Case ReportNerve-Adherent Giant Cell Tumors of Tendon Sheath: A New Presentation
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)
- et al.
WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition
Pathology
(2014) - et al.
Localized nodular synovitis: a rare cause of ulnar nerve compression in Guyon's canal
J Hand Surg Am
(1992) - et al.
Intraneural fibroma of the median nerve at the wrist
J Clin Neurosci
(2014) - et al.
Molecular cytogenetic characterization of tenosynovial giant cell tumors
Neoplasia
(2004) - et al.
Diffuse and localized tenosynovial giant cell tumor and pigmented villonodular synovitis: a clinicopathologic and flow cytometric DNA analysis
Hum Pathol
(1992) - et al.
Malignant giant cell tumor of synovium and locally destructive pigmented villonodular synovitis: ultrastructural and immunohistochemical study and review of the literature
Hum Pathol
(1989) - et al.
Giant cell tumor of the tendon sheath
J Hand Surg Br
(2013) Giant Cell Tumour of Tendon Sheath
(2002)- et al.
The diagnosis and treatment of pigmented villonodular synovitis
J Bone Joint Surg Br
(1968)
Giant-cell tumour of the tendon sheath: a review
OA Orthopaedics
Tenosynovial giant cell tumor: case report and review
Arch Pathol Lab Med
Pigmented villonodular synovitis: radiologic-pathologic correlation 1
Radiographics
Compression of the ulnar nerve in Guyon's canal by a giant cell tumor
Zentralbl Neurochir
Giant cell tumor of tendon sheath, tenosynovial giant cell tumor, and pigmented villonodular synovitis: defining the presentation, surgical therapy and recurrence
Oncol Rep
Giant cell tumor of tendon sheath in Guyon's canal causing ulnar tunnel syndrome. A case report and review of the literature
Eplasty
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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.