eMedicine Specialties > Orthopedic Surgery > Neoplasms

Giant Cell Tumor of the Tendon Sheath: Multimedia

Author: James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic and Neurosurgical Center of the Cascades
Coauthor(s): Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Contributor Information and Disclosures

Updated: Jun 26, 2009

Multimedia

Image in a 44-year-old right hand–dominant ...
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Media file 1: Image in a 44-year-old right hand–dominant man who presented with a mass on the volar radial aspect of his left index finger. The mass was painless and had been slowly growing for 1.5 years.
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Image in a 44-year-old right hand–dominant ...

Image in a 44-year-old right hand–dominant man who presented with a mass on the volar radial aspect of his left index finger. The mass was painless and had been slowly growing for 1.5 years.

Radiograph demonstrates cortical erosion from the...
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Media file 2: Radiograph demonstrates cortical erosion from the pressure effect of the adjacent mass on the radial aspect of the proximal phalanx.
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Radiograph demonstrates cortical erosion from the...

Radiograph demonstrates cortical erosion from the pressure effect of the adjacent mass on the radial aspect of the proximal phalanx.

Radiograph demonstrates the bony erosion associat...
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Media file 3: Radiograph demonstrates the bony erosion associated with some giant cell tumors of the tendon sheath and shows the unmineralized soft-tissue shadow of the mass.
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Radiograph demonstrates the bony erosion associat...

Radiograph demonstrates the bony erosion associated with some giant cell tumors of the tendon sheath and shows the unmineralized soft-tissue shadow of the mass.

Radiograph demonstrates cortical erosion from the...
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Media file 4: Radiograph demonstrates cortical erosion from the pressure effect of the overlying giant cell tumor of the tendon sheath. This apple-core effect is indicative of a primary soft-tissue mass that is causing external erosion, which should not be confused with a primary bone process such as periosteal chondroma.
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Radiograph demonstrates cortical erosion from the...

Radiograph demonstrates cortical erosion from the pressure effect of the overlying giant cell tumor of the tendon sheath. This apple-core effect is indicative of a primary soft-tissue mass that is causing external erosion, which should not be confused with a primary bone process such as periosteal chondroma.

Same tumor as in Image 4.
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Media file 5: Same tumor as in Image 4.
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Same tumor as in Image 4.

Same tumor as in Image 4.

Histologic findings of tumor shown in Image 4.
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Media file 6: Histologic findings of tumor shown in Image 4.
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Histologic findings of tumor shown in Image 4.

Histologic findings of tumor shown in Image 4.

High-power photomicrograph depicts the histologic...
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Media file 7: High-power photomicrograph depicts the histologic findings of the tumor shown in Image 4.
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High-power photomicrograph depicts the histologic...

High-power photomicrograph depicts the histologic findings of the tumor shown in Image 4.

Typical T2-weighted MRI appearance of a giant cel...
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Media file 8: Typical T2-weighted MRI appearance of a giant cell tumor of the tendon sheath. Most of the tumor has intermediate signal intensity, and portions of the tumor have low signal intensity; the latter finding likely reflects signal attenuation due to hemosiderin deposition.
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Typical T2-weighted MRI appearance of a giant cel...

Typical T2-weighted MRI appearance of a giant cell tumor of the tendon sheath. Most of the tumor has intermediate signal intensity, and portions of the tumor have low signal intensity; the latter finding likely reflects signal attenuation due to hemosiderin deposition.

Typical T1-weighted MRI appearance of a giant cel...
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Media file 9: Typical T1-weighted MRI appearance of a giant cell tumor of the tendon sheath. Portions of the tumor have decreased signal intensity.
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Typical T1-weighted MRI appearance of a giant cel...

Typical T1-weighted MRI appearance of a giant cell tumor of the tendon sheath. Portions of the tumor have decreased signal intensity.

