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Giant Cell Tumor of the Tendon Sheath

- Discussion:
    - GCT of tendon sheath are not really tumors but reactive lesions, which are similar to PVNS;
    - they do not always arise from the tendon sheath but may arise from the synovium;
    - it is the second most common benign hand tumor next to ganglions;
    - age > 30 years;
    - diff dx:
          - clear cell sarcoma;
          - fibroma of tendon sheath;
          - epithelial inclusion cyst;
          - fibrous histiocytoma of skin (dermatofibroma);
          - epithelial sarcoma 

- Clinical Features:
    - it is usually seen on the palmar surface of digits, especially at PIP of index and long fingers;
    - may or may not be painful;
    - most of these tumors are well circumscribed but some are grow diffusely (which can make excision difficult);
    - always perform a digital Allen's test of the affected digit (since this may affect surgical excision);

- Histology:
    - lesion consists of multinucleated giant cells, polygonal mononuclear cells, and histiocytes (may contain abundant hemosiderin or lipid).

- Radiographs:
    - 20% of cases show extrinsic cortical erosion, which may be a risk factor for recurrence;

- Operative Excision:
    - they are frequently encapsulated, but not as well encapsulated as lipomas;
    - it is slow growing and recurrs in 10-20% of excisions;
         - therefore, even w/ meticulous dissection, recurrence is common;
         - if there is radiographic cortical erosion, then consider removing cortical shell as well;
         - malignant transformation has not be reported despite multiple recurrences

Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases.

Giant cell tumor of tendon sheath with intraosseous invasion: a case report.     

Giant cell tumor of tendon sheath.