Soft Tissue Tumors - Giant cell tumor of tendon sheath

Home Chapter Home Jobs Conferences Fellowships Books

Soft Tissue Tumors

Fibrohistiocytic tumors

Giant cell tumor of tendon sheath - localized type

Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 28 October 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
=========================================================================

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

Terminology
=========================================================================

● 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)

Epidemiology
=========================================================================

● 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
=========================================================================

● 9 year old girl with finger nodule (Dermatology Online Journal 2011;17:9)
● 9 year old boy with giant cell tumour with cutaneous satellites near surgical scar following excision of primary lesion (Case Rep Dermatol 2011;3:118)
● 22 year old man with acutely painful finger (AJR Am J Roentgenol 2007;188:S13)
● 29 year old woman and 30 year old man with ankle masses (J Med Case Rep 2009 Dec 15;3:9331)
● 37 year old woman with tumor intertwined with ulnar nerve (Eplasty 2009;9:e8)

Treatment and prognosis
=========================================================================

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

Clinical images
=========================================================================

9 year old girl with nodule in the right index finger

Tumors at surgery

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
=========================================================================

Well circumscribed masses

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
=========================================================================

Ankle lesion

9 year old boy with hand lesion

Virtual slides
=========================================================================

Giant cell tumor of tendon sheath

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
=========================================================================

Scattered groups of mononuclear cells with occasional osteoclast-like giant cells

Positive stains
=========================================================================

● Mononuclear cells - CD68, variable muscle specific actin and desmin
● Osteoclast-like giant cells - CD68, CD45 (Mod Pathol 1995;8:155), TRAP

Electron microscopy description
=========================================================================

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

Molecular/cytogenetics description
=========================================================================

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

Additional references
=========================================================================

● eMedicine, Stanford University

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

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).