removal has not been possible.
Frequency of appearance
Giant cell tumor of the tendon sheath can occur in people of any age, although it usually attacks after the age of 30. Its most common location is hands, e.g. single fingers (middle, index, thumb). The lesions can also be manifold. The tumor is located much more often on the right than on the left hand. Rarely, it forms on the toes or around the knee and ankle joints. Sometimes the lesions cover the side of the finger and attack its entire surface in a circular pattern.
Clinical course of the giant cell tumor of the tendon sheath
These types of tumors develop very slowly, often the process lasts even several years, and the changes do not change their size for a long period of time. The tendon sheath tumor may initially be asymptomatic, but as it grows, the movements and functions of the affected limb are impaired. In addition, there may be local pain, numbness, and stiffness in the joints nearby. Importantly, the giant cell tumor is not movable in relation to the substrate because it is attached at the base to the tendon sheaths.
Treatment and diagnosis of giant cell tumor of the tendon sheath
Imaging tests are used in diagnostics – the radiological image is characteristic of a soft tissue tumor. In some patients, degenerative changes in the surrounding joints are also revealed. An ultrasound examination is also performed, thanks to which it is possible to determine the type of tumor and its exact location. Recently, magnetic resonance imaging has been very popular, especially in preoperative diagnostics and in planning the procedure. Based on the MRI, it is possible to make a diagnosis as it reveals the morphological image of the tumor. It is located close to the tendon, has a lobular structure and is well delimited. Bone destruction may also be visible.
Histopathological examination is also important in making the correct diagnosis. It reveals numerous synovial-like cells that are surrounded by giant multinucleated cells, as well as inflammatory and foam cells.
A giant cell tumor of the tendon sheath should be differentiated from:
- tumors from the nervous system,
- benign tumors located in the area of tendon sheaths,
- granulomas,
- ganglionic,
- lipomas,
- fibromas of the palmar fascia,
- tendon fibromas.
How To Treat Giant Cell Tumor Tendon Sheath?
The treatment of the disease consists mainly in surgical excision of the tumor together with a margin of healthy tissue within the tumor capsule. Sometimes small satellite nodules form around the tumor and are outside the capsule – these should also be removed as they increase the risk of relapse. It happens that the giant cell tumor grows deep into the joints, then it is necessary to partially remove the tendon or arthrodesis.
There may be extreme cases where the tumor invades the skin; then the sick part of the skin should be cut out and its transplant performed. Complications following surgical removal of the tumor are: stiffness, scar soreness, and sensory disturbances.
How common are recurrences?
Although the giant cell tumor of the tendon sheath is a benign lesion, local recurrences occur (up to 45% of cases). However, there are some factors that increase the risk of relapse:
- degenerative changes in joints,
- presence of long fingers near the DIP joint and thumb near the IP joint,
- radiological changes as a consequence of pressure on bone structures,
- completeness of the operational procedure.
In order to prevent local recurrence, complementary radiotherapy is implemented. The effectiveness of this method depends on the precise excision of the tumor. Unfortunately, despite its effectiveness, radiotherapy is associated with a high risk of complications, such as the formation of skin lesions, ulcers or the possibility of neoplastic transformation. For this reason, radiation therapy should only be recommended when complete tumor removal is impossible or there is concern that complete tumor removal will impair limb function.