Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

Abstract

Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterised by relatively high recurrence rate after surgery. The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumours, in a long-term (a mean of 4,2 year) follow-up. Patients and methods. Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated on), at a mean of 4,2 year follow-up. The final assessment was performed in a form of phone interview. Results. The tumours most frequently were located in fingers - 42 cases (72%). In 31 patients (53%) the lesion had well-defined capsule, and in 11 (19%) a satellite nodules were found around the main tumour. A total of 9 relapses (21%) occurred, all within first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with the recurrence, the primary lesion had not well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained from mild pain of the scar and/or numbness of the part of the involved finger. Conclusions. The main factor influencing the high rate of recurrence was incomplete tumour excision, what resulted from inadequately accurate surgery and the tumour morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping greater surgical margin at resection of the non-capsulated lesions was emphasised, what may translate into reducing of the recurrence rate.

Recurrent Localized Tenosynovial Giant Cell Tumor of the Left Ring Finger: A Case Report and Literature Review

“…GCTTS can cause cortical bone erosions and invasion of the medullary space, which can be seen on plain radiographs [ 2 , 6 ]. Plain radiographs of the hand and wrist show the bony structures and cannot visualize a ganglion cyst as such [ 7 ]. Magnetic resonance imaging is a useful diagnostic imaging modality for the classification of GCTTS into Al Qattan types 1 and 2 [ 6 ].…”

“…This is similar to what happened in this index patient; the lesion was earlier excised four years prior, and the lesion had now recurred. Incomplete surgical excision is widely accepted as a definitive risk factor [ 7 ]. Other known risk factors for local recurrence include the presence of adjacent degenerative joint disease, localization at the distal interphalangeal joint of the fingers or thumb, cortical destruction, type 2 tumors, increased cellularity and mitotic activity, and neurovascular dissection during removal [ 1 , 8 ].…”

Intraosseous schwannoma of upper limb –review

“…There are suggestions that neoplasm may be connected with chromosomal aberrations, mostly regarding chromosome 22. [7,8]. Rarely, schwannomas transform into malignant peripheral nerve sheath tumours, and up to 50% of malignancy events are connected with neurofibromatosis [1,5].…”

“…The ulnar nerve tends to be the most common location [9]. The upper limb is affected in approximately 19% of cases [6,8]. Intraosseous schwannoma of limbs is rare, although there are case studies in literature describing this type of neoplasm in the upper limb.…”

Surgical outcome of isolated benign peripheral nerve sheath tumors without neurofibromatosis

“…Schwannomas grow inside the nerve, causing thickening of the nerve. As the tumor is encapsulated the nerve bundles do not penetrate it, but intertwist it, which allows enucleation of the tumor [9]. There is no studies that showed the surgical outcomes after excision of isolated BPNSTs without neurofibromatosis, especially in long follow up period.…”