Soft Tissue
Fibrohistiocytic tumors
Giant cell tumor of tendon sheath - localized type

Author: Vijay Shankar, M.D. (see Authors page)

Revised: 13 October 2015, last major update August 2012

Copyright: (c) 2003-2015,, Inc.

PubMed Search: giant cell tumor of tendon sheath [title] localized
Definition / General
  • Circumscribed proliferation of synovial like mononuclear cells with osteoclast-like giant cells, foam cells, siderophages and inflammatory cells, usually in digits
  • 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 (fibrous histiocytoma of tendon sheath)
  • 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)
Clinical Features
  • Slow growing, painless mass, 2-5 cm
Case Reports
  • Excision, 4-30% recur (treat with reexcision)
Clinical Images
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Various images

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Tumor at surgery

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Courtesy of Dr. Mark R. Wick

Gross Description
  • Localized tumors 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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Well circumscribed masses

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Courtesy of Dr. Mark R. Wick

Micro Description
  • 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
  • Varying amounts of dense collagenous stroma
  • Up to 20 mitotic figures/10 HPF
  • Stroma is hyalinized
  • Cartilaginous metaplasia rarely seen
Micro Images
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Courtesy of Dr. Mark R. Wick

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Ankle lesion

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9 year old boy with hand lesion

Courtesy of Dr. Semir Vranic

Cytology Description
  • 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)
Cytology Images
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Positive Stains
Electron Microscopy Description
  • Histiocyte-like cells, fibroblast-like cells, multinucleated giant cells, foam cells
Molecular / Cytogenetics Description