Typical T1-weighted MRI findings in a giant cell ...
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Media file 10: Typical T1-weighted MRI findings in a giant cell tumor of the tendon sheath overlying the metacarpophalangeal joint. Note the low-signal-intensity areas.
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Typical T1-weighted MRI findings in a giant cell ...

Typical T1-weighted MRI findings in a giant cell tumor of the tendon sheath overlying the metacarpophalangeal joint. Note the low-signal-intensity areas.

Corresponding T2-weighted MRI findings in the tum...
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Media file 11: Corresponding T2-weighted MRI findings in the tumor shown in Image 10. Note the areas of low signal intensity.
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Corresponding T2-weighted MRI findings in the tum...

Corresponding T2-weighted MRI findings in the tumor shown in Image 10. Note the areas of low signal intensity.

Intraoperative excision of the giant cell tumor o...
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Media file 12: Intraoperative excision of the giant cell tumor of the tendon sheath shown in Image 9, which has the typical golden-yellow color secondary to hemosiderin deposition. The radial digital nerve is dissected free and slightly volar to the mass.
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Intraoperative excision of the giant cell tumor o...

Intraoperative excision of the giant cell tumor of the tendon sheath shown in Image 9, which has the typical golden-yellow color secondary to hemosiderin deposition. The radial digital nerve is dissected free and slightly volar to the mass.

After excision, the bone is curetted, leaving the...
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Media file 13: After excision, the bone is curetted, leaving the exposed radial aspect of the proximal phalanx, as shown here.
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After excision, the bone is curetted, leaving the...

After excision, the bone is curetted, leaving the exposed radial aspect of the proximal phalanx, as shown here.

Giant cell tumor of the tendon sheath after margi...
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Media file 14: Giant cell tumor of the tendon sheath after marginal excision.
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Giant cell tumor of the tendon sheath after margi...

Giant cell tumor of the tendon sheath after marginal excision.

Typical microscopic appearance of a giant cell tu...
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Media file 15: Typical microscopic appearance of a giant cell tumor of the tendon sheath. Sheets of rounded or polygonal cells blend with hypocellular collagenized zones; variable numbers of giant cells are present.
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Typical microscopic appearance of a giant cell tu...

Typical microscopic appearance of a giant cell tumor of the tendon sheath. Sheets of rounded or polygonal cells blend with hypocellular collagenized zones; variable numbers of giant cells are present.

High-power photomicrograph of giant cell tumor of...
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Media file 16: High-power photomicrograph of giant cell tumor of the tendon sheath shows occasional numerous mononuclear cells, scattered giant cells, and hemosiderin-containing xanthoma cells.
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High-power photomicrograph of giant cell tumor of...

High-power photomicrograph of giant cell tumor of the tendon sheath shows occasional numerous mononuclear cells, scattered giant cells, and hemosiderin-containing xanthoma cells.

An 11-year-old girl presented with this firm nonf...
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Media file 17: An 11-year-old girl presented with this firm nonfluctuant mass over her posterior medial left ankle that had been present for 5 months and had not increased in size. The mass was not transilluminating. Findings on frozen section were consistent with a benign giant cell tumor of the tendon sheath. The mass was marginally excised.
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An 11-year-old girl presented with this firm nonf...

An 11-year-old girl presented with this firm nonfluctuant mass over her posterior medial left ankle that had been present for 5 months and had not increased in size. The mass was not transilluminating. Findings on frozen section were consistent with a benign giant cell tumor of the tendon sheath. The mass was marginally excised.

Giant cell tumor of the tendon sheath from the ca...
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Media file 18: Giant cell tumor of the tendon sheath from the case shown in Image 17 after marginal excision.
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Giant cell tumor of the tendon sheath from the ca...

Giant cell tumor of the tendon sheath from the case shown in Image 17 after marginal excision.

More on Giant Cell Tumor of the Tendon Sheath

Overview: Giant Cell Tumor of the Tendon Sheath
Workup: Giant Cell Tumor of the Tendon Sheath
Treatment: Giant Cell Tumor of the Tendon Sheath
Follow-up: Giant Cell Tumor of the Tendon Sheath
Multimedia: Giant Cell Tumor of the Tendon Sheath
References
Further Reading
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References

  1. Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. Sep-Oct 2008;28(5):1493-518. [Medline].

