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Soft Tissue Tumors

Giant cell tumor of tendon sheath - localized type

 

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Reviewer: David Lucas, M.D., University of Michigan Health Systems (January 2009)

Revised: 26 June 2009, last major update June 2009

 

Definition

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● Circumscribed proliferation of synovial like mononuclear cells with osteoclast-like giant cells, foam cells, siderophages and inflammatory cells, usually in digits

 

Terminology

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● Also called fibrous histiocytoma of tendon sheath, tenosynovial giant cell tumor-localized type, localized nodular tenosynovitis

● Family of lesions arising from joint synovium, bursae and tendon sheath; giant cell tumor of bone, giant cell tumor of tendon sheath and pigmented villonodular synovitis may have common cell lineage (Ultrastruct Pathol 2006;30:151)

● See also Joints chapter

 

Epidemiology

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● Common, usually ages 30-50 years, 2/3 female, primarily affects the fingers

● #2 most common tumor of hand after ganglion cyst

● Rare in children, in whom recurrence is uncommon (J Pediatr Orthop 2007;27:67)

 

Case reports

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● 22 year old man with acutely painful finger (AJR Am J Roentgenol 2007;188:S13)

37 year old woman with tumor intertwined with ulnar nerve (Eplasty 2009;9:e8)

 

Treatment and prognosis

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● Excision, 4-30% recur (treat with reexcision)

 

Clinical images

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 The name of referred object is eplasty09e08_fig2.jpg                                                                              Figure 6                    

Tumor entangled in                            Tumor extension into                                        Nodular tumor of middle

ulnar nerve                                           carpal tunnel                                                       finger

 

Gross description

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● Localized tumors are up to 4 cm in small joints (larger elsewhere), circumscribed, lobulated, white-gray-brown (yellow-orange-red color due to xanthoma cells and hemosiderin)

● May have shallow grooves along deep surface due to underlying tendons

 

Gross images

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 The name of referred object is eplasty09e08_fig3.jpg                                   

Well circumscribed mass                               Well circumscribed brown mass

 

Micro description

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● Well circumscribed, lobulated, partially encapsulated

● Variable proportions of mononuclear cells (small, round to spindled, with pale cytoplasm and round or grooved nuclei), osteoclast-like giant cells with 3-50 nuclei, foam cells, siderophages, epithelioid cells with glassy cytoplasm and round vesicular nuclei

● Up to 20 mitotic figures/10 HPF

● Stroma is hyalinized

 

Micro images

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i1543-2165-129-3-360-f02                                           

Various images                                  Nodular lesion of finger                    Small histiocytes and multi-

                                                                                                                                nucleated giant cells in dense

fibrous stroma

 

 

Virtual slide (Univ Iowa)

 

Cytology description

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● High cellularity, polymorphic population of mononuclear histiocyte-like cells, hemosiderin laden macrophages, foamy macrophages and a few multinucleated giant cells (Acta Cytol 2008;52:152, Diagn Cytopathol 2004;30:14)

● Stromal cells are dispersed, polygonal to spindle shaped, with intranuclear cytoplasmic inclusions and occasional nuclear grooves and convolutions (Diagn Cytopathol 2003;29:105)

 

Positive stains

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Mononuclear cells - CD68, variable muscle specific actin and desmin

Osteoclast-like giant cells - CD68, CD45 (Mod Path 1995;8:155), TRAP

 

Electron microscopy

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● Histiocyte-like cells, fibroblast-like cells, multinucleated giant cells, foam cells

 

Molecular / cytogenetics

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● Near diploid or pseudodiploid, often t(1;2) (Fetal Pediatr Pathol 2004;23:171)

 

Additional references

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eMedicine

 

End of Soft Tissue Tumors > Giant cell tumor of tendon sheath - localized type

 

 

 

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