Giant cell tumour of tendon sheath (localised nodular tenosynovitis): clinicopathological features of 71 cases

Abstract

Aims/Background-Giant cell tumour of the tendon sheath (GCTTS) is regarded as the most common neoplasm of the hand that can recur after excision. The objective of this study was to review a series of cases in our department and to determine any clinical or pathological features that might predict the likelihood of recurrence. Giant cell tumour of the tendon sheath (GCTTS) is a benign lesion, most commonly occurring in hands and feet, but also found around the ankle and knee joints. Methods-Clinical1 2 GCTTS aVects individuals between the age of 30 to 50 years and is more often seen in women than in men.2 The nature and cause of GCTTS are unclear. It has been considered to be an inflammatory process arising as a consequence of chronic antigenic stimulation; a reactive proliferation developing from the synovial lining of the tendon sheath and joint 3 ; or a lesion of monocyte/macrophage derivation. 4 Data from previous studies have shown a 50% history of trauma and multifocality, and similar lesions can be induced experimentally after extra articular injection of blood in experimental animals. 4 Recent studies demonstrating cytogenetic abnormality in the form of trisomy 7 and autonomous growth, in addition to the clinical features of local recurrence and case reports of metastatic GCTTS, raised the possibility that it is a cancer. 5 6 However, Vogrincic et al used a polymerase chain reaction (PCR) based assay for methylation of the X linked human androgen receptor (HUMARA) in female subjects to demonstrate that GCTTS is a polyclonal proliferation. They argued that if one accepted that a population of cells forming a tumorous mass must show clonality to be classified as a neoplasm, then GCTTS is either a reactive or hyperplastic process. 7A high mitotic rate is thought to be indicative of local recurrence, 8 9 but there is debate as to how many mitoses are required. Our study was performed to ascertain whether mitotic figures were associated with recurrence and, if so, the numbers required. Materials and methodsThe department of pathology, Edinburgh University Medical School serves a population of 400 000. We searched the departmental surgical files between the years 1990-7 for cases reported as GCTTS or localised nodular tenosynovitis. We did not include cases of diVuse villoglandular tenosynovitis. The clinical data were obtained from request forms and in patient notes and evaluated together with the gross and microscopic appearances of the lesions. Haematoxylin and eosin stained sections were retrieved and examined for the following features: growth patterns, presence or absence of capsule, and its status and cellular constituents. The mitotic and apoptotic counts were assessed by randomly counting 10 diVerent high power microscopic fields (×400 magnification; field size of 0.152 mm 2 ) and were recorded as the number of mitotic or apoptotic figures/10 high power fields (HPF). Apoptotic figures accepted had a minimum size of 0.1 mm. Results CLINICAL FINDINGSWe found a total of 71 patients within a period...

Giant cell tumor of tendon sheath

“…GCTTS affects individuals between 30 to 50 years of age and is seen more oftenly in women than in men Monaghan et.al in his series of 71 cases of GCTTS noted mean age of his patients as 46.3 years with a peak incidence in 4 th decade. 3 However, one of the cases being reported here was 25 years female and other lady was 65 years old.…”

“…3 The etiology of giant cell tumor of the tendon sheath remains unclear. Various theories held responsible for this disease are trauma, disturbed lipid metabolism, osteoclastic proliferation, infection, vascular disturbances, immune mechanisms, inflammation, neoplasia, and metabolic disturbances.…”

Giant Cell Tumor of the Tendon Sheath

“…In general GCTTS can present as a solitary subcutaneous nodule of the hand, but it can also occur in other parts of the body such as the spine, ankle, knee and feet (3,4). However, with an approximate incidence of 1/50,000 per population it remains an uncommon condition (5). The incidence of GCTTS is higher in women than in men and mostly seen in the third to fifth decade (3,6).…”

Giant cell tumor of tendon sheath—Use of fine-needle aspiration cytology for diagnosis

“…It affects individuals between the age of 30 and 50 years old and is more common in females [1] . GCTTs presents as a firm, nodular mass occurring more commonly on the volar aspect of fingers and hands [2] . The various etiological factors include trauma, neoplastic, inflammatory and metabolic disease, but it is best considered idiopathic [2] .…”

“…GCTTs presents as a firm, nodular mass occurring more commonly on the volar aspect of fingers and hands [2] . The various etiological factors include trauma, neoplastic, inflammatory and metabolic disease, but it is best considered idiopathic [2] . Histologically, GCTTs is composed of multinucleated giant cells, histiocytes polyhedral, fibrotic material and hemosiderin deposits [1] .…”