  2. Abdul-Karim FW, el-Naggar AK, Joyce MJ. Diffuse and localized tenosynovial giant cell tumor and pigmented villonodular synovitis: a clinicopathologic and flow cytometric DNA analysis. Hum Pathol. Jul 1992;23(7):729-35. [Medline].

  3. Mathews RE, Gould JS, Kashlan MB. Diffuse pigmented villonodular tenosynovitis of the ulnar bursa--a case report. J Hand Surg [Am]. Jan 1981;6(1):64-9. [Medline].

  4. Enzinger FM, Weiss SH. Benign tumors and tumorlike lesions of synovial tissue. In: Enzinger FM, Weiss SW, eds. Soft Tissue Tumors. St Louis, Mo: Mosby;1995:735-55.

  5. Abimelec P, Cambiaghi S, Thioly D. Subungual giant cell tumor of the tendon sheath. Cutis. Oct 1996;58(4):273-5. [Medline].

  6. Choudhury M, Jain R, Nangia A. Localized tenosynovial giant cell tumor of tendon sheath. A case report. Acta Cytol. May-Jun 2000;44(3):463-6. [Medline].

  7. Ciattaglia G, Filosa G, Bugatti L. Giant cell tumor of tendon sheath. J Am Acad Dermatol. Oct 1991;25(4):728-9. [Medline].

  8. LaRussa LR, Labs K, Schmidt RG. Giant cell tumor of tendon sheath. J Foot Ankle Surg. Nov-Dec 1995;34(6):541-6. [Medline].

  9. Schleicher SM. Giant cell tumor of tendon sheath. Cutis. Mar 1997;59(3):133-4. [Medline].

  10. Wu NL, Hsiao PF, Chen BF, et al. Malignant giant cell tumor of the tendon sheath. Int J Dermatol. Jan 2004;43(1):54-7. [Medline].

  11. Jones FE, Soule EH, Coventry MB. Fibrous xanthoma of synovium (giant-cell tumor of tendon sheath, pigmented nodular synovitis). A study of one hundred and eighteen cases. J Bone Joint Surg Am. Jan 1969;51(1):76-86. [Medline].

  12. Reginato A, Martinez V, Schumacher HR. Giant cell tumour associated with rheumatoid arthritis. Ann Rheum Dis. Jul 1974;33(4):333-41. [Medline].

  13. Hosaka M, Hatori M, Smith R, Kokubun S. Giant cell formation through fusion of cells derived from a human giant cell tumor of tendon sheath. J Orthop Sci. 2004;9(6):581-4. [Medline].

  14. Jaffe HL, Lichtenstein HL, Elsutro CJ. Pigmented villonodular synovitis, bursitis, and tenosynovitis. Arch Pathol. 1941;31:731-65.

  15. Darling JM, Goldring SR, Harada Y. Multinucleated cells in pigmented villonodular synovitis and giant cell tumor of tendon sheath express features of osteoclasts. Am J Pathol. Apr 1997;150(4):1383-93. [Medline].

  16. Wood GS, Beckstead JH, Medeiros LJ. The cells of giant cell tumor of tendon sheath resemble osteoclasts. Am J Surg Pathol. Jun 1988;12(6):444-52. [Medline].

  17. Vogrincic GS, O''Connell JX, Gilks CB. Giant cell tumor of tendon sheath is a polyclonal cellular proliferation. Hum Pathol. Jul 1997;28(7):815-9. [Medline].

  18. Stewart MJ. Benign giant-cell synovioma and its relation to "xanthoma". JBJS. 1948;30B:522-7.

  19. Jelinek JS, Kransdorf MJ, Shmookler BM. Giant cell tumor of the tendon sheath: MR findings in nine cases. AJR Am J Roentgenol. Apr 1994;162(4):919-22. [Medline].

