From the Guidelines
Giant cell tumor of tendon sheath (GCTTS) is a benign soft tissue tumor that should be treated with complete surgical excision to prevent recurrence, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of GCTTS involves physical examination, imaging (MRI is most helpful), and is confirmed by histopathological examination after excision. Patients typically present with a firm, non-tender mass that may cause mechanical limitations in joint movement if large enough.
- The tumor develops from synovial cells in tendon sheaths and is characterized by multinucleated giant cells, mononuclear cells, and hemosiderin deposits.
- GCTTS occurs most frequently in adults between 30-50 years of age and has a slight female predominance.
- Local recurrence rates range from 10-45% after surgery, primarily due to incomplete removal.
Surgical Excision
Surgery involves careful dissection to remove the entire tumor while preserving surrounding structures like tendons, nerves, and blood vessels.
- For unresectable patients, follow-up is an option, as stated in the guidelines 1.
- For symptomatic patients or to avoid surgical morbidities, imatinib 1, nilotinib 1, and pexidartinib 1 are recommended, if available.
Systemic Therapies
Systemic therapies may be offered for diffuse symptomatic TGCT, as stated in the guidelines 1.
- Radiotherapy is not a standard treatment, although it may be indicated in very selected patients 1.
Follow-up
Following surgery, patients should be monitored for potential recurrence with regular follow-up appointments for at least 2 years.
- The role of surgery in diffuse disease is less clear, and the decision for treatment should be made on a case-by-case basis, considering the patient's overall health and the tumor's characteristics 1.
From the Research
Diagnosis of Giant Cell Tumor (GCT) of the Tendon Sheath
- The diagnosis of GCTTS is typically made through a combination of clinical presentation, imaging studies, and histopathological examination 2, 3, 4, 5
- Clinical presentation may include joint mass, pain, and limited motion, with the tumor typically growing along the tendons and infiltrating into surrounding muscle and bone tissue 2, 3, 5
- Imaging studies such as magnetic resonance imaging (MRI) may reveal an intra-articular mass with synovitis, and can be useful in diagnosing GCTTS 3, 4
- Histopathological examination is necessary to confirm the diagnosis of GCTTS, and may show a localized or diffuse form of synovial involvement 3, 4, 5
Treatment of Giant Cell Tumor (GCT) of the Tendon Sheath
- The primary treatment for GCTTS is surgical excision, with the goal of complete removal of the tumor 2, 3, 6, 4, 5
- Radical excision of the lesion is the treatment of choice, and may involve capsulotomy if the tumor originates from the joint 2, 3
- Arthroscopic resection may be an alternative method to open excisions, with advantages including less invasive surgery and faster recovery 3
- Radiation therapy may be used as an adjunctive treatment for infiltrative cases, or in cases where surgical resection is not possible 2, 6, 5
- Chemotherapy may also be used as an alternative treatment, although its effectiveness is not well established 2
- Recurrence rates for GCTTS can be high, ranging from 20-50%, and may require repeated surgical excisions or other treatments 2, 3, 6, 4, 5