Giant cell tumor of the tendon sheath: Clinicopathologic analysis of 31 cases

Abstract

Aim: To describe the epidemiological and clinicopathological findings of 31 cases diagnosed with giant cell tumor of the tendon sheath (GCTS).

Methods: The case records of all patients diagnosed to have GCTTS by our pathology department from 2009 to 2018 were analyzed. We introduced 31 cases of GCTTS in this study. Four cases of fibroma of the tendon sheath were excluded from the study. The age of patients, gender, site of occurrence, size of the lesion, presenting symptoms, treatment modality, histopathological reports, and recurrence were investigated, and noted.

Results: Ages of patients ranged from 14 to 74 years with most cases occurring in their thirties. There was a female predominance of 11 males to 20 females. The majority of patients had a painless subcutaneous palpable mass which gradually increased in size. The most frequent site of the tumor was the finger in 61.3 % (n=19). The other lesions were detected over the hand in 32.3% of the patients (n=10), foot in 3.2% (n=1), over the right knee (large joint) in 3.2% of patients (n=1). Among the small digit tumors the frequent affected site was the thumb. Single nodules (n=21) were more common than multiple (n=10). One male had maximum lesions on his left little finger with 18 GCTTS. The most common preoperative clinical diagnoses were GCTTS, fibroma, lipoma, schwannoma and epidermal cyst. Complete excision was the treatment in all of the cases. The tumors were firm/elastic, usually encapsulated, regular in shape, with smooth contour varying in size from 0.4 to 2.5 cm (average size 1.25 cm). Cut section of the tumor was grayish white mottled with yellow. Histologic appearance of the tumors consisted of multinucleated giant cells, polygonal histiocytes, foamy histiocytes and hemosiderin laden macrophages. Immunohistochemically, CD68 and ki-67 were applied in some of the patients to support the diagnosis. Local recurrence was not seen.

Conclusions: We must distinguish GCTTS from other similar pathological processes. A different histopathologic variation can be noticed between GCTTS involving the digits and large joints. The location and the strict adherence of the tumor to the tendon or neurovascular bundles may cause difficulties. Early diagnosis and treatment with wide excision prevent local recurrence.