eMedicine Specialties > Orthopedic Surgery > Neoplasms

Giant Cell Tumor of the Tendon Sheath: Treatment

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

Treatment

Surgical Therapy

Marginal excision of giant cell tumor of the tendon sheath is the treatment of choice (see Images 17-18). Complete excision can be difficult, as the mass is frequently associated with the tendon sheath or synovial joint. Often, partial excision of the joint capsule or tendon sheath is necessary for complete removal of the tumor. Meticulous dissection and exploration are essential because satellite lesions are common. A Freer elevator or other blunt probe is often helpful in teasing these satellite lesions from beneath the surrounding tendons or other structures. Avoid puncturing these lesions because seeding of adjacent soft-tissue structures may be possible. Occasionally, bony debridement with a curette or rongeur is necessary if adjacent bony erosion is present.

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.

[ CLOSE WINDOW ]
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...

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

[ CLOSE WINDOW ]
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.


 

Jones et al11 noted an association between these lesions and arthritis at the DIP joint. If such arthritis is present, debridement or fusion may be necessary to completely eradicate the process. If the tumor involves the skin, consider the excision of an elliptical area of skin along with the mass. Skin excision may necessitate secondary skin grafting. Rarely, tendon reconstruction may be necessary if tumor excision compromises the associated tendon. Even with careful dissection, reported recurrence rates are 9-44%.

Intraoperative Details

The tumor may involve the tendon sheath, volar plate, capsular ligaments, and joints. Dorsal sites frequently involve the joints or tendinous attachments to bone. Volar sites are more frequently present near the joints, presumably because the fibrous flexor-tendon sheath is thinner at the level of the joints. In a review of 115 cases, 20% had extra-articular joint involvement. In the digits, these tumors are often intimately associated with the flexor or extensor tendon. If no intimate association exists, a stalk of tissue often connects the tumor to the tendon sheath. If the mass is relatively large, smaller satellite lesions extending into the surrounding tendon sheath and synovium may be found.

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
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics

Giant Cell Tumor (Orthopedic Surgery)

Giant Cell Tumor (Radiology)

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.