Muramatsu Keiichi, Tani Yasuhiro, Ueda Masaya, Carolino Daniela Kristina D, Sugimoto Hideaki
Department of Hand Surgery, Nagato General Hospital, 85 Higashi-fukawa, Nagato, Yamaguchi, 759-4194, Japan.
J Hand Microsurg. 2025 May 21;17(4):100283. doi: 10.1016/j.jham.2025.100283. eCollection 2025 Jul.
Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. The utilization of the surgical microscope during resection of digital TGCTs appears to be beneficial for more detailed visualization. We presented the outcomes of microsurgical resection of TGCT and discussed how to prevent recurrence of TGCT.
We reviewed 34 consecutive patients with TGCT cases operated by the single operator. The age at surgery ranged from 9 to 77 years, with an average of 48. The most common affected digit was the thumb (n = 13). In all cases, an operating microscope was utilized. The postoperative follow-up period was an average of 27.6 months.
Intraoperative findings with the use of a microscope revealed an unexpectedly large number of cases with continuity to the adjacent joints. In cases of joint invasion, the capsule was opened to directly visualize the inside of the joint, and intra-articular tumor was resected enbloc together with extra-articular components. The classification of the disease was mixed type in 17 digits, localized type in 17. Postoperative recurrence was found in only one case (2.9 %).
Microsurgery may be a beneficial tool for TGCT resection, but there have been only few reports. Invasive TGCT into the volar plate or infiltrating into the bone near the tendon attachment are well visualized and could be more certainly resected. The recurrence rate after microscopic TGCT resection was only 2.9 %, which is probably the lowest rate in the previously reported literature. Microsurgery allows sufficient visualization of the TGCT invasion and is useful for dissection of digital nerves and arteries.
腱鞘巨细胞瘤（TGCT）是一种起源于滑膜组织的良性肿瘤，常见于手指部位。治疗方法为手术切除，但据报道局部复发率较高。在切除手指TGCT时使用手术显微镜似乎有助于更清晰地观察。我们展示了TGCT显微手术切除的结果，并讨论了如何预防TGCT复发。
我们回顾了由同一手术医生连续治疗的34例TGCT患者。手术年龄范围为9至77岁，平均年龄48岁。最常受累的手指是拇指（n = 13）。所有病例均使用了手术显微镜。术后平均随访期为27.6个月。
使用显微镜的术中发现显示，与相邻关节相连的病例数量出乎意料地多。在关节受累的病例中，打开关节囊直接观察关节内部，将关节内肿瘤与关节外成分整块切除。疾病分类为混合型17指，局限型17指。仅1例（2.9%）出现术后复发。
显微手术可能是TGCT切除的一种有益工具，但相关报道较少。侵入掌板或浸润到肌腱附着处附近骨骼的TGCT能够清晰观察到，并且可以更确切地切除。TGCT显微切除术后的复发率仅为2.9%，这可能是既往文献报道中最低的复发率。显微手术能够充分观察TGCT的侵袭情况，并且有助于分离手指的神经和动脉。
