Recurrence-free management of type 2 variant of giant cell tumour of extensor tendon sheath of thumb

Abstract

A 30-year-old woman presented with swelling in her right thumb of 3-month duration which was slow-growing in nature without a history of trauma. On examination, firm non-tender swelling with ill-defined border over the dorsomedial aspect of the first metacarpal was noted. The swelling was mobile only in the vertical plane with restricted adduction and abduction. Plain X-ray revealed mild erosion of the first metacarpal head. Diagnostic ultrasound confirmed the lesion to arise from the extensor tendon sheath of diffuse type without any bony involvement. A wide local excision biopsy of the swelling was planned. Intraoperatively, a 3×2 cm greyish-white mass, bony hard in consistency with lobulated surface was found arising from the tendon sheath of the extensor tendon of the thumb; it was completely excised with a wide margin. Histopathological examination revealed polyhedral cells admixed with osteoclastic type giant cells. Biopsy from the first metatarsal was normal. The patient is on follow-up for the last 5 years with no evidence of recurrence.

Giant Cell Tumor on Tendon Sheath of the Hand: The Incidence of Recurrence, Functional Outcomes and a Literature Review

“…Giant cell tumor of tendon sheaths of the hand can occur in any age predominant between the third and fifth decade of life with a great incidence of 2 per 100.000 per year between 40-50 years especially in female [8] . In majority of cases it is diagnosed in a single joint while the incidence of poliarticular comprise is less than 1% [21] .…”

“…Although pathogenesis of the tumor is not clear, many etiological factors have been described in literature such as infection, vascular disorders, osteoclastic proliferation, immune mechanisms, inflammation, neoplasia and metabolic disorders, sequel of bleeding after trauma [4,8] . The most common accepting theory is that GCTTS originates from a reactive or regenerate hyperplasia associated with an inflammatory process [9,13] .…”