Giant cell tumours of tendon sheath

Giant cell tumours of the tendon sheath (GCTTS) (nodular tenosynovitis) and pigmented villonodular synovitis (PNVS) have long been studied

• conditions are considered to be benign growths of round or polygonal histiocyte-like cells associated with multinucleated giant cells, foam cells, and hemosiderin-laden cells. Although these two conditions are considered related entities, there is a practical difference
  
  
• Giant cell tumours of the tendon sheat (GCTTS)
  
  
  • most lesions of GCTTS produce one or more discrete nodules commonly on the tendon sheath or in the small joints of the fingers and toes
    
    
  • GCTTS (nodular tenosynovitis, localised pigmented villonodular synovitis) is a solitary benign soft-tissue tumour that most commonly occurs in the hand, with recurrence rates of 25 to 45% (1)
    • postoperative radiotherapy may reduce the recurrence rate to 4%
      
      
  • less common sites include large joints, such as the ankle or knee
    
    
• pigmented villonodular synovitis (PNVS)
  • is identified by a diffusely proliferated synovial membrane bearing a villous aspect with or without nodular formation, and most frequently involves the knee joint (2)
    
    
    • is a rare, benign, proliferative lesion of synovial tissue
      
      
    • typically and most commonly occurs in the knee followed by the hip, ankle, elbow, and shoulder, and in patients who are relatively young (< 40 years)
      
      
    • although several surgical methods have been used for treatment of PVNS of the knee, including open and arthroscopic synovectomy, rates of recurrence are high (30-92%)
      • adequate synovectomy is very important to treat diffuse type of disease. Recently, recurrence rates have been reduced, because the extent of the lesion is accurately estimated by MRI preoperatively
      • arthroscopic treatment can be used for localized lesion
        • however it is almost impossible to resect all lesions in the diffuse type lesion because this disease sometimes expands to the extra-articular lesion

Reference:

• 1) Kotwal PP, Gupta V, Malhotra R. Giant-cell tumour of the tendon sheath. Is radiotherapy indicated to prevent recurrence after surgery? J Bone Joint Surg Br 2000;82:571-3.
• 2) Nakahara H et al. Clinical results of open synovectomy for treatment of diffuse pigmented villonodular synovitis of the knee: Case series and review of literature.Knee. 2012 Jan 18