Giant cell tumor tenosynovial D21.M

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Beniges giant cell synovialoma; Benign giant cell tumor of the tendon sheath; Giant cell fibroangioma; Giant cell histiocytoma; Giant cell sarcoma of the tendon sheath; Giant cell synovialoma benignes; Giant cell tumor of tendon sheath; Giant cell tumor or giant cell sarcoma of the tendon sheath; Giant cell tumor xanthomatous; Localized giant cell tumour of the tendon sheath; Nodular tendosynovitis; Tendosynovitis nodular; xanthomatous giant cell tumor

History
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Chassaignac 1852; Jaffe 1941

Definition
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The term covers a group of neoplasms that occur as well defined, nodular changes in the synovia of joints, bursae and tendon sheaths, especially in the finger joints and tendon sheaths of the hands.

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Manifestation
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Mainly occurring in middle age (30-50 years). Women are affected twice as often as men.

Clinical features
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Single, bumpy, slow-growing, non-sliding knots. Possibly multinodular appearance.

Histology
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Histiocytes, fibroblasts, fissure-like cavities surrounded by giant multinucleated cells. Hemosiderin and lipid storage. Immunohistology: Histiocytic cells express CD 68, single cells occasionally actin and desmin. In tumors, a translocation of the CSF1 gene on chromosome 1 with the COL6A3 gene on chromosome 2 can be detected.

Differential diagnosis
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Ganglion; glomus tumor; xanthoma; exostosis; cartilage or bone tumors; malignant synovialoma. A distinction from this benign variant is a diffusely growing, intra- or extraarticular variant with a comparable histological pattern, which exhibits a locally aggressive behaviour.

Therapy
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Hand surgeon performed an excision in a healthy person.

Progression/forecast
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The recurrence rate after surgical removal (surgical problems with proximity to joints and nerve trunks) is stated differently (15%-40%). In a larger surgical collective (n=64) it was 4.7% (Di Grazia S et al. 2013). If localised at the feet, a malignant degenerative tendency may be present.

Literature
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Di Grazia S et al (2013) Giant cell tumor of tendon sheath: study of 64 cases and review of literature.
G Chir 34: 149-152.
Hitora T et al (2002) Multicentric localized giant cell tumour of the tendon sheath: two separate lesions at different sites in a finger. Br J Dermatol 147: 403-405
Jaffe HL et al (1941) Pigmented villonodular synovitis, bursitis, and tenosynovitis of the knee. A discussion of the synovial and bursal equivalents of the tenosynovial lesion commonly denoted as xanthoma, xanthogranuloma, giant cell tumor, or myeloplaxoma of the tendon sheath, with some consideration of this tendon sheath lesion itself. Arch catholic 31: 731-765
Waldt S et al (2003) Imaging of benign and malignant soft tissue masses of the foot. Eur Radiol 13: 1125-1136
Wolff HH, Braun-Falco O (1972) The benign giant cell synovialoma. For clinical, histology and electron microscopy. Dermatologist 23: 499-508