Elsevier

World Neurosurgery

Volume 92, August 2016, Pages 583.e19-583.e24
World Neurosurgery

Case Report
Nerve-Adherent Giant Cell Tumors of Tendon Sheath: A New Presentation

https://doi.org/10.1016/j.wneu.2016.05.062Get rights and content

Background

Tenosynovial giant cell tumors are a group of slowly growing benign neoplasms of synovial membrane of joints, tendons, and bursae. The localized type or giant cell tumor of tendon sheath (GCTTS) is the extra-articular form of tenosynovial giant cell tumors. We describe two patients with a GCTTS, confirmed histologically at the time of surgical resection, that was adherent to peripheral nerves. Rare GCTTS can cause extrinsic compression of major nerves.

Case Descriptions

The first patient was a 36-year-old man with a left wrist mass associated with pain and paresthesia in the radial three digits. On ultrasound and magnetic resonance imaging (MRI), the mass appeared arising from the left median nerve with a picture suggestive of an atypical neurogenic tumor; however, the possibility of GCTTS could not be excluded. Intraoperatively, the tumor was adherent to the median nerve without a connection to nearby intercarpal joints.

The second patient was a 25-year-old woman with a history of malignant melanoma and an incidentally discovered mass on routine follow-up. MRI of the pelvis showed an ovoid mass related to the right sciatic nerve. The MRI picture was suggestive of a GCTTS, although a benign neurogenic tumor was favored given the anatomic relation to the sciatic nerve. Intraoperatively, the tumor appeared as a nodule implanted on the nerve, and it was easily peeled off.

Conclusion

We present a new, rare presentation of GCTTS adherent to peripheral nerves with extrinsic compression. We suggest either an implantation mechanism or an unrecognized extrasynovial origin for such tumors.

Introduction

Tenosynovial giant cell tumor (TSGCT) is a relatively rare, benign fibro-histiocytic, slowly growing proliferative disorder of the synovial membrane of joints, tendon sheaths, and bursae.1, 2, 3 Although histologically similar, these tumors have been classified according to their location and clinical behavior as being extra-articular or intra-articular, or localized or diffuse.4 The World Health Organization had adopted the term giant cell tumor of tendon sheath (GCTTS) for the extra-articular localized form of TSGCTs.5 We present two rare cases of GCTTS that were adherent to major peripheral nerves. We wonder about a possible epineurial origin. Approval from our institutional review board was obtained.

Section snippets

Patient 1

A 36-year-old man presented with a long-standing left volar wrist mass with occasional pain and paresthesia in the radial three digits. He had no history of macrotrauma, but he reported repetitive use of his left hand as a professional guitarist. Examination revealed a 2-cm mass located just proximal to the wrist crease. The results of a neurologic examination were normal. An ultrasound image of the left wrist demonstrated a 14 × 11 × 16-mm eccentric, hypoechoic ovoid mass emanating from the

Discussion

GCTTS is the most common form of tenosynovial giant cell tumor. Adults are more commonly affected than children are, with an incidence of 1:50,000, a peak in the third to fifth decades, and a slight female predominance (1.5–2.1:1).6, 7 These tumors comprise 1.6%–3.9% of soft tissue masses and occur most frequently in the wrist and hands or ankle and feet (being second only to a ganglion cyst), and then the knee, elbow, and rarely the hip.8 GCTTSs usually arise as circumscribed nodules related

Conclusion

Adherence to peripheral nerves with compression is a new, unrecognized picture of GCTTS. Absence of a connection to a nearby joint or tendon is also rare. We propose either an implantation mechanism or an extrasynovial epineurial origin as an explanation.

References (34)

  • I Rukavina et al.

    Giant-cell tumour of the tendon sheath: a review

    OA Orthopaedics

    (2014)
  • D.R. Lucas

    Tenosynovial giant cell tumor: case report and review

    Arch Pathol Lab Med

    (2012)
  • M.D. Murphey et al.

    Pigmented villonodular synovitis: radiologic-pathologic correlation 1

    Radiographics

    (2008)
  • F. Nucci et al.

    Compression of the ulnar nerve in Guyon's canal by a giant cell tumor

    Zentralbl Neurochir

    (1989)
  • R.C. Martin et al.

    Giant cell tumor of tendon sheath, tenosynovial giant cell tumor, and pigmented villonodular synovitis: defining the presentation, surgical therapy and recurrence

    Oncol Rep

    (2000)
  • B.S. Francisco et al.

    Giant cell tumor of tendon sheath in Guyon's canal causing ulnar tunnel syndrome. A case report and review of the literature

    Eplasty

    (2009)
  • Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    View full text