Stanford School of Medicine

Surgical Pathology Criteria

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Tenosynovial Giant Cell Tumor, Localized Type

Warning: This page is under construction and has not undergone final review.


  • Benign circumscribed tumor containing variable numbers of multinucleolated giant cells

Alternate/Historical Names

  • Giant cell tumor of tendon sheath
  • Nodular tenosynovitis

Diagnostic Criteria

  • Circumscribed
    • Usually under 4 cm
    • May erode bone
    • Rare in skin
  • Mixed cell population
    • Uniform round to oblong mononuclear cells
      • Cytologically bland
      • Mitotic figures rare to frequent
        • High mitotic rate may predict recurrence
    • Multinucleated giant cells
      • Same nuclear features as mononuclear cells
      • Variable numbers, absent in rare cases
    • Xanthoma cells and hemosiderin laden macrophages
  • Nearly all in hands and feet
  • Metaplastic bone and cartilage may be seen
  • Vascular invasion infrequent but of no significance

Robert B West MD PhD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: pending

Supplemental studies


  • Mononuclear and giant cells CD68 and LCA positive in most cases
  • Desmin stains dendritic cells in half of cases

Genetic analysis

Differential Diagnosis

Diffuse Type Tenosynovial Giant Cell Tumor Localized Type Tenosynovial Giant Cell Tumor
Non-circumscribed Circumscribed
Usually associated joint involved Does not involve joint
Heavy iron pigmentation Variable pigmentation


Fibroma of Tendon Sheath Localized Type Tenosynovial Giant Cell Tumor
Paucicellular Cellular
Giant cells rare Giant cells in nearly all cases
Rare cellular fibromas of tendon sheath may be indistinguishable from giant cell poor tenosynovial giant cell tumors, but have the same behavior


Foreign Body Granuloma Localized Tenosynovial Giant Cell Tumor
Associated acute and chronic inflammation No associated inflammation




  • Common tumor
  • Nearly all on hands and feet
    • 85% on fingers
    • Occasionally on knee
    • Very rare near hip
  • 30% recur
    • No metastases

Grading / Staging / Report

  • Grading and staging not applicable
  • Mangerial category
    • Ib (Recurrences do occur but are not destructive; never metastasizes)


soft tissue tumors with prominent giant cells

should read ../../ above


  • Kempson RL, Fletcher CDM, Evans HL, Henrickson MR, Sibley RS. Tumors of the Soft Tissues, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 30, 2001
  • Fletcher CDM, Unni KK, Mertens F. Pathology and Genetics of Tumours of Soft Tissue and Bone, World Health Organization Classification of Tumours 2002
  • Weiss SW, Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors, 4th edition, 2001
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