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Outcomes of surgery for giant cell tumors of the tendon sheath within the hand

100%

Żyluk A., Owczarska A.

Polish Journal of Surgery

2020

vol. 92(6)

16-21

Introduction: Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterized by relatively high recurrence rate after surgery. Aim: The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumors, in a longterm (a mean of 4,2 year) follow-up. Material and methods: Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated patients), at a mean of 4.2-year follow-up. The final assessment was performed in a form of phone interview. Results: The most common site of the tumors was the fingers – 42 cases (72%). In 31 patients (53%) the lesion had a well-defined capsule, and in 11 (19%) a satellite nodule was found around the main tumor. A total of 9 relapses (21%) occurred, all within the first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with a recurrence, the primary lesion did not have a well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained of mild pain of the scar and/or numbness of a part of the involved finger. Conclusions: The main factor that impacted the high rate of recurrence was incomplete tumor excision, which resulted from inadequately accurate surgery and the tumor morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping a greater surgical margin at resection of the non-capsulated lesions was emphasized, as it could translate into reducing the recurrence rate.

Fibroma of the Tendon Sheath – A Rare Hand Tumor

88%

Heckert R., Bear J., Summers T., Frew M., Gwinn D., McKay P.

Polish Journal of Surgery

2012

vol. 84

issue 12

651-656

Fibroma of the tendon sheath (FTS) is a rare, benign, soft tissue lesion. Clinically, FTS presents similarly to the more common giant cell tumor of the tendon sheath. It is distinguished histologically by the lack of giant cells, foamy histiocytes and synovial cells. We presented a case of FTS involving the common tendon sheath surrounding the flexor tendons leading to the third metacarpal. A 63-year-old man presented with a 3-month history of a painless mass in his right palm that had recently tripled in size. Examination demonstrated a 5x4 cm firm, nodular, superficial mass that was adherent to the overlying skin. Radiographs of the hand revealed a soft tissue mass without bony abnormality. Ultrasound demonstrated a solid, heterogeneous and hypoechoic mass and computed tomography demonstrated that the mass centered predominantly at the mid and distal portions of the third metacarpal. The patient underwent excisional biopsy of the lesion and a palmar, longitudinal incision was made from the wrist to the third metacarpal. Submitted histologic sections revealed a well-circumscribed lesion closely resembling hyalinized collagen. Neither vascular proliferations, necrosis, nor mitoses were observed. Similarly, multinucleated giant cells, pigment-laden macrophages, and inflammatory cells were also not identified. A diagnosis of FTS was rendered. We provided an additional rare case to the literature of a FTS and highlight the need to consider this entity in the differential diagnosis for any soft tissue lesion in the hand. Three months post surgery the patient demonstrated full range of motion of the hand

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2 Polish Journal of Surgery

1 2020

1 2012

1 Bear J.

1 Frew M.

1 Gwinn D.

1 Heckert R.

1 McKay P.

1 Owczarska A.

1 Summers T.

1 Żyluk A.

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Outcomes of surgery for giant cell tumors of the tendon sheath within the hand

Fibroma of the Tendon Sheath – A Rare Hand Tumor