Multiportal Arthroscopy-assisted Surgical Resection of Diffuse-type Tenosynovial Giant Cell Tumors in the Ankle Joint Yields Favorable Clinical Outcomes: A Retrospective Study.

OBJECTIVE: Diffuse-type tenosynovial giant cell tumors (Dt-TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy-assisted resection of Dt-TGCTs of the ankle. METHODS: We retrospectively reviewed the clinical data of 33 patients with Dt-TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow-up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures. RESULTS: Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow-up duration for the 33 patients was 77 months (range, 28-142 months). The median VAS score was 1 (range, 0-4), the AOFAS score was 96 (range, 65-100), and the Kofoed score was 96 (range, 67-100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow-up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt-TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p < 0.001). CONCLUSION: This study demonstrated that, with the assistance of a multiportal arthroscopic approach, surgical excision of Dt-TGCT in the ankle resulted in favorable clinical outcomes with a relatively low recurrence rate. Additionally, patients with extra-articular involvement were more likely to require concomitant open surgery.

Fine-needle aspiration cytology of diffuse type tenosynovial giant cell tumor with malignant trasformation and review of literature.

Tenosynovial giant cell tumors (TGCTs) arise from the synovium of joint, bursa, and tendon sheath. Diffuse type often affects large joints, has higher recurrence rates, metastases, and malignant transformation potential compared to the localized type. The cytopathology of TGCT, a fibrohistiocytic neoplasm distinct from other giant cell-rich soft tissue tumors, is rarely reported. Here we describe cytomorphology of a case of TGCT that was initially diagnosed on fine-needle aspiration cytology (FNAC) consisting of a mixture of singly scattered polygonal or spindle mononuclear cells with hemosiderin laden macrophages, inflammatory cells, and a population of multinucleated osteoclast-like giant cells. Persistent symptoms and repeat excision were consistent with high-grade malignant transformation of the TGCT. Atypical cytologic features in a recurrent, infiltrative, or a metastatic lesion should raise suspicion for malignancy.

Invasion Patterns and Long-Term Clinical Outcomes of Diffuse Tenosynovial Giant Cell Tumor of the Ankle Joint.

BACKGROUND: The invasion patterns and long-term outcomes of diffuse tenosynovial giant cell tumor (D-TSGCT) of the ankle joint remain unclear. METHODS: Seven patients who visited our department between 2011 and 2023 and were diagnosed with D-TSGCT of the ankle joint by contrast-enhanced MRI and a pathological diagnosis were included. The invasion patterns of ankle D-TSGCT on MRI were investigated. The recurrence rate and clinical symptoms were examined in five patients followed up for more than seven years after total resection. RESULTS: In seven patients (1 male/6 females, mean age 37.0±16.6 years, range 15-57 years) with D-TSGCT of the ankle joint, contrast-enhanced MRI at the initial presentation showed invasion within the ankle joint, extending along the tendon sheath, within the talocalcaneal joint, and in the tarsal sinus in 100% of cases, around the deltoid ligament in 86%, within the plantar surface in 43%, invasion of the interosseous membrane in 57%, around the Achilles tendon in 29%, and scalloping on the talocrural joint in 43%. The mean time from mass awareness to the first visit was 51.9±80.0 months (range 1-240 months). Gross total resection, defined as the removal of all tumors as gauged by MRI, was initially performed on 6/7 patients. One patient underwent partial resection of only the anterior part of the tumor. Of the six cases in which gross total resection was performed, 5 had long-term follow-up of more than seven years post-operatively, and one case is still only one year post-operatively. The long-term results of five patients followed for more than seven years after total resection were as follows: a mean follow-up period of 125 months (range 89-171 months), a 100% recurrence rate, a mean time to recurrence of 27.5±19.2 months (range 7-60 months), and a 16% reoperation rate. In the last follow-up, osteoarthritic changes were observed radiographically in 2/5 patients (40%), both of whom had scalloping of the talocrural joint on MRI at the time of the initial diagnosis. Four of the five patients (80%) had no clinical symptoms in the last follow-up. CONCLUSION: Ankle D-TSGCT presents with a strong local infiltrative pattern inside and outside the ankle joint along the tendon sheath, radical resection may be difficult, and the recurrence rate may be higher than previously reported. On the other hand, there are many cases that remain free of clinical symptoms in the long term after recurrence, and surgical indications for ankle D-TSGCT need to consider function preservation as well as recurrence rates.

Diffuse Tenosynovial Giant Cell Tumor Encircling the First Metatarsal Bone Remodeling after Resection. A Case Report.

Introduction: The term tenosynovial giant cell tumor encompasses a group of rare soft-tissue tumors. A new classification divides the group in localized and diffuse type, depending on the involvement of the surrounding tissues. Due to the unclear origin and heterogeneity in extend of the diffuse-type giant cell tumors, there is only limited evidence on the tumor-specific treatment. Thus, every case report has an added value toward setting disease-specific guidelines. Case Report: Presentation of a diffuse type tenosynovial giant cell tumor encircling the first metatarsal. The tumor had mechanically eroded the plantar aspect of the distal metaphysis, with no signs of tumor spread. After an open biopsy, resection of the mass was performed without debriding or resecting the first metatarsal. Repeat imaging postoperatively showed no recurrence at 4-year follow-up and a bony remodeling of the lesion. Conclusion: Bone remodeling is possible after complete resection of diffuse tenosynovial giant cell tumor when the erosion is caused by mechanical pressure and no intraosseous expansion of the tumor is present.

