Imaging of giant cell tumour of the tendon sheath

Abstract

Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.

A rare case of giant cell tumour arising from anterior cruciate ligament: Its diagnosis and management

“…The pigmented villonodular synovitis represents the diffuse intra-articular form and has a high rate of local recurrence in the extrasynovial localization. 8 The localised form presents as a solitary and well defined mass. It can be intra-articular or extra-articular.…”

“…Large joints like knees are less commonly affected. 6,8 When affected, clinically, patients have signs of mechanical derangement. With the knee joint, meniscal symptoms and locking are often present.…”

“…MRI has been reported to be the best non-invasive technique to diagnose this tumour. 6,8 MRI diagnosis must be confirmed by histopathological examination. Arthroscopic excision is a safe and effective procedure for the treatment of these tumours.…”

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“…Although some uncertainty remains concerning its histiogenesis, karyotypic abnormalities isolated in GCTTS cells have largely been accepted as evidence of a neoplastic phenomenon [20]. GCTTS is the second most common soft tissue neoplasm of the hand, surpassed in incidence only by ganglion cysts [10,13,16,18,26]. It is a benign proliferative lesion of synovial origin that occurs most commonly in the hand and fingers [18], typically throughout the third through fifth decades of life [10], and it shows a slight female preponderance [10,13,18].…”

“…As a result, it is an invaluable tool in preoperative planning. On MRI, GCTTS presents as a lobulated mass that is hypointense or isointense to skeletal muscle on T1-weighted images, while varying from hypointense to hyperintense on T2-weighted sequences [11,16,17,26]. The decreased signal intensity is attributable to the paramagnetic effect exerted by hemosiderin, which causes a blooming artifact on the gradient echo sequences [17,26].…”