  20. Bancroft LW, Peterson JJ, Kransdorf MJ. Imaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am. Nov 2008;46(6):1093-103. [Medline].

  21. Wang Y, Tang J, Luo Y. The value of sonography in diagnosing giant cell tumors of the tendon sheath. J Ultrasound Med. Oct 2007;26(10):1333-40. [Medline].

  22. Agarwal PK, Gupta M, Srivastava A. Cytomorphology of giant cell tumor of tendon sheath. A report of two cases. Acta Cytol. Mar-Apr 1997;41(2):587-9. [Medline].

  23. Iyer VK, Kapila K, Verma K. Fine-needle aspiration cytology of giant cell tumor of tendon sheath. Diagn Cytopathol. Aug 2003;29(2):105-10. [Medline].

  24. Phalen GS, McCormack LJ, Gazale WJ. Giant-cell tumor of tendon sheath (benign synovioma) in the hand. Evaluation of 56 cases. Clin Orthop. 1959;15:140-51. [Medline].

  25. Moore JR, Weiland AJ, Curtis RM. Localized nodular tenosynovitis: experience with 115 cases. J Hand Surg [Am]. May 1984;9(3):412-7. [Medline].

  26. Reilly KE, Stern PJ, Dale JA. Recurrent giant cell tumors of the tendon sheath. J Hand Surg [Am]. Nov 1999;24(6):1298-302. [Medline].

  27. Wright CJE. Benign giant-cell synovioma; an investigation of 85 cases. Br J Surg. Jan 1951;38(151):257-71. [Medline].

  28. Goda JS, Patil P, Krishnappan C, Elangovan D. Giant cell tumor of the tendon sheath treated by brachytherapy (surface mold) technique-A technical illustration. Brachytherapy. Oct 22 2008;[Medline].

  29. Rodrigues C, Desai S, Chinoy R. Giant cell tumor of the tendon sheath: a retrospective study of 28 cases. J Surg Oncol. Jun 1998;68(2):100-3. [Medline].

  30. Darwish FM, Haddad WH. Giant cell tumour of tendon sheath: experience with 52 cases. Singapore Med J. Nov 2008;49(11):879-82. [Medline].

  31. Messoudi A, Fnini S, Labsaili N, Ghrib S, Rafai M, Largab A. [Giant cell tumors of the tendon sheath of the hand: 32 cases]. Chir Main. Jun 2007;26(3):165-9. [Medline].

  32. Gholve PA, Hosalkar HS, Kreiger PA, Dormans JP. Giant cell tumor of tendon sheath: largest single series in children. J Pediatr Orthop. Jan-Feb 2007;27(1):67-74. [Medline].

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Further Reading

Related eMedicine topics

Giant Cell Tumor (Orthopedic Surgery)

Giant Cell Tumor (Radiology)

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Keywords

giant cell tumor, localized nodular tenosynovitis, fibrous xanthoma, xanthoma of the synovium, xanthoma of the tendon sheath, xanthogranuloma, xanthosarcoma, fibroma of tendon, myeloid endothelioma, endothelioma, villous arthritis, fibrohemosideric sarcoma, giant cell fibrohemangioma, benign synovioma, sclerosing hemangioma, pigmented villonodular synovitis

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Contributor Information and Disclosures

Author

James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic and Neurosurgical Center of the Cascades
James R Verheyden, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and American Society for Surgery of the Hand
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine
Disclosure: Lippincott, Williams, and Wilkins Royalty Editing/writing textbook; Genentech Grant/research funds Clinical research; Orthovita Grant/research funds Clinical research; National Institutes of Health Grant/research funds Clinical research

Medical Editor

Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine
Disclosure: Lippincott, Williams, and Wilkins Royalty Editing/writing textbook; Genentech Grant/research funds Clinical research; Orthovita Grant/research funds Clinical research; National Institutes of Health Grant/research funds Clinical research

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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