Sonkusale Aashay, Gandhi Pratik, Maurya Vivek, Giri Vishal
Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.
Department of Orthopaedics, Government Medical College and Hospital, Nagpur, Maharashtra, India.
J Orthop Case Rep. 2023 Aug;13(8):32-35. doi: 10.13107/jocr.2023.v13.i08.3804.
Giant cell tumors of tendon sheath are benign, rarely malignant, soft-tissue tumors arising from tenosynovial sheath and periarticular soft tissue. They usually present as painless masses with some restriction of movement. Histopathological diagnosis is gold standard although pre-operative fine-needle aspiration cytology (FNAC), plain radiographs, and MRI help in narrowing down the differentials. Giant cell tumor of the tendon sheath (GCTTS) although benign is notorious for having a high rate of recurrences, with most important risk factors being adjacency to joint and incomplete excision. Adequate marginal excision forms the mainstay for managing these tumors. Adjuvant radiotherapy has found some role in treating and decreasing the chances of recurrences.
A 55-year-old lady was brought to the outpatient department with a history of painless, gradually progressive swelling on volar aspect of thumb. Swelling was well defined with a smooth surface. Overlying skin showed no signs of local inflammation or adherence. Pain radiographs showed soft-tissue shadow with some articular bony erosions. A ultrasound-guided FNAC and MRI showed a picture of GCTTS. An excisional biopsy was done and confirmed the diagnosis.
GCTTS is a benign entity with a slow course of evolution, although uncommon, and should be kept as differential for swellings of hand and feet. Complete excision with no evidence residual tumor is diagnostic as well as curative. A regular follow-up is essential on account of high rates of recurrences.
腱鞘巨细胞瘤是一种良性、极少恶变的软组织肿瘤，起源于腱鞘和关节周围软组织。它们通常表现为无痛性肿块，伴有一定程度的活动受限。组织病理学诊断是金标准，尽管术前细针穿刺细胞学检查（FNAC）、X线平片和磁共振成像（MRI）有助于缩小鉴别诊断范围。腱鞘巨细胞瘤（GCTTS）虽然是良性的，但因其复发率高而声名狼藉，最重要的危险因素是靠近关节和切除不完全。充分的边缘切除是治疗这些肿瘤的主要方法。辅助放疗在治疗和降低复发几率方面发挥了一定作用。
一名55岁女性因拇指掌侧无痛性、逐渐增大的肿胀病史被送至门诊。肿胀边界清晰，表面光滑。覆盖的皮肤无局部炎症或粘连迹象。X线平片显示软组织阴影，伴有一些关节骨质侵蚀。超声引导下的FNAC和MRI显示为GCTTS表现。进行了切除活检并确诊。
GCTTS是一种良性病变，病程进展缓慢，虽然不常见，对于手足部肿胀应将其列为鉴别诊断之一。完整切除且无残留肿瘤证据具有诊断和治愈意义。鉴于复发率高，定期随访至关重要。
