van der Heijden L, Gibbons C L M H, Dijkstra P D S, Kroep J R, van Rijswijk C S P, Nout R A, Bradley K M, Athanasou N A, Hogendoorn P C W, van de Sande M A J
Leiden University Medical Center, Department of Orthopedic Surgery, Postzone J11-70, PO Box 9600, 2300 RC Leiden, The Netherlands.
J Bone Joint Surg Br. 2012 Jul;94(7):882-8. doi: 10.1302/0301-620X.94B7.28927.
Giant cell tumours (GCT) of the synovium and tendon sheath can be classified into two forms: localised (giant cell tumour of the tendon sheath, or nodular tenosynovitis) and diffuse (diffuse-type giant cell tumour or pigmented villonodular synovitis). The former principally affects the small joints. It presents as a solitary slow-growing tumour with a characteristic appearance on MRI and is treated by surgical excision. There is a significant risk of multiple recurrences with aggressive diffuse disease. A multidisciplinary approach with dedicated MRI, histological assessment and planned surgery with either adjuvant radiotherapy or systemic targeted therapy is required to improve outcomes in recurrent and refractory diffuse-type GCT. Although arthroscopic synovectomy through several portals has been advocated as an alternative to arthrotomy, there is a significant risk of inadequate excision and recurrence, particularly in the posterior compartment of the knee. For local disease partial arthroscopic synovectomy may be sufficient, at the risk of recurrence. For both local and diffuse intra-articular disease open surgery is advised for recurrent disease. Marginal excision with focal disease will suffice, not dissimilar to the treatment of GCT of tendon sheath. For recurrent and extra-articular soft-tissue disease adjuvant therapy, including intra-articular radioactive colloid or moderate-dose external beam radiotherapy, should be considered.
滑膜和腱鞘的巨细胞瘤（GCT）可分为两种类型：局限性（腱鞘巨细胞瘤，或结节性腱鞘炎）和弥漫性（弥漫型巨细胞瘤或色素沉着绒毛结节性滑膜炎）。前者主要累及小关节。它表现为单个生长缓慢的肿瘤，在MRI上有特征性表现，通过手术切除进行治疗。侵袭性弥漫性疾病有多次复发的显著风险。对于复发和难治性弥漫型GCT，需要采用多学科方法，包括专门的MRI检查、组织学评估以及计划好的手术，并辅以放疗或全身靶向治疗，以改善治疗效果。尽管有人主张通过多个切口进行关节镜下滑膜切除术作为切开手术的替代方法，但存在切除不充分和复发的显著风险，尤其是在膝关节后室。对于局限性疾病，部分关节镜下滑膜切除术可能就足够了，但有复发风险。对于局限性和弥漫性关节内疾病，复发时建议进行开放手术。对于局限性疾病，边缘切除就足够了，这与腱鞘巨细胞瘤的治疗没有太大区别。对于复发和关节外软组织疾病，应考虑辅助治疗，包括关节内放射性胶体或中等剂量外照射放疗。
