Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint

Abstract

BackgroundDiffused-type giant cell tumor(Dt-GCT) is a rare, aggressive disorder of the joint synovium, bursa and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in Dt-GCT. We present a retrospective study of a series of patients who are diagnosed with Dt-GCT about the ankle joint, there clinical outcome is evaluated in this study.Material and methodFifteen patients with radiologically and histologically confirmed Dt-GCT about the ankle joint were identified in our foot and ankle department. Patients were managed with open synovectomy for the tumor tissue and bone grafting for bony erosions. X-rays and MRI scans were used for evaluation of the tumor and bony erosions pre- and post-operatively. Pre- and post-operative ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumor Society (MSTS) score.ResultsThe mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2 mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8 mm. 7 patients had tendon involvement, 2 patients had recurrence and progression of ankle osteoarthritis. Both of them underwent ankle fusion. At the time of last follow-up, the mean AOFAS-AH score increased from 49 to 80 points (p < 0.05), the MSTS score increased from 12 to 22 points (p < 0.05).ConclusionFor Dt-GCT with bony erosions, open synovectomy combined with bone grafting seems to be a safe and effective operation for the salvage of ankle joint. Fusion is recommended for failed and severe cartilage destruction of the ankle joint.

Giant cell tumor of tendon sheath: A report of 216 cases

“…In clinical work, GCTTS needs to be differentiated from lipoma, tendon cyst, epidermal cyst, sebaceous cyst, cyst calcification, hemangioma, osteochondroma, gout nodules, rheumatic nodules, tendon tuberculosis, tendon fibroma, and other rare diseases. 37,38 Physicians frequently observe the characteristics of related diseases and have rich clinical diagnosis experience, so the differential diagnosis of related diseases is not difficult to make. When a painless, sessile and relatively tough mass occurs on the hand of a female patient, GCTTS should be highly suspected.…”

Case Report: Open Resection of Giant Tendon Sheath Giant Cell Tumor around the Ankle

“…Studies have shown that complete surgical resection is the gold standard for the treatment of GCT-TS (7), and open synoviectomy and bone grafting may be safe and effective surgery to save the ankle joint. Xingchen Li et al (8) believe that external fixation should be performed simultaneously to prevent pathological fracture in patients with severe bone and soft tissue damage. Ankle arthrodesis can be performed if necessary, and the patient will be transferred to the oncology department for further radiation therapy after the patient's condition stabilizes.…”

Peroneal tenosynovial giant cell tumor in the sinus tarsi: A rare case report

“…Recent articles describe TSGCT in two sub-types: localized (L-) or diffuse (D-) TSGCT. L-TSGCT is usually painless, has a tendency to cause impingement due to tumor mass whereas D-TSGCT, which is also known as pigmented villonodular synovitis, shows up with pain, swelling and more osteochondral destruction (8).…”