Radiological and pathological characteristics of synovial hemangioma of the knee.

Synovial hemangioma, a rare benign tumor that occurs most frequently in the knee in children and young adults, has four histological subtypes: Venous, arteriovenous, cavernous and capillary hemangiomas. Since the clinical presentation and radiological findings of synovial hemangioma are non-specific, there is frequently a long period between the onset and the diagnosis. The cases of nine patients, pathologically diagnosed with synovial hemangioma and surgically treated, were retrospectively analyzed. All nine patients had persistent knee pain. In addition, three patients also had a swollen knee with intra-articular hemorrhage. Plain radiography revealed intra-articular phleboliths in two patients. In seven patients, T1-weighted magnetic resonance imaging showed low signal intensity with small signal voids. On T2-weighted imaging, all patients showed high signal intensity containing small signal voids. All patients underwent surgical excision; there was no postoperative recurrence after the final operation, and the knee pain had disappeared at the final follow-up. From the pathological findings, the diagnoses were venous hemangioma, cavernous hemangioma and capillary hemangioma (three patients each).

Diffuse-type Tenosynovial Giant Cell Tumor Invading the Temporal Bone: Three Cases.

Diffuse-type tenosynovial giant cell tumor (D-TSGCT) is a destructive benign tumor-like proliferative disease that occurs in synovial tissue characterized by villous nodular hyperplasia of joints, tendon sheaths, and synovium. D-TSGCT invading the temporal bone originating from the temporomandibular joint (TMJ) is very rare. Here, we report 3 cases of temporal bone D-TSGCT originating from the TMJ. The tumors in the three cases were originating from the TMJ and further invading the middle ear, the carotid foramen or the temporal lobe respectively. The second patient clearly involved the carotid foramen. The third patient clearly affected the temporal lobe. Lesions were completely removed in 3 cases, and all 3 patients were followed up for 30, 20, and 7 months, and none had recurrence. There are very few reports describing such cases. Although this report is not representative of most scenarios, there is still a potential that it provides a relatively reliable surgical idea for similar cases.

MR imaging findings for differentiating nonhemophilic hemosiderotic synovitis from diffuse-type tenosynovial giant cell tumor of the knee.

PURPOSE: To evaluate the differences in MR findings between nonhemophilic hemosiderotic synovitis (HS) and diffuse-type tenosynovial giant cell tumor (D-TGCT) of the knee. METHODS: This study included 13 patients with histopathologically confirmed intra-articular hemosiderin deposition of the knee (eight with nonhemophilic HS and five with D-TGCT) who underwent preoperative MR imaging including T2*-weighted images (T2*WI). We retrospectively reviewed the MR images and compared MR findings between the two pathologies. RESULTS: Lateral meniscus tear and lateral articular cartilage injury (88% vs. 20%, p < 0.05) and distribution in the suprapatellar bursa of the maximum thickness of T2* hypointense synovium (75% vs. 0%, p < 0.05) were significantly more frequent in nonhemophilic HS than in D-TGCT, respectively. Among patients who underwent contrast-enhanced imaging, all five patients with nonhemophilic HS showed minimal to mild enhancement of the thickened synovium with superficial linear enhancement, whereas all four patients with D-TGCT showed moderate to severe enhancement (p < 0.01). CONCLUSION: As compared with D-TGCT, lateral meniscus tear, lateral articular cartilage injury, lesser degree of contrast enhancement of the thickened synovium, and distribution in the suprapatellar bursa of the maximum thickness of T2* hypointense synovium were characteristic features of nonhemophilic HS.

Diffuse-type giant cell tumor of the tendon sheath in the temporal region incidentally diagnosed due to a temporal tumor: A report of two cases and review of the literature.

Diffuse-type tenosynovial giant cell tumor (D-GCTS) is a rare benign lesion that not only frequently occurs in the fingers, but also along the tendon sheaths of the foot and ankle. The present study reports the cases of two middle-aged patients that were diagnosed with D-GCTS. The presentation of the D-GCTS lesions was extremely rare, as the tumors were located in the temporal fossa and threatened the skull base and external auditory canal. There were similarities and differences between the two patients in their clinical symptoms, disease progressions and invading sites. The patients' disease course occurred unnoticed with the absence of pain, was protracted and became infiltrative. However, the female patient was admitted to the hospital due to the occurrence of pain in the left temporal region, and the male patient presented at the doctor due to a painless left temporal mass and external auditory canal bleeding. Therefore, the operation area of the two patients was not the same. This type of illness should be considered in the differential diagnosis for masses occurring in the temporal region. Total tumor removal is the best treatment for D-GCTS, and the careful monitoring of recurrence can achieve a good clinical outcome subsequent to the surgical resection.

Malignant tenosynovial giant cell tumor of the leg: a radiologic-pathologic correlation and review of the literature.

Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion. Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying. Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease. We present the multimodality appearance of a case of malignant diffuse-type TGCT that recurred 2 months after resection with subsequent rapid clinical progression.

Multiple metastases from histologically benign intraarticular diffuse-type tenosynovial giant cell tumor: a case report.

Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a relatively rare mesenchymal tumor. It is a locally aggressive but virtually nonmetastasizing neoplasm and thus regarded as benign. Only a few D-TGCTs with benign histology have been reported to metastasize. We report an extremely rare case of benign D-TGCT in which multiple metastases developed 9 years after surgery for the primary tumor. The present case suggests that conventional D-TGCT has the potential to form distant metastases, albeit exceptionally rarely, and that this probable implantation phenomenon can be managed conservatively.